A Lifetime of Cardiology

It’s remarkable when I think about it, but I have been aware of cardiology as a specialty of medicine since my early childhood.

While other children spoke fondly of their grandparents—I would always blankly respond that I never knew my paternal grandfather.

You see—Bapu ji, by all accounts a remarkable man, suffered an untimely death by myocardial infarction in 1973 seven years before my birth, at the age of 60.

With that family history as a backdrop, diseases of the heart—and specialties focused on care of heart—have been a constant presence in my life.

I remember returning from a school trip to Camp Bernie in the 5th grade to go see Dad at his bedside following his first angiogram.

In my first year of medical school, I rushed home to be with him when chest pain and shortness of breath necessitated his first of many (9) stents.

And in my first year of internal medicine residency (at Brigham and Women’s Hospital, one of cardiology’s strongholds), Dad’s heart stopped beating regularly.

A pacemaker was implanted to restore his heart to a normal rhythm.

My Dad’s many cardiologists—I remember each and every one: Harvey Goldberg, Kenneth Stein, Geoffrey Bergman, Samin Sharma, Richard Goldweit, the late Alvin Frieman—literally saved his life at various critical junctures.

And as a direct result of their care, my parents celebrated their 50th wedding anniversary in 2017. Dad retired last month after 50 years of leadership and clinical practice in cancer pain management. And he has been able to proudly watch 5 mischievous grandchildren grow up and thrive under his watchful eye.

I am so incredibly grateful to the cardiologists in our lives. We owe them many lifetimes of gratitude.

But they are only part of the story of keeping my Dad well all these years.

My Dad’s care was informed by:

• A bedrock of innovation that was systematically divined over decades by selfless academic and industry scientists.
• A commitment to rigorous scientific inquiry within cardiology that is unparalleled in comparison to most other fields of medicine.
• Bold new device development and creativity in material science.
• Large-scale clinical trials and the countless hundreds of thousands of brave patients who subjected themselves to experimentation.

Each of these have coalesced to support significant advances in quality and quantity of life.

Which leads us to an important question:

What will be the source of the next great advances in heart care?

I believe the next great innovations will not be new medicines, devices, or procedures.

They will be new models of care delivery.

Models of care delivery that focus on prevention and integrate physical and behavioral health and their social determinants.

Models of care delivery that facilitate the concepts that we know work—evidence-based medicine, robust exercise, diet—imbued with the humanity, empathy, and integrity that patients expect and need.

Models of care delivery that support clinicians with functional (dare I say, usable) clinical IT systems and reasonable reimbursement amounts that afford them the time to deliver the high-quality of care they are capable of delivering.

Models of care delivery that integrate home-based technology to provide continuous feedback about patient health—rather than just seeing patients in the few minutes a year that they are under a doctor’s care.

For as much scientific innovation as the field has enjoyed in the last century, our models of care delivery have remained largely unchanged.

My mentor and collaborator at Harvard Business School, Professor Michael E. Porter, used to say that the American healthcare system is characterized by 21st century medicine being delivered in 19th century delivery models.

The result? Our knowledge of what is" best care" fails to make its way to the patients who need it most. The focus is too often on heroic interventions like the ones from which my father benefited than close preventative management of upstream causes.

We need to change that focus and—as physicians and healthcare practitioners—definitively own and drive the redesign of care.

We need to keep patients out of the hospital, not celebrate the expensive (but, preventable) marvels that happen within them.

Cardiology was a specialty well-known to me (and likely millions of others) for all the reasons and life-altering events that I described.

Paradoxically, the success of its future will lie in fewer young people knowing it quite as well as I do.

(remarks given at CareMore Health's 3rd Annual Cardiology Symposium)