by Dr. Shanthi Paramothayan
BSc MBBS PhD LLM MScMed Ed FHEA FCCP FRCP
Consultant Physician in Respiratory and General Medicine
Dr. Shanthi Paramothayan has been a Consultant Physician in Respiratory and General Medicine working in the NHS for more than 17 years. She has extensive experience and expertise in all aspects of respiratory medicine. She has a degree in Medical Biochemistry, has a PhD from the University of Cambridge and qualified from St. Bartholomew’s Hospital Medical School, University of London, with distinction in medicine. Shanthi is a Fellow of the Royal College of Physicians and a Fellow of the American College of Chest Physicians.
Shanthi trained in Respiratory Medicine in SouthWest London, including the Royal Brompton Hospital,where she learnt about the management of complex cases. She chose to specialise in Respiratory Medicine because it combines both acute and chronic conditions and is linked with all the other key specialties:cardiology, nephrology, rheumatology andneurology. She enjoys the diagnostic challenge of making an accurate diagnosis and implementing management which leads to improvement in the patient’s health.
She has extensive experience in all sub-specialties in respiratory medicine, including: asthma, allergic lungdisease, asbestos-related lung disease, bronchiectasis,chronic obstructive pulmonary disease (COPD), lung cancer, mesothelioma, tuberculosis, pulmonary emboli,occupational lung disease, pneumonia, respiratory infections, pleural disease (including pleural effusions), empyema, sleep-related disorders, including obstructive sleep apnoea, respiratory failure, sarcoidosisand interstitial lung disease, includingpulmonary fibrosis.
She has conducted research into many conditions, including sarcoidosis, pulmonary hypertension and cystic fibrosis. She has several publications and has presented the findings of her research in conferences.Her publications in sarcoidosis are widely cited.
She has been trained to do Meta-analysis and has completed several Cochrane Reviews. This taught her to look at clinical trials in some detail and separate evidence into high quality and that which is not meaningful.
As well as working for the NHS, Shanthi has a small private practice at Spire St. Anthony’s Hospital in Cheam and BMI Shirley Oaks Hospital in Croydon.Patients are referred by the General Practitioner, by Consultant colleagues or patients self-refer themselves.
Patients are referred for a review of conditions such as asthma or COPD or with unexplained symptomsof cough, breathlessness, haemoptysis (coughing up blood), chest pain and weight loss. Often patients are referred because of abnormal findings, for example a chest X-ray or CT scan.
Dr. Paramothayan takes a detailed history and undertakes a thorough clinical examination. She then recommends investigations that are required: chest Xray,CT thorax, spirometry, lung function tests, ultra sound of the lungs, pleural aspiration, bronchoscopy,sleep studies.
Shanthi is an experienced Bronchoscopist, is trained at reporting sleep studies and competent at pleural procedures
Shanthi has a Masters degree in Medical Education from the Royal College of Physicians, is a Member of the Association of Medical Educators (ASME) and is a Fellow of the Higher Education Academy (FHEA).She has been actively involved in teaching and training undergraduates and postgraduates for 15 years.
She has been an examiner for MBBS final examinations for 13 years and for the postgraduate membership examinations (PACES) for the Royal College of Physicians (RCP) for 10 years. She has been a question writer for the RCP, on the Board for MRCP 1and a member of the Education and Training Committee of the British Thoracic Society.She was commissioned to write a text book entitled“Essential Respiratory Medicine” by Wiley-Blackwells which was published in November 2018. This text book is for undergraduates, postgraduate doctors in training, GPs, nurses, and other healthcare practitioners.She has also written several articles for newspapers and journals.
Medico-legal practice Dr. Shanthi Paramothayan has a Masters degree in Medical Law (LLM) from theUniversity of Cardiff and has been doing medico legal work for 6 years. She has completed over 50 medicolegal reports with good feedback.
Shanthi has always been interested in the legal aspects of medicine and enjoyed the Masters course,especially reading about the complex medical cases.When instructed to do a case, she takes a scientific and analytical approach. She undertakes a detailed review of all the clinical information, including medical history,and the results of all investigations. This is the critical first stage. When instructed to do so, she sees the patient/client in her private clinic to take a history,conduct an examination and do investigations that are necessary. She then writes the report, making sure that she answers the relevant questions asked. She is up to date with the latest guidelines in respiratory medicine from the British Thoracic Society (BTS) and NICE. She is not judgmental and does not jump to conclusions. She refers to the current literature in herr eport. As Shanthi is organised, her reports are completed on time with clear and precise conclusions. She enjoys discussing cases with other expert witnesses.She does not deal with personal injury claims, only with Clinical Negligence.
The themes of cases that are referred to her are: occupational lung diseases, delay in the diagnosis of a condition, the wrong diagnosis being made and wrong management of a condition.
Examples of recent cases include;
Case 1: Missed Pulmonary Embolism
Pulmonary embolism (PE) is a common occurrence,particularly in hospitalized patients. The risk factors for developing a PE include immobility, malignancy,underlying thrombophilias (conditions that make your blood clot easily) and long-haul flights. People who develop a PE usually present with shortness of breath, pleuritic chest pain (pain on breathing in) and sometimes haemoptysis (coughing up blood). Dr.Paramothayan was asked to review the clinical notes and CT images of a young woman who developed breathlessness after several long-haul flights and presented to her General Practitioner (GP). Unfortunately,her GP did not recognise the symptoms and signs of PE and treated the patient for musculoskeletal pain. The woman became more breathless and a few days later was admitted to hospital and was diagnosed with multiple PEs from a CT pulmonary angiogram.There was no doubt that the diagnosis of PE had been missed, but the question was whether as a result of the delay in diagnosis, the extent of the PE was worse and whether she had developed long-termcomplications. By referring to current literature on this subject, Dr. Paramothayan was able to demonstrate that, on a balance of probability, that the woman’s symptoms 5 years after the incident were unlikely due to the PE and that the delay in diagnosis was unlikely to have resulted in the long-term symptoms
.Case 2:Lung injury secondary to road traffic accident
Dr. Paramothayan was asked to review the notes of a woman with Chronic Obstructive Pulmonary Disease(COPD) who had been involved in a serious Road Traffic Accident (RTA) resulting in several broken ribs and lung contusion. She was admitted to the Intensive Care Unit of a hospital for several days and after several weeks on the ward was discharged home. Dr.Paramothayan was asked to comment on whether her ongoing symptoms of breathlessness two years after the accident were due to COPD or whether the rib fractures and lung contusion contributed to her chronic symptoms. Dr. Paramothayan reviewed the woman in her clinic, undertook a physical examination,a spirometry and a chest X-ray. Dr. Paramothayan referred to the NICE COPD guidelines and concluded that, on a balance of probability, the worsening of her breathlessness over the two-year period was more likely to be due to the natural history of COPD which results in a gradual decline in lung function.
Dr. Paramothayan is happy to receive queries about medico-legal cases. She can be contacted by e-mailor by telephone.