Well, #EACTS2021 may be over...but I'm not done! 😆
One of the most important sessions was on Women In Cardiothoracic Surgery
I suppose I should clarify - not writing a 🧵on this for likes or 'virtue signalling' - my wife's journey through her training gave me some insights...
#EACTS2021
Opening talk on why @EACTS needs a womne's committee from @JolandaKluin - this was a great talk to set the tone for the session
#EACTS2021
Prof Kluin discussed the many challenges that can face women in medicine, in academic medicine, in surgery and in cardiac surgery
#EACTS2021
Cannot tell you how much I loved this point. Prof Kluin explained how she could have used either of these title slides - both are true, one more modest than the other, one more likely to be used by women than men. When one takes a step back & thinks about it...so true
#EACTS2021
Prof Kluin also alluded to constant challenges women face in all walks of life - even the President of the EC, Ursula von der Leyen, and the now infamous #sofagate episode - worth watching the video if you missed this
I think unsurprisingly, yet sadly, women much more likely to have considered leaving due to gender bias, or to have felt discriminated against at work on the basis of simply being a woman ☹️
Some important lessons here for those planning and in charge of surgical training. Women don't feel supported at work - don't complain we don't have enough surgeons, yet fail to stop behaviours that can trigger the loss of trainees!
#EACTS2021
Next talk from Dr Jasmine Hanke reporting results of the German survey on Women in Cardiac Surgery
I liked this summary slide of the multiple - really, it's *multiple* - challenges and career-limiting factors for women as a whole, not just in surgery
So...this is what they did...all centres responded. Dr Hanke was pleasantly surprised to learn that 24.7% of trainees were female, much higher than she expected / perceived
Started off by showing % of people in different countries that would be comfortable with a woman as a leader...why is this not 100%? Surely you want the best person, irespective of gender?
And look at Jacinda Ardern! Has there been a better leader in past 2 years?
I am sure this slide was depressing for women - only 74% of women perceive other women as equally suited for leadership roles as men - love the Madeleine A quote!
#EACTS2021
So...why do I feel this resonates so much? Well, apart from the fact that it is an obvious and big inequality - and most of us don't like inequalities - as I said above my wife - an anaesthetist - had a lot of nonsense from men in her training too
#EACTS2021
Decided on a career in anaesthetics, well on the way through training yet the frequent uninvited 'advice':
"Have you not thought above GP?"
"You know it's hard with children and the early starts"
"Do you need to work if your husband is a Dr too?"
etc ad infinitum
#EACTS2021
Tip to my fellow men - even though you may think this 'advice' is helpful, in almost all situations it isn't!
If your advice on a woman's career isn't sought...don't give it! Seriously, learn when to stfu!
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Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.
A worked example below:
In the PLAX view, you can assess the scallops of the leaflets
In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface
Here, you can see the valve looks slightly different & no prolapse is seen
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively ⬇️ costs whilst ⬆️ profit margins, leverage debt if needed, and then sell, often at a large profit
Does this matter when it comes to delivering healthcare services?
Sixty years ago this month - October 1963 - US cardiologist Dr Robert Bruce published a paper detailing his efforts to devise a multi-stage treadmill test
Little did he know this would go on to become the Bruce protocol the most widely used for exercise testing
A thread...
Prior to this, 'stress testing' to evaluate cardiac function was performed using the Masters 2-step technique, first described in 1935. This crude but simple test involved repeated steps up & down over 90 seconds
Bruce, amongst others, recognized the limitations of this test & set about developing an exercise treadmill test
His initial work focused upon a single stage protocol, but he soon realized this wasn't stressing fitter patients enough & the test was taking too long!
We know now that it is perfectly possible for symptomatic individuals to have abnormal stress tests, with inducible ischaemia, but not have significant epicardial CAD on angiography
So we should stop using epicardial CAD as the arbiter of whether the test is 'right' or 'wrong'
I helped recruit patients for #ISCHEMIA between 2012-13; we saw at least a dozen patients with barn door (core lab verified) abnormal stress tests but normal coronaries on angiography
Here is just one example! Rest on left, stress (exercise) on right...