Dr Jagdeep Singh – Consultant Cardiologist 

Early Career & Motivation 

Can you tell us about your path into cardiology?

 My path to cardiology was driven by my commitment to academic and clinical excellence, beginning with the TMA Pai Gold Medal for overall best student in my undergraduate, MBBS training. I then received early training in Malaysia where I worked in Kuala Lumpur General Hospital which was the apex referral centre in the country. I was struck by the need for and consequence of rapid decision-making and action that is required in acute cardiac care – and was immediately hooked! 

I then moved to Scotland to pursue a Doctorate in Medicine (MD), focusing on the physiological mechanisms of heart failure therapeutics. My Doctorate thesis in 2019 focused on the repurposing of a diabetic drug for use in heart failure, which supported the introduction of an entire class of medication (SGLT2-inhibitors) as a central pillar of treatment for patients with this condition. 

Following on from my Doctorate, I trained in Cardiology, specialising in cardiac devices and heart rhythm 

Was there a particular moment or experience early in your career that inspired you to specialise in this field? 

I recall the moment I was on call as a junior doctor and was attending to a young patient with a cardiac arrhythmia presenting to the Emergency Department in the early hours of the morning. There wasn’t a Cardiologist who was immediately available and I had to take decisive action to treat the patient. By the time the Cardiologist arrived about 30 mins later, the patient was stable and well. The Cardiologist told me that if it wasn’t for my recognising a particular pattern in the ECG and selecting the correct treatment, the patient would have died that day. That sparked my fascination with ECGs and managing patients with heart rhythm disease. 

Clinical Practice

Could you describe a typical week in your work across district general and regional cardiac centres?

My week is divided between leading the Cardiac Arrhythmia and Implantable Devices Unit at Victoria Hospital and also performing operations at the Royal Infirmary of Edinburgh. I do the majority of my work seeing patients on the ward, running clinics as well as multi-disciplinary team discussions around complex cases in Victoria Hospital. While in the Royal Infirmary, I perform complex cardiac interventions like LASER surgery for pacemaker and defibrillator lead extractions, and provide this service for patients living in north, south and east of Scotland. 

Working across both a district general hospital and a regional tertiary centre provides unique insight into standards of care at different levels of service provision. This perspective is particularly valuable when I review medico-legal cases, where context and available resources must be carefully considered. 

Are there any defining cases or experiences that illustrate the impact of your work on patients’ lives? 

A significant milestone was introducing the first Left Bundle Branch Area Pacing (LBBAP) service in Scotland. By providing a more natural, physiological way to pace the heart, it can prevent the long-term deterioration sometimes seen with traditional pacemakers. 

Additionally, I established NHS Fife’s first dedicated Cardio-Oncology clinic. This ensures that cancer patients, who are often at high risk for treatment-related heart issues, have direct access to a highly specialised expert with the deep technical knowledge required to protect their cardiac health during oncology treatment. This transformed the level of service that cancer patients (and oncologists!) could get locally in my Health Board (known as Trusts in England and Wales). 

What aspects of cardiology, and particularly device therapy, do you find most rewarding? 

Many of the most impactful cases involve patients with advanced conduction disease or heart failure who are profoundly limited by symptoms. Seeing a 

patient regain functional capacity after appropriate device therapy is deeply rewarding! 

Equally significant are cases where careful assessment avoids unnecessary or inappropriate intervention. In cardiology, good practice is often as much about knowing when not to intervene as when to proceed. 

Innovation & Leadership 

You introduced Scotland’s first left bundle branch pacing service — can you explain what this involves and why it matters for patient care?

LBBAP is a sophisticated technique that stimulates the heart’s own conduction system (a network of nerves) rather than its muscle. This results in a more harmonious and synchronised activation of the heart which is starkly different from the current standard of pacemakers which can lead to long term heart muscle damage and dysfunction. 

I introduced a regular LBBAP service for the first time in Scotland at the end of 2022 and my team and I were recognised with the Cardiology Team of the Year Award at the Scottish Healthcare Awards in 2023. The judges cited the fact that we were able to deliver cutting-edge pacing services with limited resources in a district general hospital, as the primary reason for the recognition. 

I now proctor other consultant cardiologists from hospitals around the country, teaching them best practices in this new pacing technique, thereby extending the reach of this technique to a wider pool of patients. 

How do you balance cutting-edge clinical work with training, research, and leadership responsibilities? 

My leadership roles include National Programme Director for Scientific Sessions at the British Heart Rhythm Society and Expert Advisor to the MHRA. I also serve as the Clinical Governance Lead in the Department of Cardiology in my hospital. 

I find these roles, along with training and research as extensions of my clinical work. They are all inextricably linked and they all inform each other. 

Could you share an example of a time your clinical innovation directly improved patient outcomes? 

remember in the early days after I introduced the LBBAP service in Victoria Hospital, there was a patient undergoing a complex pacemaker procedure in the 

Royal Infirmary. His old pacemaker had resulted in heart muscle damage, and he needed an upgrade to a different device. The doctors were struggling to get a complex pacemaker called cardiac resynchronisation therapy into the correct position in the heart. I was able to help the team by switching to a LBBAP and the patient made a remarkable recovery very quickly after that. 

Had it not been for the LBBAP as a bailout, the patient would have been condemned to further deterioration of his heart muscle function. This also helped the doctors in the Royal Infirmary recognise the benefits of being able to perform LBBAP, especially in complex and high-stakes scenarios. 

Medico-Legal Work 

How did you first become involved in expert witness work, and what drew you to this aspect of your career?

My involvement in clinical governance and my work as an advisor to the MHRA (and NICE prior to that), naturally led me to expert witness work. I was drawn to the intellectual challenge of deconstructing complex clinical events to provide evidence-based clarity for the court. 

What I hadn’t anticipated was how much it would influence my own day-to-day practice. There is no doubt that my work as an expert witness has made me a better clinician! 

What training or certifications have you undertaken to ensure your work meets the highest medico-legal standards?

My commitment to clinical excellence extends equally to medico-legal reporting. I have attended multiple report writing training and courtroom mock up sessions with Specialist Info and Bond Solon. I am also a Certified Medicolegal Expert by University of Aberdeen / Bond Solon. 

How does your clinical experience influence the way you approach medico-legal cases? 

Working in busy secondary and tertiary care hospitals as a high-volume cardiac device specialist and a Governance Lead, I have a deep understanding of the standard of care as it exists in modern Cardiology practice. This allows me to provide solicitors with a robust and realistic assessment of a case’s merits and 

the courts with a clear understanding of complex medical issues, translating technical clinical details into evidence-based opinions. 

In your experience, what makes a clear, useful instruction from a solicitor, and how does it shape your report? 

I think a clear and useful instruction is one that provides a precise clinical timeline alongside specific, focused questions. When a solicitor focuses their instruction with a clear set of questions, it allows me to apply my clinical and regulatory expertise to produce a targeted, evidence-based report that directly addresses the issues in dispute, avoids unnecessary complexity, and gives the court or parties a reliable foundation for informed decision-making. 

Research & Teaching 

How does your research in heart failure and cardiac devices inform both your clinical practice and expert witness work?

My research work keeps me at the forefront of evolving clinical evidence, guidelines, and device technology. In clinical practice, this means my decisions are grounded in the latest evidence rather than outdated convention. 

In expert witness work, it gives me the ability to assess whether the standard of care applied in a case reflected current best practice at the time or fell short of it. Research also sharpens my ability to critically appraise clinical records, identify gaps in management, and present complex technical findings in a way that is accurate, balanced, and accessible to a non-clinical audience. 

You train clinicians nationally and internationally in advanced pacing techniques — what key principles do you emphasise? 

When I proctor clinicians in LBBAP across the UK and internationally, the focus is always on procedural safety and robust post-operative monitoring to ensure the highest possible standard of care. My proctoring work usually involves senior clinicians who are already performing cardiac device implants, my overarching principle is that technical skill must always be underpinned by sound clinical judgement, clear procedural planning, and a commitment to patient safety above all else. 

How important is it for a practising cardiologist to remain active in both research and teaching when giving medico-legal opinions? 

It is essential. 

Medicine evolves rapidly. An expert who is no longer clinically active risks assessing past decisions using outdated or theoretical standards. Ongoing practice, teaching and research ensure opinions are grounded in contemporary reality. 

International Work & Broader Perspective 

Could you tell us about your medical mission to Nigeria and what you learned from providing advanced care in a resource-limited setting? 

It was a privilege to provide life-saving interventions while also training local clinicians in these techniques to ensure a sustainable impact on the local community. 

Working in a resource-limited setting reinforced something that is easy to take for granted in well-equipped hospitals; that clinical excellence is built on sound judgement, adaptability, and teamwork, not just technology. It challenged me to distil complex procedures to their essential principles, and to communicate those principles clearly across different levels of experience and clinical culture. That experience deepened my appreciation for the importance of knowledge transfer and capacity building, and it has made me a more resourceful and empathetic clinician. 

How have experiences like this shaped your approach to patient care and medico-legal work in the UK? 

Experiences like these have sharpened my appreciation for context and nuance, both in clinical practice and in medico-legal assessment. Practising in environments where resources, infrastructure, and support systems vary significantly has taught me to evaluate decisions not in isolation, but against the realities that faced the clinician at the time. That perspective is directly transferable to expert witness work. 

In medico-legal practice, the central question is never simply whether an outcome was adverse. It is whether the clinician’s reasoning, decision-making, and actions were reasonable, defensible, and consistent with the standard expected of a competent consultant at that time, given the available facilities, 

prevailing guidance, and clinical urgency. A complication is not in itself evidence of negligence. Medicine involves inherent risk, and experienced clinicians must sometimes make difficult judgement calls under pressure and with incomplete information. 

My role as an expert is to bring that clinical reality to the fore, to provide an honest, balanced, and evidence-based opinion that serves the interests of justice rather than either party.