Dr Bishop is a trained cardiologist in Australia who works in both research and seeing patients, also author of several educational books on cardiology and creator of The Healthy Heart Network. He graduated and completed training in Tasmania becoming part of the Royal Australian College of Physicians. His first 10-15 years working consisted mostly of seeing patients who needed health support due to issues within coronary arteries. He became the first cardiologist in Tasmania to use the latest technology to define the health of an individual's arteries. Dr Bishop’s aim within the last 5-10 years mainly focuses on using imaging technology identify risk and prevention - he also made an appearance at TEDx in 2020.
How does the idea of 'preventing not curing heart disease' play into your career?
'When we go into medicine, a lot of what we learn historically is how to treat diseases. We spend a few years learning anatomy (human body & structure), then move into pathology (understanding diseases). For years I'd always seen patients who were in need of medical help with arterial issues. Well about a decade ago, cardiac CT (a form of imaging) became broadly available, which allowed us to freeze the heart and gain an image. When this became possible, it occurred to me and my colleagues that if we could analyse someone's arteries and identify the problems before they had an event, we could implement therapies and care to prevent the risk of injuring and possibly death.'
Is most of your career involved in research and technology rather than seeing patients?
‘No, not at all. I’m often involved in aspects of research, components of position papers and writing. Additionally, I’ll work with national committees to guide on the most suitable applications of medicine. However my day-to-day practice is seeing patients, and sending them off for a scan.
For example, I might see a 55-year old male with slightly elevated cholesterol, I’ll send him off to have a scan and find that there is nothing there, which provides great reassurance there he won’t experience a heart attack in the short-term.
Conversely, another 55-year old male patient may undergo a CT scan and return with significantly higher levels of plaque (an indicator of heart disease), where he’s at a much higher risk. The strategies that we typically use to prevent a heart attack would then be put in place for these patients, especially if it’s someone who’s already had one and wanting to prevent the next. The aim is to get ahead of the game with heart disease in terms of the treatment we can provide.’
I’ve noticed that most of the time doctors will see patients who are at health risk, however you focus on preventing it to begin with. Would you say this is significantly more effective?
‘Well there’s a saying; “an ounce of prevention is worth a pound of cure” which makes perfect sense. If you can go upstream from where the problems are, and avert them or prevent them from progressing, you’ll produce great results. The truth is, it does require a mind shift within both the doctor providing this healthcare to set an aim, but also the patient not thinking ‘Well I feel fine, I don’t think I need to see a doctor.’
To be able to acquire the amount of knowledge and skill you have, how long did your journey beginning from medical school take you?
‘I began as a medical student with a 6 year medical degree, with a compulsory intern year and two as a junior doctor. After this was a specialist training programme, then numerous written exams. I then took part in several practical exams after a few years where essentially you speak to and examine patients with an examiner assessing you. I then went into further training for 2-4 years after this as well to become an official cardiologist as a sub-specialty.’
Cardiology is a difficult and time consuming specialty to be in. Were there any periods of time throughout your career, especially during medical school and training where you felt quite static and contemplated the value of your career?
‘Absolutely. The job is hard - there is no question about that and I can certainly remember times when I found that the pressures of the job really made me question whether this was what I wanted to do. It took quite a bit of enjoyment out of the job; long hours, lots of work and lots of demand, and the consequences of getting things wrong are profound. If you impact on someone’s life through either lack of care, or wrong care - or just the sheer fact that someone’s really sick and will die regardless of what happens. These things are impactful, so you carry quite a fair portion of emotions with you.
I still remember a circumstance I was put under as a junior doctor, where I was the physician on call at the cold face of an emergency; everyone needed me as their doctor, to admit patients and so on. I remember how stretched and difficult I found it to deal with at the time. Later I came to realised and reframe that these individuals ask for my help because they value my advice, valued the training I had done and my expertise. Honestly, it’s also a privilege to have people ask for your support and care in that way - but there is no question that it’s difficult at times.’
At the moment, if another situation where you were put under pressure again, owed, your way of dealing with that situation differ from past circumstances?
'No doubt. You’d so things differently now. You do get wiser as things happen, and deal with things in a specific way. I’ve been asked before, 'how do you deal with the pressure of being in a space where people are prone to die?', cardiology people can die for example. The only way I’ve been able to deal with it and my colleagues too is by looking at the situation in front of me. You ask yourself ‘Have I done everything I possibly could’ve or should’ve to the best ability’, you don’t go home until you have. If you have and the patient dies as the outcome for example, then you’ve done the right thing. We can’t control the universe, we can only do the best we can. I think if you cut corners though and don’t do what you should be doing, then you should have every reason to feel guilty if the outcome was profound.
It’s mostly about differing mentality all together - most of us protect ourselves from the potential emotional rollercoaster of the job by bringing the best quality to what we do. This mentality often occurs at any and all times when seeing our patients.’
I’m aware of how healthcare systems differ across countries globally. Would you say that there are any unique qualities of the Australian healthcare system provide significant benefits to the population?
‘The system in Australia has an enormous safety. In other words, anyone can have access to some level of healthcare which is tremendous. There is a private system which allows people some choice of the doctor who looks after them, and sometimes pay more for that. But I would say the delivery of healthcare here is remarkably good - if we compare ourselves to the United States, healthcare is more available. If we compare ourselves to the United Kingdom, our ability for patients to self-select specialists is also tremendous. Hence, we almost sit between the UK and the US model.’
It was previously mentioned that you’ve the author of several books. Could I enquire on the contents of your books?
‘The books are a general distillation of my own experiences to ensure that we’re providing the best sort of information for patients and even general practitioners (GP) to understand a particular condition. The approach has always been to deliver high complicated medical concepts in a conversational and easy-to-digest way. They’re patient education books more than anything, but they can also benefit medical students and junior doctors. Providing foundational concepts around different conditions, it simplifies difficult knowledge and have them embedded for further learning.’
For students my age and slightly older, are there any pieces of advice you would give to those aiming to pursue the industry of healthcare and medicine?
‘It’s hard work to get through these courses, it’s a given. I think anyone who thinks it’ll be an easy journey will be a bit disappointed. Occasionally, there are some students who are truly gifted academically and will breeze through. However the majority will have to put in the hours. In that context, it’s incredibly important for people to schedule time for both themselves and studies. I found that my habit was having dedicated study blocks and dedicated time off-blocks. It’s incredibly important to look after your mental health during the time of learning. It’ll improve your sleep, outlook and retention.
It’s so easy to get caught up in our learning and content. The more you learn, you’ll realise the knowledge just continues. You know you could sit down at desk and never leave, especially if you’re reading something and expose yourself to a new piece of knowledge and so on. You really have to make sure boundaries are present to look after your health.
Another important comment I’d make is if you’re looking to work in a space where you’re dealing with patients. I strongly encourage you to really value and treat the patient as an a human being, not as a condition. It’ll change the way you learn, when you’re dealing with real people and real families. You want to connect with them as people not care for them as a disease, it’s the right mentality to have.’
We would like to thank Dr Bishop for his informative talk and guidance, which is highly inspiring and beneficial to students who would like to pursue a specialty career in cardiology. Enquire more about his educational books and talks below:
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