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Raphael Balcon was a major influence on cardiology in the UK for 40 years. His work for the British Cardiac Society as treasurer and later as president built on the foundations laid by his predecessors and helped ensure that the society gained strength and influence.
Raphael’s career began in 1960 when advancing technology was beginning to make an impact on the specialty. Coronary angiography was in its infancy. The cardiologist faced an exciting future as diagnostic and therapeutic techniques appeared (and sometimes disappeared) at a remarkable rate. These developments fired a lifelong love for the specialty.
Born in 1936, Raphael was educated at Christ College, Finchley. He studied medicine at King’s College Hospital. While an undergraduate he married Elizabeth in 1959, qualifying in the following year. His fellow students will remember his ability at the poker table as well as his intellectual capacity. Residency at King’s was followed by 6 months at the London Chest Hospital, the beginning of a long association. He spent a year at Wayne State University in Detroit and there experienced the latest advances in cardiac investigation. In 1964 he gained membership of the Royal College of Physicians and was awarded a British Heart Foundation Fellowship, tenable at King’s College Hospital. He combined clinical work with groundbreaking research into the use of β-blockers for the treatment of angina and arrhythmias.
From 1967 to 1970 he was senior registrar at the National Heart Hospital working with Donald Ross, Edgar Sowton and Lawson McDonald, all becoming close friends. Although he and Edgar made a brief, abortive foray into nuclear-powered pacemakers, he focused on coronary artery disease for which surgery was in its infancy. His skill with the cardiac catheter made a major contribution to the development of selective coronary angiography in the UK. In 1969 he was elected a member of the British Cardiac Society, and received the Doctorate of Medicine from London University. The following year brought Fellowship of the American College of Cardiology.
In 1970 Raphael was appointed to the London Chest Hospital, where he spent his 31 consultant years. Together with John Wright he built the unit into an international centre of excellence which attracted both visitors and trainees. In recognition of his ability he was elected a Fellow of the Royal College of Physicians in 1977. The application of invasive diagnostic and interventional techniques was an area with which his name became synonymous.
Raphael led by example. Often he would appear in the operating theatre or intensive care unit to help with patient management. The training of junior doctors was a strength. Many of today’s cardiologists owe a debt to Raphael for teaching practical skills, logical thought, effective communication and, not least, humility. In recognition of this he was appointed dean of the Cardiothoracic Institute of the University of London, a post he held with distinction. In autumn 1980 coronary angioplasty was performed for the first time in the UK by Raphael at the London Chest Hospital, Edgar Sowton at Guy’s Hospital and Anthony Rickards at the National Heart Hospital.
Raphael’s name appears on more than 100 publications primarily covering the diagnosis and treatment of arrhythmias and coronary artery disease, all of them notable for their quality and his personal contribution. He realised the importance of accurate data collection and longitudinal studies. In 1971 he began collecting data on angiographic results and clinical outcomes, initially storing the data on a punch card system and later using computers, enabling data to be collected jointly with the National Heart Hospital. His 30-year follow-up study of patients who had undergone coronary angiography was a seminal work.
Raphael played a full part in hospital administration. He did not suffer fools gladly and those on the receiving end of his cutting comments rarely forgot the experience. He notably used his wisdom and experience to cool many difficult situations, although his peacemaking was not always appreciated by the protagonists. He inspired an exceptional degree of loyalty from junior staff and consultant colleagues that reflected both his loyalty to them and the respect in which he was held.
Among his non-clinical appointments were the presidency of the British Cardiac Society from 1995 to 1997, chairman of the European Congress of Cardiology Organisation, chairman of the Royal College of Physicians’ Cardiology Committee, and numerous others. After retirement he continued to serve on committees, being a member of the steering group of the Central Cardiac Audit Database and various government working parties. He used his data management skills to calculate realistic costing for cardiac interventions and applied them to the government’s payment by results project, ensuring that tariffs were based on real costs. Raphael was a non-executive director and chairman of medical software companies providing key elements of the electronic clinical record and continued to use his programming skills up to a few days before his death.
The Balcons were renowned for their hospitality and open house. Innumerable colleagues from the UK, Europe and beyond were entertained at their home and enjoyed his favourite champagne and Elizabeth’s fine cooking. Sport also figured strongly in his activities. Regular tennis matches between morning catheter sessions and afternoon outpatients were a mandatory part of junior staff training. An accomplished skier, he took regular breaks with his family at their Swiss chalet. Raphael was also was a skilled carpenter with a workshop at his country home. There he made pieces of furniture of high quality and originality, often for friends and family. He loved walking and the design and construction of unique walking sticks was a favourite activity. He was a member of the British Stickmakers Guild.
Raphael Balcon inspired colleagues and friends. Cardiology in the UK is the poorer for his loss.
He was born on 26 August 1936 and died on 15th January 2008 aged 71. He is survived by his wife, Elizabeth, daughter and grandchildren.
Competing interests: None delcared.