Barinder Hansra, MD – Page 2 – The Early Career Voice

COVID-19: The Good, the Bad, and the Ugly

April 8, 2020April 8, 2020 Barinder Hansra, MD

In the 1960s a movie titled “The Good, the Bad, and the Ugly” was released. The plot revolved around three gunslingers competing to find a fortune in a buried cache of Confederate gold amid the violent chaos of the American Civil War. Despite the initial negative criticisms of the movie, it has since accumulated very positive feedback and listed in Time’s “100 Greatest Movies of the Last Century.” The Coronavirus (COVID-19) seems to be running a parallel course. The amount of media coverage surrounding coronavirus (COVID-19) over the past several months is not only shocking but overwhelming. I personally cannot recall any other illness getting as much media coverage as COVID-19 has in the past several months. On a daily basis, we are flooded with updates, changes in clinical practice, number of cases across the country, and recommendations on how to quickly flatten the curve. Here is my take on COVID-19 (and yes, I intentionally end with “the good”).

The Bad: An observation I noted was an uptick of in-basket messages from my patients who were more anxious from social media posts than from traditional news sources. Many patients mentioned posts seen on numerous social media platforms with conflicting information or claims to proven therapies. I combated these messages with clear recommendations from various professional societies but also recognizing we do not have established data in all medical arenas. This seemed to help improve my patients’ anxiety and concerns. Even too much media of any kind can amplify distress, which was evident by my own constant engagement in news sources and social media.

The Ugly: With social media being a part of everyday life, we all have seen pictures of people buy massive amounts of toilet paper, mounds of sanitizer, and selves stripped of essential goods. As increasing number of regions declared a state of emergency, panic buying was affecting the public. Panic buying occurs typically in a time of crisis resulting in increased prices and takes essential goods out of the hands of people who need it most – for example, personal protective equipment for health care workers. What’s worse is this led to price gouging where masks, sanitizers, and cleaning supplies were being sold at an exuberant price. Fortunately, several businesses across the country established hours for senior citizens to shop in peace and have access to essential good. Several communities started to help combat panic buying by donations and fundraising help offset such behavior to help those in need – keep up the strong work!

The Good: Despite the bad and ugly, COVID has had a positive impact. The biggest change I have seen is how much more cognizant we are about healthy habits. People are not going to work if they feel ill, increasing use of hand sanitizer after being in public, and encouraging proper hand washing techniques to mention a few. Granted, we think these should be the norm but COVID highlighted how this was not the case.

While countries are closing their borders, scientists are shattering their boundaries looking to collaborate with colleagues across the globe. I was able to join in on several fantastic webinars hosted by frontline healthcare staff from across the globe to learn from their experiences so we don’t make the same mistakes for our own patients. Leading institutions in America were holding lectures to share their research, clinical experience, and any clinical anecdotes to help improve patient outcomes. I believe a big part of this movement is due to the fact the virus is not limited to one remote area of the world but has spread across the globe. It is affecting every country and countless citizens – it’s hitting home. Scientists and doctors are standing together, working collaboratively, and are driven to find an effective treatment option. It’s this type of comradery that has helped all frontline health care providers to fight this pandemic.

Although there are is plenty of “bad” and “ugly” surrounding COVID, the amount of “good” is far reaching, inspirational, highlighting the need of team work and intense desire of all of us to help #FlattenTheCurve.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

March Madness – Dealing with the Stressing of Training

March 9, 2020March 9, 2020 Barinder Hansra, MD

March is synonymous with college basketball, winning brackets (or losing in my case), and general merriment. For those of us in medicine, it may have a different meaning – stresses of matching, winter blues, and a general feeling of being burnt out. For me, March was one of the hardest months to get through in training, despite it being my birthday month.

Living in Massachusetts means long winters and I notice the general spirit of trainees tends to drop during this time. The novelty of winter has grown old, as the holidays have passed and we all seem to anxiously await the spring. The grueling winter days make it challenging to be outdoors, inhibiting us from enjoying our hobbies, and in short, tired of being cold. My friends who have trained or are working in cold climates (i.e Minnesota, Michigan, Wisconsin, Vermont to mention a few) have echoed the same sentiment. My personal interactions with interns and residents are often highlighted by fatigue, decreased empathy towards patients, and a desperate need for “the year to be over.” So, what are the tools we can use to help get through our own March Madness?

Here are a few tips and tricks that have helped me improve my wellbeing.

Stress to Strength: Growing up, I played soccer, basketball, tennis, tried picking up running (but limited by jumpers’ knee), and occasionally surfing. Clearly, none of these are great activities if it’s cold outside which caused me to feel claustrophobic in the winters. I instead work out in the hospital gym much more to try to stay active and have a positive outlet for when I am stressed. I often get asked, “what’s a good strategy for me to make it to the gym with our crazy schedule?” I’ve realized not everyone wants to go to the gym before work (which is my routine) but having small, achievable goals is the way to go. For example, try going one day before work, one day after work, and once during the weekend. You don’t need to go every single day to be healthy or stress-free. Having a few days per week in dedicated time slots will help create structure and not make going to work out feel like a chore.

Mindfulness: Mindfulness is becoming more popular in the west and for valid reasons. It is the ability to pay attention to the present moment with curiosity, openness, and acceptance. We can exacerbate stress if we ruminate about the past, worry about the future, or even engage in self-criticism; and I have been guilty of all 3. I discovered a great app called “Headspace” that helped me with guided mediation and mindfulness. The app has evolved to help fit nearly everyone’s needs and I have recommended it to several friends/colleagues.

Making my list, checking it twice: Trainees have so many tasks they need to complete: pre-rounding, rounding, Epic tasks, notes, discharge summaries, more Epic tasks, case reports, quality improvement projects, and if they have time – grocery shopping. I always keep a list of tasks I need to complete – partly because it helps me stay organized, but also my obsessive-compulsive personality LOVES to cross tasks off the list. If you get overwhelmed with the countless tasks you have to do, start keeping a list. This will help create structure, organization, and improve productivity.

Reach Out: We all need to have friends, family, and colleagues to turn to when we are feeling burnt out. Fortunately, many training programs have resources available from their GME office, which are often underutilized. My clinic preceptor (and friend) Dr. Brigid Carlson has invited me out for coffee, dinner with her family, and always welcomes me to speak to her if I am feeling overwhelmed. Knowing I have someone to turn to has helped me not “bottle things up.”

Although March Madness is traditionally stressful with college basketball, it should not be the same for the workplace. With spring on the horizon, many of us feel the stresses of training but there are resources to help us to continue to be successful.

Why Cardiology?

February 13, 2020February 13, 2020 Barinder Hansra, MD

“Why Cardiology?” is one of the most common questions I have been asked by friends, family, interns, residents, and even the occasional stranger sitting next to me on a flight. Despite being a simple question, the answer is very complex. I initially started residency thinking I would pursue a career in pulmonary/critical care – I loved the acuity, broad differential diagnoses, and the bond created with families. However, after my first month in the unit, I quickly abandoned this career path for multiple reasons. Shortly thereafter, I did my first rotation on the cardiology wards service with Dr. Matthew McGuiness (who is still one of my closest mentors) and I saw the light.

The month on the cardiology wards service is best described as “finding the missing piece of the puzzle.” I loved the anatomy, physiology, patient population, subtle differences in presentations, and my interactions even as an intern with patients. I also loved the depth of cardiology – including both clinical and basic science research opportunities, advanced fellowships options, and the ability to create my niche in cardiology. I learned cardiologists were pursuing careers in preventative cardiology, cardio-oncology, cardiac critical care, and cardio-obstetrics. I was blown away at the possibilities of a career in cardiology and having the ability to create my perfect dream job.

As I mentioned earlier, I was very interested in critical care when I started residency but did not want to be in the medical ICUs. The cardiac intensive care units were much more interesting to me with advanced hemodynamics, malignant arrhythmias, various mechanical circulatory devices, and seeing how quickly the realm of the cardiac ICUs were changing. The CCUs are no longer filled with patients who have had a STEMI requiring a week-long admission, but rather those with decompensated heart failure/cardiogenic shock requiring mechanical circulatory support (MCS) with LVADs, Impella, or ECMO.

I am now combining all of my loves – cardiology, critical care, and obstetrics (yes, I at one point wanted to go into OBGYN) for my job as an attending. With the help of my mentors, I have been able to combine all my passions into one. I will be attending in the cardiac intensive care unit and have a predominantly general cardiology clinic with a focus on cardio-obstetric patients. And the best part, every cardiology fellow can create his/her dream job.

A few key questions to ask yourself are:

Do I see myself as someone who enjoys the in-patient or the out-patient setting? This will help focus career options and set the stage for your career.
Am I a proceduralist or not? For me, I hate wearing lead, so it was a simple decision to not go into interventional or EP.
What type of patients do I get the most joy of taking care of. In my case, it was the critically ill and women who are pregnant with cardiovascular disease.
Who is 5-10 years ahead of me career-wise and has my ideal job? This has helped me be more active with research, clinics, conferences, and improve my fund of knowledge. It also gave me a roadmap to follow – no need to reinvent the wheel.

Of course, these are starting points and it’s a vast topic that takes time to explore. My journey of “why cardiology” has been filled with highs and low, but with the help of various mentors I have a clear vision of what I envision for my future career.

Have You Picked Your Mentor’s Brain Lately?

January 6, 2020January 8, 2020 Barinder Hansra, MD

It’s funny how people meet – some are coordinated efforts at work or meetings while others are random. I met one of my mentors – Dr. Jane Freedman – in the outpatient echo lab. We had never met prior to my fellowship but I recognized her name from the echo reports of my patients. After introducing myself to Jane, I fired all sorts of questions her way – mostly about restaurants in Boston we both enjoy, things we do in our free time, how to get involved in the AHA, and how best to read echocardiograms. This sparked not only a great friendship but an even better mentorship.

Jane has become my work-life-balance mentor, advising me on how to be an effective chief fellow, developing my own leadership style, types of jobs to pursue, and balancing personal life with the intense time commitment of medicine. I soon realized in order for me to be a good mentee, I had to support my mentor when I could. This included, attending her talk at the AHA not out of a feeling of obligation but out of a genuine desire to support my mentor. Over time, our mentor-mentee relationship has taken on more academic facets – largely, honing in the on the type of job I would want in the future. Jane has pushed me to clarify the type of job I want to pursue and more importantly, what are the reasons for wanting it.

mentor Over the course of my training, I realized that not all of my colleagues have mentors to turn to for these critical career conversations. It made wonder how mentors can help fellows in training, and more importantly, what are the key elements to a successful mentor-mentee relationship. To understand what made our mentor-mentee relationship successful, I asked Jane at a recent dinner at one of the many great restaurants we wanted to try.

In her experience, a successful mentor-mentee relationship comes down to be receptive as a mentor and mentee. You have to have the self-awareness of the relationship to provide support for those seeking it. In addition, the relationship has to be symbiotic. The mentor has to give advice to the mentee based on the level he or she is at. For example, the chair of cardiology may not be a good mentor to a first-year fellow if he or she is not able to give the appropriate support needed for the fellow at that specific stage of training. Conversely, the mentee needs to work hard towards the goals and expectations he or she has set for this to be a successful relationship. This made me think: how do we go about even choosing the ‘right’ mentor??

Jane highlighted that everyone needs more than one mentor. For example, an academic mentor to help me pursue research opportunities, a clinical mentor who helps cultivate knowledge in my area of interest, and even a work-life mentor that I can turn to when this demanding job seems undoable. Every mentor offers something unique to the relationship and more importantly, not one mentor will be able to give you everything you need. Jane stressed that she never stopped at one mentor but sought those that will help her become successful in all aspects of her life and career.

Jane explained that while she was training she reflected on what would improve her work-life balance. There were only so many things she could accomplish in a day and had to recognize where she needed help. For example, with the various apps to help improve efficacy, I could order groceries to be delivered to our home. The time saved at the grocery story can be spent with my significant other or at the gym. Something Jane stressed – which I took to heart – was to never feel guilty for not being able to do it all. People who go into health care are incredibly driven but we all have our limits. It’s important to recognize these limits to prevent burnout, enjoy our work, and continue to work on achieving a balanced life.

A piece of advice Jane gave me is to make sure I pick a career path that will make me happy, not the one I think I should take. With the extensive amount of board certifications in cardiology, fellows feel pressured to take them even if they do not want to. Again, this comes back to a point Jane highlighted earlier – we need self-awareness to be successful.

As dinner started to wind down, I was able to reflect on how I was performing as a mentee and what steps I can take in the future to make our relationship more successful. Checking in with my mentors always brings about new found motivation and energy to continue to strive for success.

5 Ways on How to Continue Carrying the Momentum from the Scientific Sessions

November 29, 2019November 29, 2019 Barinder Hansra, MD

The American Heart Association’s Scientific Sessions is one of the biggest conferences in cardiology. It draws students, residents, fellows, affiliate practitioners, attendings, researchers, and so many more. Therefore, attending a conference of this caliber is a big deal! The event is full of intense information. New ideas. New contacts. New solutions. And, new found energy. Most of us are revitalized after any scientific session which I believe is due to a multitude of factors including: meeting experts in our field, seeing new clinical trials, attending small group sessions for a more intimate experience, and reconnecting with friends and colleagues. Eventually, the conference comes to an end and we go our separate ways. Seems as we get closer to home, the exhaustion from the trip and the ensuing clinical responsibilities become more of a reality. This massive surge of energy is quickly plummeting. As an early career FIT, we have several responsibilities that can quickly take away from the momentum we have built during the sessions so how do we continue to sustain it?

Write: As soon as I get home or even every night at the conference, I jot down my thoughts. This helps me prioritize what is important for me to focus on once the conference is over.
Speak to your program leadership: When I came back from AHA 19, I had an inform discussion with my program leadership on the entire conference and what I learned. Specifically, I used this time to discuss how I can accomplish the goals I have set forward. The leadership is well aware of the program strengths/weaknesses but more importantly, others who can help mentor me in achieving my goals.
Debrief with your co-fellows: After the sessions, the entire fellowship class can get together to discuss ideas for quality improvement, collaborate research, or changes they would like to implement in the fellowship. This is a great way for junior fellows to start getting involved in existing projects if they feel starting one of their own will be too daunting.
Reach out: Hopefully you were able to network while you attended the sessions. I always reach out to the people I met asking for advice or if they are looking to collaborate on projects. I’ll also reach out if I have a question regarding how to care for a complex patient – after all, the scientific sessions are a fantastic time to meet providers who are considered experts in their fields. This continues to foster a professional relationship for years to come. Conferences are a great time to see what is “hot” in cardiology and meet the individuals that are leading the charge. Take advantage of this unique opportunity to cultivate your career.
Sign up For Another AHA Conference: Remembering how good I feel after a conference helps me stay motivated. Whenever I’m dragging my feet, I revisit the ideas I wrote down in the first point to remind myself how much I learned, wanted to accomplish, and the new network I created. Having another conference to attend helps me stay motivated and not lose steam on projects.

Hopefully, these five easy tips will help keep the momentum going strong long after the conference is over to continue to be successful.

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.

10 Easy Ways To Make The Most Of Your Time At Scientific Sessions

November 17, 2019November 26, 2019 Barinder Hansra, MD

Anyone who has attended any of the scientific sessions realizes very quickly that it is a marathon, not a sprint. We may have specific goals to accomplish while at the sessions so how can we make the most of our time? Although there is no one right answer, through my personal experience, I believe the following is a useful way to get started.

Take a look ahead – The sessions are jam packed with several sessions occurring at the same time or in overlapping times. If you look at the program ahead of time, you will be able to better organize your time and prioritize what sessions are going to be most beneficial.
Get the inside scoop – If you are a first-time attendee speak to your colleagues, faculty, and mentors who have attended scientific sessions about their experiences. By speaking to my mentors, I was able to get tips and tricks that helped me focus my energy on lectures that would be engaging and pushing myself to going to sessions that may be out of my comfort zone. Often, there are professional interest groups that you are able to attend to network or take a deep dive into specific topics.
Look good…feel good – I cannot count amount of times I have been thankful for wearing business casual to semi-professional clothes. You will be surprised at how often you will run into program directors, researchers, investigators, or others that could serve as a mentor. I always wear a dress shirt, blazer, and slacks when I am attending the sessions. If I am presenting then I will always have a tie. Trust me gents, it goes a long way.
Keeping it profession – To build on #3, keep plenty of business cards on hand. Each time I interact with anyone at the sessions, I give them my business card and ask for theirs. Fortunately, my fellowship provides me with business cards but if yours does not, you can easily make them at a low cost. I also then store the business cards in an app that helps keep them organized. This will help reach out to your network later and easily allow others to be able to reach you.
Team building – It’s been a tradition for UMass to have a team dinner at any and all scientific sessions. It’s a great way to discuss our day, see what our colleagues are engaged in, and what we are looking to accomplish for the remainder of the sessions.

Team Dinner – continuing to bond, support, and encouraging.
Engage in tech – The sessions have several platforms to enhance the experience. Specifically, apps are created to help improve the experience, provide maps (very helpful if you’re not familiar with the venue), and allow you to create a schedule to stay organized. Twitter is becoming a fantastic modality to stay informed of the most recent trails, engaging small group talks, or networking opportunities.
Network – The sessions are filled with a vast range of attendees. I always make an effort to introduce myself to anyone who is look at the same poster as me, sitting next to me at a session, or even getting coffee. Of course this requires us to get out of comfort zone but it becomes easier and incredibly fruitful.
Stay hydrated – I always bring a water bottle with me to the sessions. You will be going from session to session and forget to take care of your needs. A protein bar is also a great idea and may hold you over until you get to a proper meal.
Support your colleagues – If residents, fellows, or attendings are presenting at the sessions, I always try to make it. Not only does it give me a chance to engage in his/her research but also offers a chance to learn. We often are not familiar with the research our colleagues are undertaking but this gives the perfect opportunity to become more involved and potentially collaborate.

Our fantastic medical student Benjamin Maxwell with our amazing faculty member Dr. Lara Kovell who has helped serve has a mentor roll.
Enjoy!! No matter what happens or how prepared you are, enjoy the energy surrounding the sessions. This is a time for you to get excited about science, clinical trials, and celebrate the success in our field. I always come away with more than when I first arrived and use this momentum to continue to progress in my career.

Attending scientific sessions is a time we get inspired, have renewed energy, and perhaps most importantly continue to grow professionally and personally. Hopefully gleaming from my experience will help enhance your own.