The Respiratory Medicine Division at CGH has only been standing on its own for a few months. But the head of the division, Dr Jagadesan Raghuram, is quick to point out that his new role is challenging rather than daunting.
The avid mountain climber likens his current task to his first mountain climbing experience during his medical officer training. His senior doctor suggested a trip to Mount Snowdon, the highest mountain in Wales, and rather than let the young Singaporean doctor take the easy route to the top, he told him to tackle the far steeper route.
Of that moment, he recalls: “I looked up and the word ‘daunting’ came to mind. What normally takes three hours for an experienced climber took me six hours. The experience opened my eyes to a never-say-die attitude.”
It is precisely that attitude which fuels his desire to provide the best possible care for patients in the newly formed Respiratory Medicine Division.
The need for specialised care for patients with chronic respiratory disease has increased four-fold over the past five years, explains Dr Raghuram. “The need for a separate division was the logical step forward so that we can organise our services better to meet the needs of the patients in a more cohesive manner,” he says.
“The new division is something that has been on the drawing board for three to four years. And it’s just fortunate, for me, that I came over at the right time to head it,” he adds.
Long and careful planning went into the establishment of the new division as it needed a core group of doctors who could support its existence. The division now has seven respiratory specialists and a further two registrars are in training.
Respiratory specialists treat patients with airway and lung disorders such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary infections and lung disease.
Chronic obstructive pulmonary disease is a term referring to two lung diseases - chronic bronchitis and emphysema - that cause obstruction to airflow. That obstruction interferes with normal breathing.
Dr Raghuram’s own interests lie in managing patients with end-stage lung disease, and particularly patients who are going for lung transplantation. His other specialities are managing patients with pulmonary hypertension, plus those requiring critical care.
Continued training is important, says Dr Raghuram, because respiratory medicine is an evolving science as well as an art, and what may be right today may be wrong tomorrow.
Like him, his team is more than ready for the challenges of the new division, one of which is the greater influx of patients
over the years.
In general, outpatient workload has doubled over the last decade because of a greater awareness of diseases like asthma, sleep-related breathing disorders and chronic obstructive pulmonary disease.
The increase in patients, aside from awareness, is also because smoking, obesity and stress are factors contributing to many respiratory problems, he says. Dr Raghuram wants to improve existing services and introduce others.
One of the new additions is bedside ultrasound for evaluation of patients with pleural effusions and also to assist in central venous catheter placement in critically ill patients. Currently, patients would be taken to ICU to have central venous catheters inserted under ultrasound guidance.
“We are also in the process of setting up a rapid response team to support patients who require emergency treatment at the bedside. It is like bringing ICU (intensive care unit) care to the bedside,” explains Dr Raghuram.
Under the new system, a patient in the general ward can be monitored and if the patient’s condition deteriorates, the nurse on duty can activate the rapid response team for assistance at the bedside.
“The idea behind the rapid response team is to see whether providing this kind of care at the bedside can prevent a patient’s condition from deteriorating to the point where they need ICU care,” he adds.
Dr Raghuram is also keen to collaborate with the hospital’s Ear, Nose and Throat Department in setting up integrated clinics. He explains that the need to put two clinics together makes sense when they are treating the same patients for a variety of sleep-related issues.
The respiratory physicians are an integral part of CGH’s new Integrated Sleep Service (ISS). A patient will be referred from the polyclinic or general practitioner to the doctor in attendance at the ISS who will then decides whether it is an ENT problem or whether the patient needs to be seen by a respiratory physician or other specialists.
The respiratory physicians see other respiratory and non-respiratory sleep disorders, such as Obesity-Hypoventilation Syndrome (OHS), Restless Legs Syndrome (RLS), and Narcolepsy.
“With an integrated service, the patient comes to one centre and is seen by the relevant specialists required to treat the problem,” says Dr Raghuram.
After his own medical studies in the UK, Dr Raghuram returned to Singapore in 1993 and joined Singapore General Hospital. In 1998, he spent a year at Duke University Medical Centre in the United States for his HMDP training in critical care medicine and lung transplantation. On his return, he put those skills to use at the National Heart Centre as a transplant pulmonologist.
In early 2006, he made the move over to CGH, but still runs the weekly transplant clinic at the National Heart Centre. The father of two says that working at CGH has been a pleasure because he believes the smaller hospital is more family-friendly, especially as his 12-year-old son and eight-year-old daughter need a lot of attention at this stage in their schooling.
Aside from overseeing his children’s studies, he is also setting big goals for the division. “I want to make Respiratory Medicine Division a division that will offer excellent care for patients with chronic respiratory disease, as well as provide excellent care for patients requiring intensive care management,” he says
I want to make Respiratory Medicine Division a division that will offer
excellent care for
patients with chronic respiratory disease, as well as for those
requiring intensive care management.
- Dr Jagadesan Raghuram