It’s been 50 years since Dr. Paul Dorian first walked through the doors of St. Michael’s Hospital. A pioneer in electrophysiology and a leader in sports cardiology in Canada, Dr. Dorian reflects on nearly five decades of delivering innovative heart care, the unique culture and values at St. Mike’s, and what he hopes the Hospital never loses as it heads into the future.
In your tenure at St. Mike’s, what has remained most constant at the Hospital?
The esprit de corps, as we’d say in French— the team concept—was unbelievably good when I started at St. Mike’s. I’ve worked in other hospitals in Toronto and elsewhere in the world since then, and there are very few places like St. Michael’s in terms of what we now call the culture of caring. It was really that team spirit, the people actually working together.
A lot of that traces back to Dr. Joseph Marotta, who was the physician-in-chief when I started and an extraordinary individual. He attracted extremely high-quality interns and trainees. He was a clinician’s clinician, very exacting and demanding. He was like a coach who expected you to give your maximum effort every time you stepped on the ice, whether you were winning or losing.
Also, in my earliest days, the Hospital's CEO was Sister Mary Zimmerman. If I had a sick patient, I’d call up the sister in charge and say, “I have a very sick patient, can they be admitted to the hospital? She would never say, “No, there’s no bed.” They would always find a way.
So, for me and other clinicians, it has always been an extraordinary place to work. I’m happy to come to the Hospital every single day. I’ve been unbelievably lucky to practice medicine at St. Mike’s.
What makes St. Mike’s so different from other hospitals?
The Hospital has never lost its culture of commitment, camaraderie, and equity. Everyone is treated with the same compassion, dignity, and respect, regardless of their circumstances. That matters to us.
What would shock young clinicians today about cardiology when you first started in medicine? In other words, what has improved?
Our ED looked very different when I started—it was a small, cramped space compared with the advanced Slaight Family Emergency Department we have today.
In those early days, interns carried much of the responsibility for patients in the ED because emergency medicine was still evolving as a specialty. We quickly learned the importance of listening to our nursing colleagues. We would ask, “Should I be worried about this patient?” If the answer was yes, we listened, and we learned.
On the technology side, I was the first electrophysiologist at St. Mike’s, specializing in diagnosing and treating dangerous heart rhythm disorders. When cardiac ablation therapy was first introduced, it was a complex and resource-intensive procedure offered by only a few centres. The technology has come a long way since then and continues to transform care for patients with heart rhythm disorders.
How has donor support changed what’s possible for heart patients?
We’re enormously grateful to our donor community. It’s an absolute privilege to be able to do what we do without regard for whether patients can afford their care. That’s the good news about Canadian healthcare, and I wouldn’t trade it for anything.
The downside is that high-tech heart care is expensive to deliver and largely made possible by philanthropy. The Schroeder BRAIN&HEART Centre gave us the space, and donor support has funded the equipment and our trainees. They have supported the work I’ve done, the work our unit has done, and the work the cardiology department has done over the years. So we’ve been extraordinarily fortunate.
What have your patients taught you over the course of your career?
Everything. I learn from patients, every minute of every day, not only about their medical problems but also about their lives. I pride myself on treating every patient as an individual. I like to hear their personal stories. I’ve had patients tell me about their families, tell me about their culture, tell me about their life experiences, and tell me where I should travel in Italy. We have all these remarkable conversations.
By listening to patients, I’ve learned to be a much better doctor. When I’m teaching medical students, I say: “99 percent of being a good doctor is learning to listen to and talk with patients. Testing is completely secondary.”
What does the future of cardiology look like at St. Mike’s? Can you share your thoughts on the expansion of the Hospital’s Sports Cardiology Clinic and the renovation of Cath Lab 4?
It’s going to get even better—more sophisticated, more complex, and more sub-specialized.
I've been a lifelong athlete myself, and I've always had an affinity for cardiac patients who are passionate about sport. Over the last decade, cardiologists have increasingly recognized athletes with heart disease as an underserved patient population. For many people, being told to stop exercising can be devastating. My philosophy, which I summed up in an editorial If in Doubt, Let Them Play, is that our role is to help patients understand the risks and make informed decisions that align with their values.
About six years ago, my colleagues Drs. Paul Angaran and Kim Connelly, and more recently, my son David Dorian, helped establish St. Michael's Sports Cardiology Clinic to care for recreational and elite athletes with heart disease. Today, it is one of only a handful of programs of its kind in Canada, but demand continues to grow.
One of the biggest needs is a modernized Cath Lab 4. The most effective treatment for many heart rhythm disorders in athletes is ablation, but our current lab is aging and can no longer be serviced. A renovated Cath Lab 4 would allow us to care for significantly more patients across the Greater Toronto Area, where access to this specialized expertise remains limited.
When you look at the next generation of cardiac care, what gives you hope?
I’m quite optimistic. I hope sport continues to become an increasingly important part of people’s lives, especially as they get older. Exercise benefits cardiac and mental health, social well-being, and overall quality of life. As more people with heart disease choose to remain active, we need to continue evolving how we care for them.
Our expertise will continue to grow through research and new technologies, including wearables that allow us to monitor patients in the community and help them exercise more safely and confidently.
What I hope we never lose—as sports cardiologists and as part of the St. Michael’s community—is the importance of listening to patients. We don’t just treat the heart. We care for the whole person. Understanding a patient’s values, goals and preferences is essential to having the thoughtful conversations about risks and benefits that guide good care.
As for my time at the Hospital, you could say that I’m a St. Mike’s lifer. This place has become part of who I am.
This interview has been edited and condensed.
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