Bien Soo Tan, senior consultant, Department of Diagnostic Radiology, Singapore General Hospital, Singapore, and chairman of the Asia Pacific Congress of Cardiovascular and Interventional Radiology (APCCVIR, 15–18 May 2014, Singapore) told Interventional News that disease patterns and health economics in Asia can differ from those in Europe or the USA which means that treatment strategies cannot be inferred solely from research performed outside Asia. “We in Asia need to define our own evidence,” he said.
What drew you to medicine and interventional radiology?
I wanted to be in a profession where I could help people. I think that the healthcare profession is special, as healthcare professionals have the privilege, on a daily basis, to reach out to people when they are ill; when they are at a low point. I was struck by the emerging field of interventional radiology when I was a house officer, I managed a patient who had just had a percutaneous biopsy of a lung lesion performed by a radiologist under X-ray fluoroscopic guidance. I was amazed that the patient was so well and that I could not even see a wound on the skin. This prompted me to find out more about interventional radiology and I applied for diagnostic radiology traineeship so that I could specialise in interventional radiology.
Which innovations in interventional radiology have shaped your career?
Interventional radiology is a specialty that constantly strives to improve treatments through innovations and this whole concept of never being satisfied with the status quo is what has shaped my career, rather than any single technique or innovation.
Who were your mentors and what wisdom did they impart to you?
I am very fortunate to have many mentors and teachers throughout my career. I would like to mention two special people particularly. One of them is Dr Kim Ping Tan, who was my predecessor as head of the Department of Diagnostic Radiology, Singapore General Hospital. He is a man of vision, far ahead of his time. He anticipated new trends in radiology and introduced many innovative ideas within our department. I learnt from him that it is our duty to nurture our younger colleagues and we only succeed in this initiative when they surpass us in ability and achievements.
The other person is Professor Andy Adam, who was my supervisor when I was a fellow at Guys’ Hospital, London. He has since become my life-long mentor in interventional radiology. He is also a tremendous teacher. I learnt from him that in any initiative that we undertake, we need to put in our best efforts and pay attention to details. I believe that has been the secret to his great success and I count myself very lucky to have him as one of my mentors.
In your tenure as director of Vascular and Interventional Radiology in SGH, there was a large expansion of interventional radiology services and Singapore was established as the largest centre in South East Asia. How did you achieve this?
We achieved this through teamwork, and strong support from the department and the hospital. I work with a great team of people in interventional radiology, who have a strong belief that our techniques work well and can benefit many patients. They were not afraid to pull together and work long hours as more and more patients required our services. It also helped that we worked with many enlightened clinical colleagues who entrusted us with their patients. With the backing of management, our services then grew naturally.
The team at the Interventional Radiology Centre at SGH has conducted several investigator-led randomised controlled trials, studying various aspects of haemodialysis interventions. In a nutshell, what is the Asian perspective on haemodialysis interventions?
Our Asian perspective is that we need to understand that disease patterns and health economics can differ from those in Europe or the USA, and as a result, treatment strategies cannot be inferred solely from research performed outside Asia. We in Asia need to define our own evidence.
For example, we have just published a randomised clinical trial which showed that for haemodialysis access angioplasty, conventional balloon angioplasty can achieve optimal results in 85% of patients, thus precluding the need for routine use of more expansive devices like high pressure angioplasty balloons. Our study showed that in the 15% with suboptimal angioplasty, the more effective device to use is the cutting balloon. (J Vasc Interv Radiol 2014; 25:190-198).
You have authored several chapters including one on the interventional radiology management of acute haemorrhage. How has management of acute haemorrhage changed over time?
During my career, the development of microcatheters, new embolic materials and improved imaging has led to interventional radiology being pushed to the forefront in the management of acute haemorrhage.
Can you please describe a memorable case you treated using interventional radiology techniques?
The case I remember most is not one where I was successful, but one where I felt I learnt a lot from. This was a young mother with end stage renal failure whom I had treated earlier in my career. She was on haemodialysis and required an angioplasty for a recurrent stenosis of her central vein. Unfortunately, she collapsed just as I had completed the procedure and despite extreme efforts in resuscitation, she could not be revived. Facing her family to break the bad news was one of the most difficult moments that I have encountered in my career. Fortunately, during this meeting with the patient’s family, I was supported and guided by the senior physician who was the primary doctor. It was a tough learning experience for me. It was later confirmed that the procedure was not directly related to the cause for her death.
This event is deeply etched in my memory, and we need to be aware that sometimes, our treatments may not result in a positive outcome, and that we need to always be humble and be prepared to be forthcoming with the patient and/or the family. It is not easy to break bad news, especially when it is unanticipated. Having learnt from this experience (and others since), I do try to make it a point to be there for my younger colleagues when such an unfortunate event involving them occurs.
You have held various appointments in the Singapore Armed Forces by virtue of the compulsory national service programme in Singapore. How has your experience in the Armed Forces influenced your approach to leadership and as a treating clinician within a hospital environment?
My experiences in the Armed Forces have certainly helped me by equipping me with people management skills. The Army in Singapore is a national service army, so to motivate people in this type of environment, a leader has to take time to understand his colleagues and to always lead by example. I have always strived to do this in the hospital environment when dealing with colleagues and patients.
As someone who takes pride in training fellows and young doctors in interventional radiology, what are the key things that you like to emphasise to your trainees?
Never forget that the patient in front of us is a unique person who is someone’s father, or mother, or brother, or sister or child. And never forget the reason why you applied to enter the medical profession in the first place.
As the 2014 organising chairman of the APCCVIR, what are your goals for the conference?
For this year’s APCCVIR, we are deliberately focusing on the developing talents in interventional radiology from the region. Our theme for the Congress is “InspIRation”, and we have brought together the top talent from the Asia-Pacific region as well as the rest of the world as faculty. By having a comprehensive scientific programme, workshops including hands-on sessions and opportunities for scientific and interesting case presentations, we hope to “inspIRe” young colleagues to achieve greater heights in clinical and academic interventional radiology excellence.
How is interventional radiology perceived in Singapore and what are the key challenges that face the subspecialty?
In Singapore, the life expectancy has increased and with an aging population, both cancer and cardiovascular diseases are on the rise. We are also seeing increasing incidence of diabetes and renal failure. The interventional radiology procedures related to these disease spectra, for example interventional oncology procedures, are therefore widely used. Interventional radiology still suffers from a lack of public recognition. At the same time, as the need for interventional radiology procedures increase, there is a danger of not being able to keep pace with training sufficient manpower to meet the demand. Interventional radiologists, as they are now involved in more complex procedures, will also need to be more involved in the clinical care of their patients. This scenario is also applicable to the wider Asia Pacific region, although there may be some variation between countries.
What concerns you most about the practice of interventional radiology today?
At this stage of my career, I am less concerned about personally being able to perform a complex interventional radiology procedure. I am now more interested in outcomes and outcome measurements, and that is why at our centre, we are performing several investigator initiated clinical trials to define evidence.
I am most concerned that we sometimes tend to be too focused on the technical aspect of a case and forget the person behind it.
What are your interests outside of medicine?
My family is my focus. My wife, Soo See, and I are the proud parents of four lovely children, Sarah, Deborah, Joanna and Yuancheng, and we have a dog called Cleo. We treasure family time and love travelling when the opportunity arises. I also try to keep fit. While I used to enjoy running, I have given up after my knees gave way and now enjoy a good swim instead. I am a football fan and have followed the fortunes and misfortunes of Manchester City Football Club since 1969. I also enjoy discovering new food haunts on our island of Singapore, which is a food paradise, and hope to start a food blog when I retire.
– Senior consultant, Department of Diagnostic Radiology, Singapore General Hospital, Singapore
– Clinical associate professor, Faculty of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (2008–present)
– Adjunct associate professor, Duke–NUS Graduate Medical School Singapore (2008–present)
– Visiting consultant, Department of Cardiac Radiology, National Heart Centre, Singapore, 1999–present
– Visiting consultant, Kandang Kerbau Women’s and Children’s Hospital, Singapore (2000–present)
– Visiting consultant, Changi General Hospital, Singapore (2002–present)
– Chairman, Residency Advisory Committee for Diagnostic Radiology, Ministry of Health, Singapore, 2010–present
– Royal College of Radiologists, UK (1995)
– Fellow, Academy of Medicine, Singapore (1996)
– Certificate of Specialist Accreditation in Diagnostic Radiology, Specialist Accreditation Board, Ministry of Health, Singapore (1998)
– Specialists Register, General Medical Council, UK (1999)
Awards and honours
– Distinguished Fellow of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE, 2013)
Membership of professional societies (selected)
– Academy of Medicine Singapore (AMS)
– College of Radiologists Singapore (CRS)
– The Royal College of Radiologists (RCR)
– Singapore Radiological Society (SRS)
– Society of Interventional Radiology (SIR)
– Cardiovascular and Interventional Radiology Society of Europe (CIRSE)
– Singapore Medical Association (SMA)
– European Society of Radiology (ESR)