Meet the Specialist with Dr Archana Rao, Consultant Cardiologist

To coincide with International Women’s Day, which we celebrated earlier this week, we are pleased to share the next instalment of our Meet the Specialist series.  This is where we hear from LHCH specialists about their career experiences, inspiration, achievements and hopes for the future.  This time we spoke to Dr Archana Rao, known to colleagues as Archie, who is a Consultant Cardiologist specialising in devices and heart failure.

A career in medicine

Dr Rao studied medicine in India almost 30 years ago when she decided to move to the UK for more structured training.  She shared:

“I moved over here with my husband; we took our licensing exams (PLAB).  I think I always knew I wanted to be a medic.  I liked the interaction with patients and following them throughout their journey. 

“In 1998, following an A&E job, I did a medical rotation in Bristol.  At the end of the rotation, I felt I was quite good at working in acute situations when patients were unwell.  I enjoyed the adrenaline of working in those situations. Having completed my Membership of Royal College of Physicians Diploma (MRCP), I did an intensive care job in Bristol.

“I was in two minds as to whether to pursue intensive care or do a more hands-on medical specialty.  I finished intensive care and got the opportunity to do a short-term registrar (LAT) post in Cardiology.  I was expecting my baby, but as it was only three months long, I chose to do the post, and I loved it!  As a cardiology registrar, I got hands on experience and thought it was perfect for me.  I could be a medic and a surgeon and have the best of both worlds. That’s how my cardiology journey began.

“When I’d had my baby, I went on to do my MD (Research) at Queen’s Medical Centre in Nottingham.  This gave me the opportunity to avoid on-call for an 18-month period whilst our son was little.

“It was very clear to me I wanted to train in a place which had plenty of clinical work, high volumes of patients and procedures because this is what was important to me.  I was less fussed about how good it looked on my CV or what people thought.  I was shortlisted for the Mersey Deanery cardiology registrar post.  I think that was the beginning of my career as a Device Cardiologist.  It mattered to me that I could do the job I set out to do.  When this opportunity came up, it was just what I was looking for with really good quality work.  I was very pleased when I got offered the post and we moved up to North West England.  At the time, my husband was working for the Yorkshire Deanery, then moved to Manchester to pursue his MD, and then to Cambridge to do his specialist training in Surgery.  We had lots of interesting conversations across motorways as to who's going to pick our son up.”

Device and heart failure specialist

Having experienced various areas of medicine, Dr Rao found her niche.  She explains what appealed to her about the role and her memories of starting here at LHCH.

“When you think about hands-on medical specialties, cardiology is at the forefront of that because you follow the patient journey.  This is certainly what I do as a Heart Failure and Device Specialist. 

“My work begins as soon as the patient is referred with shortness of breath, assess them and treat them with medical therapy.  I’m interacting with the wider heart failure team and, if needed, we offer the patient a cardiac device.  I implant and follow up these devices.   

“I’ve found my perfect job. I’m able to be a medic by assessing the patient, planning for them, and then largely carrying out that plan.

“When I first started in the North West I worked at Aintree Hospital for 2 years doing a medical registrar post.  I learnt loads, it was a very busy job and with a full week of nights.  I gained lots of experience which stood me in very good stead.  I performed all types of procedures such as chest drains and lumbar punctures.  We did pretty much everything in those days.

“Since moving to LHCH, I have been extremely fortunate training with well-respected colleagues such as Dr. Ramsdale and Dr Palmer, who taught me angiography and angioplasty.  I then moved to train with Professor Wright, and I’ve always tried to pick up skills and keep myself updated.  Towards the end of my training, I was fortunate enough to be offered a consultant post and then I took this up in 2008.  

“Since then, I hope I have contributed to improving patient care, particularly in the heart failure and device arena in the North West.  Along with Professor Wright, and our younger colleagues, we offer lead extraction at LHCH.  We are very ably supported with cross-disciplinary working with our surgical colleagues.”

A determination to succeed

Dr Rao admits her journey has not been easy, but well worth it for a career that has been hugely important and meaningful:

“It's certainly not been easy, because as overseas doctors, my husband and I were trying to build a career with a young child, with no family support in the country.  It's been challenging but very worthwhile.

“Whilst my husband was pursuing a surgical career, we swapped on call rotas to suit childcare needs.  We ‘muddled along’ and made it work because it's important enough to both of us.”

Advice for aspiring medics

An advocate for cardiology, Dr Rao feels strongly about inspiring the next generation of cardiologists.

“I think for me, the journey has been one of nurturing relationships, training the juniors to become able colleagues, and succession planning as we take on the next challenge.  I think inspiring people to just do what they see as a worthwhile career and accept there will be sacrifices to be made. If it’s worthwhile to you, that's your decision and that's what you do.”

Career highlights

Dr Rao has a national profile and is often asked to share best practice, learning and innovations with peers from across the country and abroad.

“I've often been asked to speak at the European Heart Rhythm Association (EHRA).  I’ve been faculty at their conference every year, for the last 10 years, and I keep getting asked to go back and deliver not one but a few lectures at that meeting.

“The first time I was invited, there was a bit of imposter syndrome.  I wasn’t sure that I was deserving, as there were so many senior and experienced people in attendance, but 15 years in I belong!

“I'm also very proud of the fact that I've been part of many EHRA Consensus documents on contemporary management of device patients.  

“I'm just as proud of the service I deliver alongside my team which has evolved considerably over the years.  As a large tertiary centre, we deliver high volumes of cardiac implants with excellent outcomes.  When you look at published LHCH outcome data, you see that we are a high-volume implanting centre, and a large extraction centre with very, very good outcomes.  

“The educational aspect is very important to me.  I have offered a Device fellowship for many years.  I have personally mentored many cardiologists who have gone on to establish excellent and very high-profile careers in cardiac device therapy.  A lot of my fellows are now colleagues and peers in large tertiary centres delivering very high-quality work.  We've kept that two-way interaction and communication going where we will still have a conversation about complex cases and learn from each other.”

The human touch

Dr Rao added that one of the areas she takes great pride, is ensuring that she remembers details about her patients.

“I really know and care about my patients.  When registrars come along, they are often surprised how much I seem to recall about each individual patient.  I do a very high volume of procedures every year and see hundreds of patients in outpatient clinic.  I have done this for 18 years as a consultant and 5 years before that as a registrar.  I just seem to know them, and I'm really pleased that I've retained that human touch to the care and management of patients.”  

LHCH heart failure and device services

LHCH is one of the busiest cardiac device implanters in the country and offers follow-up care for cardiac devices.  Dr Rao highlighted other key aspects of the service:  

“We have more than 6,000 patients having remote follow-up of their cardiac devices.  In addition, we provide a comprehensive Heart Failure service integrated with the Cardiac Device Service.  We have remote management incorporated into the care pathways and the ethos of this is providing a continuum of care.  From when the patient first presents to outpatients, where the GPs or primary care referred patients to us for a possible diagnosis of heart failure to managing complexities of their heart condition and following it through.
“The service also includes nurse led up titration clinics for optimisation of medication, implanting the devices and following them up on a remote basis.  Patients are being followed up by remote management, monitored in the comfort of their own home, and then we're picking it up in the clinic and managing the condition.

“Towards the end of life, we're offering patients very holistic care that may include deactivation of ICD (Implantable defibrillators), and appropriate management.  I'm very proud by the way the service has developed.

“We've now got a very strong inherited cardiac conditions clinic into which appropriate patients will be referred where we have genetic testing available.  We work closely with the genetic counsellors to ensure patients get tailored care as needed.

“I know our service encompasses various aspects of care for individual patients and we're trying to make it as seamless as possible, with less duplication of tests, fewer clinic appointments and reduced delays.  We try and make every contact count.”

International Women’s Day

When asked if she was aware of health inequalities in diagnosis and treatment of heart failure Dr Rao said:

“I think health inequality for ethnic minorities, selected post codes and women is real.  Partly it is because they're under-represented in research and therefore the evidence base is also biased in as much as there isn't equal or even satisfactory representation.  

"As medics, we need to be cognisant of vulnerability and inherent biases.

“As a healthcare system, we could and should break down any postcode, language, racial or gender barriers that exist.  We should allow people time to process information and do so with empathy because there are different challenges for different subgroups which are underrepresented, and it takes time and effort.

“It’s important to be aware of barriers that may not be visible.  With regards to barriers to women in the profession, my mantra has always been you do what feels right for you, being a woman simply doesn’t come into it!  I think it’s served me well.

“There will be challenges, of course, but these are par for the course and taking them in one’s stride makes success ever sweeter.”

The future

Discussing the future for the service, Dr Rao hopes that collaboration between different hospitals means greater opportunities for patients and services alike:

“I’m hopeful more collaboration between Liverpool hospitals will mean less duplication of work, more streamlined pathways for patients and more quality work for those of us who continue to develop and provide services.  

“We need to embrace change and ensure that the quality of care is never compromised, and patients remain at the centre of all we do.”