6 Questions: What's It Like to Work in Cardiology?
By Hadiyah Brendel
Physician
Dr. Mark C. Haigney, Director of the Division of Cardiology/Director of Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, F. Hebert School of Medicine, Uniformed Services University (USU)
Dr. M. Alaric Franzos, Associate Professor of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University (USU)
Years in field
Haigney - 28 years
Franzos - 8 years as a Cardiologist, 19 years as a Physician, over 30 years as a Navy Officer, retired US Navy Captain
Special Interests
Haigney - My primary interest is in the cause of cardiac arrest in the young, whether due to a genetic condition, or the use of a drug, or supplement. I’m also interested in electrophysiology, which relates to electrical problems in the heart.
Franzos - Exertional collapse, particularly sudden cardiac death, artificial intelligence, leadership
Favorite Accolade
Haigney - Getting promoted to Associate Professor at USU. That gave me the freedom to continue pursuing a career in academic cardiology. I also received the teaching prize from the medical students twice; that certainly was very meaningful to me.
Franzos - A small plaque in the form of a surfboard with the phrase: “When average performers have had enough for the day and call it quits, champions are usually just getting started. Discipline is the watchword of great performers. Discipline makes the difference between the good and the great. Semper Fi. You saved my life.” It came from a patient of mine who I knew was in extremis [close to death] and I was treating him in Hawaii. It captures the essence of my motivation for medicine.
Q. Why did you decide to specialize in Cardiology?
Dr. Mark Haigney, Director of the Division of Cardiology/ Director of Military Cardiovascular Outcomes Research (MiCOR). (USU photo) |
As an intern though, I spent a month in the intensive care unit. Two weeks in the cardiac side, and two weeks in the medical intensive care unit side. That made up my mind. I felt the cardiac patients had a better chance of surviving and leaving the hospital in fairly good health. That certainly made an impression on me. You want to see your patients get better. The thing about heart disease is if it doesn’t kill you right away, usually we have very good treatments. It just becomes a question of identifying who’s at the highest need for those treatments.
Franzos: I was a navy pilot before I was a physician, so I have a lot of history in the service. But cardiology is an interesting specialty. Of course, the heart is fundamental to the practice. As I was going through medical school, it was fascinating to me how the heart as a pump worked. But then I began to appreciate that the heart also has a sophisticated electrical system. As I learned about those two very basics of the heart, they came together in something that was not only compelling but understandable to me. I was fortunate that I found both a passion and a clarity about the subject. That helped drive me forward.
After I learned the basics and realized I was fascinated by cardiology specifically, my mother ended up having a heart attack in my fourth year of medical school. She was hospitalized in a very severe condition. The school, [USU], was phenomenal and allowed me to do an elective rotation, away in my home town. That [way] I could be with my mom while she was being treated and in recovery. They set it up with a local physician to be my supervisor and the local physicians at the hospital welcomed me in and allowed me to participate in rounds with my mother. And seeing that compassion reflected back to me now, in the form of a family member of a patient, really helped shape the way that I treat my patients in the future. So, really particularly valuable. My mother ended up doing well. She had about a 20% chance of survival of one year. She ended up surviving another 10 or 12 years after that. So, really a great success story all around considering the nature of the tragedy.
Q. What does a cardiologist do?
Haigney: Cardiologists see patients in clinic who have complaints due to their heart. And we perform a number of different tests. Cardiology requires you to know a number of techniques: ultrasound, angiography, measuring intra-cardiac electrical activity, nuclear scans, CT scans, MRIs. It's a specialty that has almost as much radiology within as it does clinical medicine. A typical military cardiologist has to be an expert in a range of techniques and imaging modalities. When they’re in clinic, they may be called to perform and interpret those various tasks. Certainly, they may be called to send a patient to cardiac surgery or to some other less invasive, but still interventional, procedure.
I also attend in the Cardiogenetics Clinic, in the Walter Reed National Military Medical Center’s Pediatric Subspecialties Clinic. That clinic combines me with a geneticist, a genetics counselor, and a pediatric cardiologist. We see patients who have indications that they may have a genetic cardiac condition. We’re able to order genetic testing and give them an expert opinion on whether or not they have that condition. Then, we look at the family to see if anyone else in the family has the condition. Many of the patients we see in that clinic are very young, mostly active duty age and their families.
Franzos: It’s a pretty broad field that deals with the health of the heart and the health of the blood vessels. And there’s subspecialties including interventional for opening clogged arteries, electrophysiology for pacemakers and defibrillators, and advanced heart failure and transplant.
You might think, well that’s for old people, that doesn’t really apply to young troops. But in reality, for our young troops, heart-related and cardiovascular-related problems represent a significant amount of concern. In particular, in a deployed setting, heart issues are among the top five reasons why people get removed from a deployed environment. And for 80% of those people who are evaluated back home, [they] are returned back into theater because their heart issues were resolved. Or [they] were not concerning enough, allowing them to go back to their combat position. So with all those heart issues impacting not only our older population but also our younger population, it clearly makes sense for cardiology to play a prominent role in military medicine.
Q. What is one of the biggest challenges about working in this field?
Haigney: I had a challenging conversation with a patient we diagnosed with hypertrophic cardiomyopathy. Unfortunately, you can’t be an infantry soldier if you have advanced heart disease. From this patient’s perspective, they went from being perfectly healthy and happy to now having a potentially life-threatening condition that can affect their family. It’s very hard for people to hear that kind of news. It’s hard to give them that news. The tough part is when you identify a disease before it causes a problem, it can be hard for the patient to see that as good news, but it is far better than diagnosing a condition after it has killed the patient.
Q. What aspects of your job do you find most fulfilling?
Dr. Marc Alaric Franzos, associate professor of Medicine at USU's School of Medicine. (Photo credit: Tom Balfour, USU) |
Then, there are cases where something bad happens but we have a very good treatment. One recent patient we saw passed out in a restaurant and turned out to have a very rapid arrhythmia, an arrhythmia that very easily could have killed them. But, they survived it. They’re going to get an implanted defibrillator which will prevent the same arrhythmia in the future. They’re very glad to be alive. And very grateful that we have the ability to give them protection so their family doesn’t have to worry.
Q. In your medical studies, what prepared you the most for this profession?
Haigney: Almost everything you do as a doctor continues to prepare you to do a better job. Whether it’s your training before you leave your fellowship, or working with your colleagues, or attending conferences. Early in my career, one thing that set me up for success was teaching the medical students physical exam. Particularly, what’s called the auscultation of the heart. That’s using the stethoscope to listen for abnormal heart sounds and murmurs. This is a skill that is really hard to teach. And despite having four years of cardiology training, I still didn’t understand some of the nuances of cardiac auscultation. Teaching the medical students forced me to really learn it and has made me much more confident in my use of the physical exam. Pretty much everything you do in your field continues to reinforce the things you learn. But teaching is one of the most, I think, effective ways of improving your practice. If you can explain something to a first year medical student, it means you really understand it.
Q. What advice can you offer medical students considering this specialty?
Haigney: I recommend doing a cardiology rotation during fourth year as well as speaking with me, Dr. Franzos, Dr. [Robert] Goldstein, or other cardiologists as well. We have a lot of research projects going on. Learning about the research is a good way for a student to get a sense of whether the things that are being done in cardiology are interesting to them.
Probably the most important thing is to remember to do an internal medicine residency. Internal medicine residency is a requirement for cardiology. It’s a very important discipline. It prepares you to think about disease in a more mechanistic way than if you would in surgery where you’re more interested in finding an anatomical problem and fixing it. The internal medicine residency also prepares you if you were to change your mind. You might decide while you’re doing residency that you actually don’t want to do cardiology, you want to do gastroenterology, or nephrology or infectious diseases. All those specialties, including endocrinology, hematology, oncology, require three years of internal medicine first. You don’t have to decide as a medical student that you want to do cardiology. It’s great if you’re interested, and we would love to have more medical students involved in research, but the time when you have to make your real decision is during your internal medicine residency.