A cardiologist is a physician who has trained himself in a special way to deal with any problem of heart.Ironically , it exists only on paper.The field has developed so vast no one can master everything .There is no such “Pan or global cardiology expert” .In fact it would be shortly become unethical to try to become one !
Pediatric cardiology has developed into such a big field , doing a echo in newborn or infant has become a comprehensive job and requires special talent .This unique and excellent study from Narayana Institute , Bangalore published in the prestigious Annals of pediatric cardiology throws up interesting realities about the quality of echo report done by adult cardiologists in children .The error rate appears huge and stands at prohibitive 38%. While many errors were minor , major were also not insignificant (23%)
With bulk of the pediatric echo involves in the critical decision making process of device closures and interventions the data required becomes vital .The commonest cause for error is probably not due lack of knowledge and but to due to lack of commitment and continuous exposure in doing echocardiograms in those age group.
While this paper decently skirts the issue of quality of pediatric echo done in medium sized hospitals without pediatric cardiology service ,I can say the error rates or inadequate reportage could be significant in such hospitals with apparently good ranking .
Of course ,we have many adult cardiologist who do excellent pediatric work , It looks like , as a general rule performing pediatric echocardiograms by non -institutionalized adult cardiologist may not be appropriate ! It may be wise for them to avoid doing echocardiogram in small infants with truly complex disorders (even perceived complex) till they gain the required expertise and confidence.
I recall an adverse issue happened years ago , when I had missed an associated PAPVC in ASD that made my surgeon anxious on table .In a country like ours there is no one to audit our work , “our conscience remains the only option” to deliver the best for our patients especially so, when they are tiny lives in distress.
Who am I to suggest who should do echocardiogram ? , after all every cardiologist is licensed to do that . One simple suggestion would be , if not confident they can at least mention in their report it is only preliminary evaluation and need to be followed up with an expert . I do that whenever its required and gives me peace of mind as well !
More controversies* to come
Can adult cardiologist do pediatric intervention ?
* Controversy : One of the meaning for this word is “It is a thought process set into motion , that aids digging up hidden truths ”