Cardiovascular and pulmonary rehabilitation physiotherapist | Dr. Sharvari Sanjay Kumthekar

What is your name, title, and workplace? 

Dr Sharvari Sanjay Kumthekar (PT)

Cardiovascular and Pulmonary Rehabilitation Physiotherapist

P. D. Hinduja Hospital and Medical Research Centre, Khar (West)

What is your educational background? year of graduation?

• Masters in physiotherapy (MPTh), cardiorespiratory conditions- Maharashtra University of health sciences- Batch of 2016
• Bachelors of physiotherapy (BPTh), Maharashtra University of health sciences- Batch of 2013
• “Pulmonary Rehabilitation Course” by European Respiratory Society with Busary position at Leuven, Belgium, in January 2020.
• Certificate course in “Lymphedema Management” at Tata Memorial Hospital, Mumbai, India, from 13th to 17th August 2018.  

When did you start working and describe your early roles?

I was sure, I wanted to switch the profession by the end of the third year of my B.P.Th, as I was not able to see a future beyond SWD, IFT, US, EMS, Paraffin wax bath, and some exercises (mostly isometrics! ).  I didn’t have any inclination towards Sports, Community Based Rehabilitation, Neurosciences or Paediatrics.

At the beginning of my final year B.P.Th, I decided to work part-time for earning some extra pocket money. My parents did not want me to go for home visits from a safety perspective, as I was staying in a hostel in a different city.

So, I spoke to my OPD in-charge and she recommended me to a pain management clinic owned by a very senior pain physician for a paid observership. I went for the interview and saw the adjoining consultation rooms, one for the pain physician and another, well equipped, was for the physiotherapist. 

My working hours were 4.30 pm to 8.30 pm, Monday to Saturday and the pay would depend on the number of patients I treated. I was allowed to study or do my home-works, when I did not have patients in the clinic. So, I took the job!

Initially, as I joined, I helped and learned from the senior therapist who was working there already. She soon left the job for personal reasons and I got the opportunity to do the clinical decision-making on my own. 

I, then, requested the pain physician to let me observe him during his consultations. This gave me the opportunity to learn about detailed history taking, clinical evaluation, understanding the x-rays, MRIs and CT scans better while analyzing clinical reasoning, in a better way. 

He often allowed me to accompany him for some procedures like nerve blocks, which helped me understand the procedures, when exactly are they indicated, and how they work as well as the anatomical landmarks to evaluate better. 

This entire experience of learning while earning was responsible for re-considering continuing with the same profession.

Why did you decide to specialize in cardiorespiratory physiotherapy? 

While working in the municipal hospital for our clinical hours every day, by the end of my final year B.P.Th, I had developed good professional dynamics with most of the doctors. One of them, head of the internal medicine unit, was also a partner in a secondary healthcare hospital, mainly focused on a well-equipped ICU and Burn unit.

The morning rounds of physiotherapy being provided by the master’s students from our college, as a part of their clinical hours, at this hospital, the founders were looking for someone who could provide evening sessions, mainly to their ventilated patients and patients in the burn unit. I was offered the job after a brief interview, as the physician had seen my work at the municipal hospital as well.

I switched my job from an observership at the pain-management clinic to a 30 bedded secondary care hospital, as a part-time consultant physiotherapist, only to gain the experience of working in the ICU and burn unit, as my internship started.

This job taught me so many things – from emergency medical services like Basic Life Support to interactions between pharmacology and exercises.. and from prevention of contractures in patients with burns to suggesting occupational modifications for them, I developed an interest in cardio-pulmonary physical therapy by seeing the change that can be brought to people’s lives. That’s when I decided, I wanted to go for this specialization.

I chose to continue working there after the internship was over while preparing for the entrance exam as a pre-requisite to post-graduation. I got admission to the same college as B.P.Th, the principal of the college being my guide, for M.P.Th in cardio-respiratory sciences.

I was certain to be in the same area for the next 3 years as I started with post-graduation studies, so, I decided to start treating patients also, at the same hospital where I worked part-time.

My dissertation was on Pre-Hypertension for which I also got an opportunity to talk during a CME in Pune, organized by Ranbaxy, after the JNC 8 guidelines were published. 

The whole theoretical studies at the college, evidence-based practice with the guidance of professors and seniors during clinical training at the municipal hospital, and part-time work experience, where I could apply all of my knowledge, skills, and expertise to plan therapies helped make a strong foundation.

What did you do soon after completing your Master’s? 

As I completed my M.P.Th in August 2016, I moved back home, to Mumbai. While I was waiting for the results, I prepared the CV, also created a LinkedIn account, and registered on online job portals. I went to all the big and small hospitals to submit the CV in person. Also, e-mailed it wherever possible.

As a fresher in cardio-pulmonary therapy, I thought, an institute-based job could give me the opportunity to use modern infrastructure to treat a wide variety of cases while paying a fixed salary. Also, being new to the city, I had no connections or I knew no one who had seen my work, so, I thought, it would also be helpful to develop a professional network.

I went for a couple of interviews but I wasn’t happy with the salary those organizations were offering and hence, I decided to start a freelance practice till I could get a job that will pay a sufficient salary.

So, I collaborated with a home healthcare company to get leads for home visits and was doing well. I got an offer as an ICU therapist at a well-known hospital in Bandra. The pay wasn’t meeting my expectations but was more than what I was offered earlier, so I decided to continue taking home visits in the evening time after work. I could barely survive there for 3 weeks all thanks to the workplace environment that didn’t suit my comfort and growth.

I had almost forgotten about the fact that I had submitted my CV at Lilavati Hospital and Research Centre in August, when I got a call from their HR executive in November, asking me if I can come for an interview. I was excited to work with one of the best hospitals in Mumbai and hence, I prepared thoroughly for the interview. 

The Chief Physiotherapist and the Medical Director took my interview followed by the salary negotiations with HR. The next day I was informed that I have been given the 1st position on the waiting list and they will give me a call in a few weeks for fixing my date of joining.

I joined Lilavati Hospital and Research Centre on 1st January 2017 and have never looked back since then.

What are you doing currently?

I am working at P. D. Hinduja Hospital and Research Centre, Khar (West), as a Cardio-Vascular and Pulmonary rehabilitation therapist. Also, have my freelance practice in suburban Mumbai.

How long have you been in your current role?

More than 2 years and 5 months ( Since 1st January 2019 )

How did you find your current job? Application or connections?

My current organization had a Department of Cardiac Rehabilitation already. They wanted to start Pulmonary Rehabilitation as well in the same set-up with some modifications that were necessary. 

They got to know about me through a friend of mine who was called for the same position but wasn’t interested in the offer then. The HR executive called me and asked if I was interested. I went through a series of interviews the next day, along with a few more candidates, and then was informed by the end of the day that I was selected for the position.

How did you prepare yourself for the interview?

I think, getting your basics right is the key for the first job interview along with good communication skills and presentable attire. Being prepared for an interview after your first job, according to me, is more of a process that happens with your ability to learn from your experiences at the first workplace, while updating your knowledge and skills, simultaneously!

What is the typical day of work for you?

My work shift starts at 8 am and ends at 4 pm at the hospital. A morning round to the ICU and Wards for the In-patients referred for Cardiac or Pulmonary Rehabilitation and the rest of the day is spent in Out Patient Department of Rehabilitation with a 30-45 minutes break for lunch. Later in the day, my colleague joins me, who also looks after the evening rounds to the ICU and wards.

We also offer Preventive Cardiology Consultations for patients with Lifestyle Disorders or the presence of more than 1 risk factor observed during their health check-ups.

As a part of my freelance practice, online consultations or home visits are scheduled from 4.30 pm to 7 pm.

After that, it’s family time!

What are your work hours?

8 hours, 6 days a week 

Do you do home visits?

A lot more before the pandemic, but prefer online sessions over home visits now, keeping in mind the safety issues.

Home healthcare is an integral part of physiotherapy, especially in India, due to the lack of disabled-friendly infrastructure and tremendous costs, effort, manpower, and time required to overcome the challenges if a patient has to go to the rehab center as often as 3 days per week for 8-12 weeks or sometimes more.

But what I would like to add is –

The concept of a home visit, for me, has evolved from making the patient do all the exercises in front of you, everyday, to more of teaching them basic concepts and making them more independent. Consultation and guidance for modification or progression of exercises, every once or twice a week is then sufficient to monitor the patient and ensure optimum outcomes and long-term adherence to beneficial behavior due to comparatively low costs involved for a better quality of specialized therapy.

What do you like about your job?

Almost Everything! I love the positive impact that can be brought into people’s lives which in turn is reciprocated with efficacious smiles and abundant blessings! Who wouldn’t like it if their work gets them the opportunity to learn, earn, grow and make a difference to this world while becoming more grateful towards life with each passing day?

What do you think can be improved in your field?

Awareness – Among the healthcare providers and the laymen about the benefits of rehabilitation programs in terms of improved quality of life, improved life expectancy, reduced morbidity, reduced number of exacerbations, and hospitalization thereby reducing the cost paid by the patient and family for the healthcare, promoting psychosocial wellbeing, etc. 

An early referral would also help to decelerate the progression of the disease and take care of the co-morbidities. Cardiopulmonary Physiotherapy is so much more beyond the so-called “Chest PT” and everyone needs to know that.

Documentation and publication – of every atypical case and of all the cases which have been benefitted from the program should be analyzed, documented, and published with the help of qualitative and quantitative outcome measures. Government should have dedicated grants for physiotherapy researches.

Education – The students could be taught the recent techniques and methods in their curriculum so that they won’t have to pay extra for doing so many other courses after or alongside their master’s program.

Therapists should practice their specialty and refer patients to the other specialties if and when required in order to provide the patients with the most appropriate treatments that will ensure faster and complete recovery. This will build confidence and goodwill about the profession in society. Evidence-based practice should be the preference as compared to conventional protocols.

There needs to be a multidisciplinary team including a trained occupational therapist, speech-language pathologist, medical social worker, dietician, psychologist apart from the doctors and physiotherapists, for Cardiac or Pulmonary Rehabilitation, with frequent interactions and meetings to optimize the benefits of pharmacotherapy and exercise therapy for the patients. This will also ensure the induction of proper lifestyle modification for long-term adherence to healthy behaviors.

Last but not the least, the government should have some wage policies for all Physiotherapists according to their education, length of experience.

Can you name books, courses, and workshops that helped you in your career?

There are infinite books and research papers that have helped me tremendously. 

• “CanRehab 2017” Conference and Workshop on Physical Impairments arising from Treatment of Breast Cancer – Prevention, Detection & Management, at Tata Memorial Hospital, Mumbai
• Certificate course in “Lymphedema Management” at Tata Memorial Hospital, Mumbai, in 2018.
• “Pulmonary Rehabilitation Course” by European Respiratory Society at Leuven, Belgium in January 2020
• Clinical Exercise testing and prescription course by ERS (2020)
• Clinical interpretation of spirometry course by ERS (2020)
• ATS 2020 virtual congress
• ERS 2020 virtual Congress
• Rehabilitation of patients with COVID-19 (WHO, 2021)

What is next for you?

Covid19 pandemic has left all of us completely uncertain about the future, so the plan is to go with the flow and try to make the most of every opportunity that comes my way, while being grateful for what I have!

What is your advice for someone who wants to follow in your footsteps?

As much as I think that, this is just the beginning of a really long journey that I have always dreamed of, a few things that I’ve always believed in are –

• Knowing all the basic concepts well in details
• Continuously learning new things for self-improvement
• Sincerity, dedication, and timely adaptation
• Working hard in every way possible, to achieve each goal (no matter how big or how small it may seem)
• Connecting the dots for a precise understanding of a patient’s health condition 
• Tailor-making exercise prescriptions with a patient-centric approach
• Good communication with the patients, their families, and every healthcare provider who is involved in the process of rehabilitation
• Documentation of quantitative as well as qualitative outcome measures
• Last but not least – Gratitude!

Where can people reach you?

Linkedin profile: https://www.linkedin.com/in/sharvari-k-b7208339/