Welcome to the Heartbeat in Conversation Interview Series.

My forty years in Cardiology have been exciting and have changed dramatically every 5-7 years of my career. I actually wasn’t interested in medicine until after I finished college, because I was more interested in biochemistry. But then I ultimately got into some medical research, and then was encouraged to go to medical school — and it turned out to be a very good decision. I went to the University of Chicago, and did very well there. I really liked medical school. And then I did my training after medical school in medicine and Cardiology at Harvard/Mass General Hospital. Then, after seven years of doing that, I moved to Seattle, and have been in three institutions since that time, including two large group practices with hundreds of doctors and many specialty clinics. I was then asked to go over to the University of Washington to one of their main teaching hospitals to start a heart failure program, which I did, and then got roped again into a lot of administrative things, and so quickly became chief of cardiology, and started this and started that. So a lot of what I’ve done is actually me taking stock and asking “Well, what’s going on here? How can we make it better?” So I’ve started lots of programs. I also did a special fellowship and echocardiography at Mass General. I’ve always been interested in cardiac imaging. I was also an invasive but non- interventional cardiologist. I like doing things with my hands, and the manual dexterity that it takes to do things like that.

Patient context and experience are essential to understand. I like to know how a subject has spent their life, and what their goals are. Diagnosis is in many ways developing pattern recognition skills–piecing together symptoms, physical signs combined with a direct review of test results, especially imaging. But always, it is important to challenge assumptions: what don’t I know? Is there data on the problem I am trying to solve? How can I intervene, and how can I translate my process into patient teaching and define the course of therapy?

We recently saw a heart failure patient who was “packaged” as a 65 year-old man with routine hypertensive heart failure. But the more we looked at the data, it became clear that this man had a complex systemic disease that required specialized blood and imaging tests. So, virtual cardiology provided an opportunity to turn on my “pattern-recognition” radar with a clinical team that shares that approach.. Again, the more data we have, the better and faster this process can go.

I think the biggest advance will be in some secure cloud-based data repository that includes all medical data and imaging on a patient. We need to develop ways of examining patients, perhaps with breakthroughs in defining and using biometric data we have yet to gather. We also need to understand virtual care better (benefits and drawbacks) and accordingly educate patients and practitioners about the results.

I think that we also have to realize that the American College of Cardiology keeps emphasizing that at least 25-30% of cardiologists are between the ages of 50-55, and that there might not be enough cardiologists in our aging population for the future. So, we have to be able to work in teams in order to leverage the expertise of each of the team members, the nurses, and the medical assistants, technicians, as well as the cardiologists. The only way we can do that is to be able to do quick evaluations with comprehensive information. And if you don’t have the information, you’re going to make mistakes. The key is having a comprehensive medical record stored in the cloud that is secure — and giving patient’s confidence that it’s secure. These two dynamics acting in parallel are essential. And I’ll reiterate again – it must include every single piece of medical information.

I cannot emphasize enough the need for having comprehensive data. It improves care, promotes credibility with patients and caregivers, and sets a standard for superior care. That includes clinical information, but also a full profile of the patient’s social, socio-economic and philosophical milieu. Then heart care becomes something living, breathing and evolving.