Prof Terrance Chua was the first cardiologist in Singapore to sub-specialise in nuclear cardiology when he studied it in Los Angeles.
ASSOCIATE Professor Terrance Chua spearheaded a whole new service – nuclear cardiology – at the National Heart Centre Singapore
Associate Professor Terrance Chua was the first local cardiologist to sub-specialise in nuclear cardiology when he studied it in Los Angeles. When he returned, he paved the way for a whole new service at the National Heart Centre Singapore (NHCS), offering patients state-of-the-art scans of their cardiovascular systems.
It started off as a one-camera outfit but grew rapidly. Today, the department has three fully-used scanners, including one of the latest and fastest in the field. About 9,000 patients use the service each year.
“I don’t think it was as much due to my efforts as it was because the service turned out to be quite useful. We also had help not only from our hardworking team but also from other departments such as the Nuclear Medicine physicians and the physicists.
“I think it is great when people work across boundaries rather than just staying within the well-defined space of their own specialties, which is the natural thing to do,” said Prof Chua, Deputy Group Director (Medical), SingHealth, and Deputy Medical Director and Senior Consultant, Department of Cardiology, NHCS.
Against conventional wisdom
Prof Chua, 54, is someone who does not hesitate to go against conventional wisdom if it makes sense to him. Often, when he starts talking about efficiency, people do a double take.
He believes that a department or service does not always need to operate at maximum capacity. “In fact, sometimes it needs to be just a little bit inefficient so that the patient gets the best care,” he said.
He cites his nuclear cardiology service as an example. The service accepts scan requests from the Accident & Emergency (A&E) Department for patients who come in with chest pains within 24 to 48 hours of their A&E visit. “That means I have to set aside slots for these patients, instead of filling up all my available slots. So efficiency- wise, that’s not optimal. But that means the patient who really needs it more urgently gets scanned faster and therefore diagnosed earlier,” he said.
As about a quarter of these A&E patients have heart problems which need immediate treatment, that slight inefficiency is something his department can tolerate as long as the patients benefit.
A firm believer that the system, and not the individual, provides care, Prof Chua supports projects that improve care through teamwork – working with other departments.
He says that many people assume that getting good care means getting a good doctor, and that getting a good doctor guarantees good care. “Although there is some truth in that, our aim should be to deliver good care regardless of which doctor you see. Sometimes you can deliver better care by reorganising your system than by having the best doctors, or the latest and greatest technology. Teamwork, measurement of outcomes, and feedback are essential. ”
Prof Chua says that many healthcare systems now realise that optimal health care is delivered when the focus is on long-term outcomes rather than episodic care, even though sometimes, hospitals are incentivised to benefit from more admissions. “The ministry understands this very well and so does SingHealth, but it is not easy to do it.”
His philosophy of life influences his work, and vice-versa. Outside of work, Prof Chua also finds that learning new things keeps him going. Currently, he is picking up tips on medical education from his oncologist wife. They have also gamely taken on tai chi with their 18-year-old son.
An avid reader, he is now reading The Creative Destruction of Medicine. Written by a cardiologist, it describes how medicine may change in the future with the advancement of various things, including computer technology. Naturally, the book has been making its rounds among his colleagues.
Although retirement is far from his mind, Prof Chua is already looking beyond his own tenure. One of his biggest tasks at present is to build up the next generation of cardiologists who will succeed him and his peers.
“That’s one of our biggest challenges – finding the talent and building it up,” he said, adding half in jest, “So that we can all retire!”
• This story was first published in Singapore Health, Nov/Dec 2013.