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Advice Given and Lessons Learned After My First Year as an Attending in the Cardiac ICU

One year ago, I started my journey as an attending pediatric cardiac intensivist.  People often say that you learn more in your first year as an attending than in your last year of fellowship, and I believe that is 100% true.  As I began this journey, I asked for advice from my previous mentors and compiled them into an article I published in the inaugural edition of the Pediatric Cardiac Intensive Care Society newsletter. Now, after surviving my first year and learning lots of lessons, I’m taking that article and adding some of my own observations/spin to the advice that I received. (My new editorial comments/additions/insights are in italics or bold italics).

“Wellness and self-care are critical. This is not an easy profession; it does not allow you to rest on your laurels when you’re actively caring for some of the sickest kids in the world and it’s not without its toll. Burning bright at 110% all the time will consume anyone, so practice self-compassion. ‘You are neither weak nor powerful. Bad things will happen. Try to blame yourself less.’ And take some time off for things that are really important to you. When you find yourself perseverating about a clinical situation or patient interaction that you wish could have gone differently, give yourself a time-out.  Don’t beat yourself up endlessly.  Take a minute to say ‘I cannot change the past; next time, I’ll react this way….’ and then sit down and force yourself to think about something else for a while: listen to music, sing a song, watch TV, read something for fun. 

In our field, we are both blessed and cursed to have lots of opinions about the work we do. Seek advice often, but when you’re making decisions, do what feels right for the patient. Definitely go with your gut; it’s almost never wrong.  By its nature, we are a team-based subspecialty, so always be respectful of your colleagues. We depend on each other and need to be kind and caring to one another.

‘Be flexible. Learn your new system before trying to make changes in it. Avoid saying “At my institution, we did it this way.” Although your past experiences are vital in helping you develop your style and way to do things, it is just as important to learn what works in your new system and then make changes that will be effective. Find several mentors. One person doesn’t have to fill all your mentoring needs. Ask questions frequently. I think I sat down with a senior colleague on an almost daily basis to rehash my decisions when I started.’ -Catherine Krawczeski, MD.  I definitely am still working on this. I ask for mentorship, but I really need to be more proactive in my mentor/mentee relationships.

Your presence on the unit as a trainee, no matter how experienced, is different when you become faculty. ‘Although you won’t always feel like it, you are the leader of the unit. As such, your reactions… are taken to heart more so than when you were a trainee… Share compliments liberally (but be genuine) and deliver critiques gently and with compassion. Teach as much as you can — everyone wants to learn and often those who are struggling crave it the most.’ Don’t take for granted the knowledge that you have.  Something that may seem second nature and completely basic to you might actually be a huge, mind-blowing revelation to someone else – we all learned what we know from someone else.

Pay close attention to your patients and give them what they need. Some patients will do well if you let them heal without tinkering, and some will not, despite everything that you do to help. However, there is a small subset of patients who really need your utmost attention, thoughtful consideration, and active, intensive doctoring; your job is to identify this group and do everything in your power to give them the best outcome possible. Again, go with your gut.  When something seems like it might need a closer look, then it probably DEFINITELY needs a closer look.

‘Under the best circumstances, it takes at least two years for any new cardiac intensivist to begin to feel competent with clinical decision-making on most of the patients admitted to the CICU. Thus, it’s not realistic to expect you will be on top of a unit full of active cardiac patients soon after completing fellowship. And even after many years of experience in cardiac intensive care, it’s important to recognize that you are not truly in control of the clinical path of all of your patients. It’s simply not a place to feel comfortable and relax your vigilance.’ -Stephen Roth, MD, MPH. Preach!!!

Finally, time is short, do not waste a minute, always show up, be visible, get involved and take chances. From a young faculty administrative perspective, don’t be afraid to say ‘no’ when asked to do things that will extend you beyond your limits as far as time, energy, or passion,  but don’t be afraid to say ‘yes’ to things that you think will be difficult just because you’re afraid of failing – these are opportunities for growth.  Growth is hard, but worth it.

And when things are going south, take it one step at a time. Step 1: Keep calm and check the pulse and look at the ETCO2.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Baby Steps in Heart Failure and Palliative Care

Any fellow or NP who has worked with me in the CVICU can tell you, I’m notoriously conservative when it comes to my treatment plans in infants and children recovering from acute on chronic heart failure.  After witnessing first-hand how fragile these patients can be throughout my training, and seeing all the sequelae of patients who were weaned too quickly, I have become very strict about how quickly I allow my team to de-escalate the critical care therapies in these children.  Of course, baby steps in moving patients forward need to be balanced with ICU length of stay, central venous access, and other drivers of patient outcomes/complications.  Honestly, I don’t think there’s a right or wrong answer, but I do think that the following scenarios are not uncommon:

  • “Let’s wean the dexmedetomidine every 8 hours so we can get off by tomorrow…”
    • Three days later, the patient is on an even higher dose, in addition to clonidine and milrinone, because he had an acute decompensation during withdrawal.
  • “Let’s increase the feed volumes to 160cc/kg/day because we’re only gaining 10g/day of weight…”
    • One week later, the patient has lost 300g because she’s been NPO for feeding intolerance.

Treating critically ill heart failure patients, even when they’re in recovery-mode, is an art.  It’s really hard to find the balance.  My experience thus far has pushed me to the conservative side of the spectrum in this patient population.

So, as I have come to accept the importance of baby steps in my clinical practice, recently I began asking myself: Why am I so hesitant to bring up palliative care in my patients with complex disease?  I sometimes feel like I’ve waited too long to broach the subject, despite knowing that perhaps meeting the palliative care team early and taking baby steps forward with setting goals and accessing resources would be beneficial for the families of many of our complex patients.  One of my friends and former co-fellows, Hayley Hancock, recently published this study, which showed the benefits of early palliative care consultation for families of patients with prenatally diagnosed single ventricle heart disease.  These families were introduced to palliative care, even before their children were born, yet there was still a benefit to the family, including less anxiety and better family relationship and communication scores.  I know that palliative care teams are often quite busy and may not have the resources to get involved with every single patient with complex heart disease, but I do see the value in introducing the concept early.  As palliative care resources become more available, I hope to be able to encourage baby steps in this important area with my complex patients earlier when it’s appropriate.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Post-Call Hypertension – Physician Health in High Stress Specialties

Should we be getting hazard pay for taking in-house call?  As awareness of physician wellness topics (most buzzworthy: #burnout) is growing, it’s important to realize that we, as physicians, are human and have all the requisite needs for health, wellness, rest, and routine as our patients do. 

A few weeks ago, I had a routine doctor’s appointment for myself, which I had scheduled on a post-call morning (when else do we have time to take care of ourselves?).  As she took my blood pressure and repeated it twice, the MA seemed flustered.  I’ve been quite healthy my whole life and had never had an issue with hypertension.  Of course, the new AHA hypertension guidelines do put me closer to the at-risk group, but I’ve still been well below the cutoffs and I’m (relatively) young.  My systolic during this visit was above 140.  Admittedly, I had just had a Venti coffee and a Monster energy drink in the waning hours of the call night, but this was very unusual for me. 

Of course, I had it rechecked when I wasn’t full of caffeine and low on sleep and the values were back in the normal range.  However, when I mentioned this encounter to some of my more experienced colleagues, they were not surprised.  Apparently, there is a silent epidemic of hypertension and diabetes plaguing otherwise healthy cardiac intensivists that begins in the early-mid-career range.  Colleagues and colleagues of colleagues have all been touched by this phenomenon, but I can’t find much of anything about how to address this in the literature. 

There are several recent studies linking shift work with hypertension.  And it makes sense that the chronic stress of frequently being in a hospital for 12-24 hours continuously with a phone/pager that could go off with a disaster or emergency at any second may begin to take its toll on your arteries in mid-life.  But there are not really any great solutions at this point.  We need to be around to take care of our patients.  In the era of increasing in-house attending physician coverage in cardiac ICU’s, this is only likely to get worse. 

The common sense bullet points seem to be the focus of many of the anti-burnout physician wellness programs: good nutrition, adequate/regular exercise, sleep/rest, resilience, and self-care behaviors.  However, I think another important aspect is prevention.  Any of us beginning our careers in these high-stress shift-work specialties should be proactive in reducing our cardiovascular risk as much as possible and as early as possible.  And we should be active participants in seeing our own physicians so they can screen for these issues; better patients are better doctors.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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It’s Finally Here: New AHA Statement On Resuscitation In Pediatric Patients With Heart Disease And Comments From The Author

Do you want to read something amazing, awesome, and interesting? The AHA recently published its latest Scientific Statement: Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

Cardiac arrest in the hospital is 10 times more common among children with congenital heart defects or other acquired heart conditions compared to children with healthy hearts, according to the statement published Monday in the journal Circulation.  As a pediatric cardiac intensivist, I often find myself overthinking things when I go for my PALS or ACLS recertification.  “Well, if the patient is having a pulmonary hypertensive crisis, then I’d actually do this also…” or “At this point, I would have already activated ECMO.” In all honesty, I don’t reach for my PALS card during a real-life resuscitation in the pediatric cardiac ICU anymore.  Not because I don’t follow the guidelines – I am the first to admit that high-quality CPR is the cornerstone of resuscitation and my team has these algorithms streamlined and burned into the backs of our minds – but because I have so many other things going through my head for this patient population.  (Does this baby have pacing wires? What vessels are patent? Is the shunt occluded? How will vasopressin affect this kid’s physiology? Has this chest tube been draining appropriately leading up to the arrest?)  None of these things are specifically addressed in the AHA resuscitation guidelines, until now. 

Bradley S. Marino, MD, MPP, MSCE, Professor of Pediatrics and Medical Social Sciences at the Northwestern University Feinberg School of Medicine and a Pediatric Cardiac Intensivist at Ann & Robert H. Lurie Children’s Hospital and Chair of the AHA Council on Cardiovascular Disease in the Young along with his expert colleagues on the AHA Congenital Cardiac Defects Committee have painstakingly taken the time to address the unique issues surrounding peri-resuscitation care and considerations for the high-risk pediatric cardiac population.  “The new statement is meant to be a powerful tool for health care professionals to both improve survival in children with heart disease who have a cardiac arrest and prevent cardiac arrests from ever happening in these high-risk children,” said Dr. Marino.  “This scientific statement is a critical supplement to the American Heart Association’s Pediatric Advanced Life Support Guidelines that has been long overdue,” Marino said.

I asked Dr. Marino what the most important thing was that the authors learned while putting together the statement. “Given the incidence of cardiac arrest in the pediatric cardiac population, activities to prevent cardiac arrest are very important.  We need to do more to modify our present clinical care systems to minimize the incidence of cardiac arrest.  In addition, we need to tailor our resuscitation strategies for children with cardiac disease. While the PALS recommendations are very helpful to resuscitate all children with cardiac arrest, more information was needed to address the special needs of the pediatric cardiac population.”

The statement reviews all of the stages of cardiopulmonary resuscitation (pre-arrest, during CPR, and post-resuscitation care) and the considerations for each stage of single-ventricle palliation, right- and left-sided heart disease, pulmonary hypertension, cardiomyopathies and myocarditis, and arrhythmias.  They also speak to considerations related to patient age, patient location, ECPR, and all of the various pharmacologic agents that we use frequently in these patients. 

As for Dr. Marino’s hopes for providers to take away after reading the statement, he says “Tailoring resuscitation is possible once providers understand the specific anatomy, physiology, and cardiopulmonary interaction that is present at each patient’s bedside.”

It’s definitely a long document to read through, but is a critical review for all providers who care for pediatric patients with heart disease, especially those of us in the ICU setting.  Click here to read it.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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What Exactly Does A Pediatric Cardiac Intensivist Do?

When someone asks me what I do, my answer is usually pretty short and vague.  “I’m a physician.” “I’m a pediatric cardiologist.” “I work in an ICU.”  This is frequently enough detail to move the conversation along to other topics and I rarely dwell on the nitty gritty of what I actually do at work. 

However, recently, I’ve noticed that when physicians, nurses, or other healthcare providers ask what I do, my vague response is seldom enough.  Many are very curious, but have no clue what the scope or responsibilities of my subspecialty actually are.  Someone even recently asked, “So, do you just follow the surgeons around all day and help them take care of their patients?” 

This lack of awareness is partially because it’s such a relatively young subspecialty, though it continues to grow rapidly.  It doesn’t fit what people think of when they envision other realms of perioperative care.  Many people are used to systems where patients are primarily cared for by their surgeons in the perioperative period.  There are also vast differences in the way that congenital heart centers are structured, which affects how adult cardiology care and pediatric cardiology care are delivered differently.  The complexity and varied physiologies of congenital heart surgery patients is also quite different from the adult cardiac surgical population.

Another reason is because there are so many different ways to become a pediatric cardiac intensivist.  Based on the history and development of our subspecialty, we have sprouted from the convergences of multiple different fields; cardiac intensivists can bloom from various taxonomies including pediatric cardiologists, pediatric intensivists, neonatologists, anesthesiologists, and surgeons.  The training pathways are varied, but our ultimate job description remains the same: to care for critically ill pediatric and adult congenital patients with heart disease. 

Of course, this is an oversimplification.  Because of the heterogeneity and newness of pediatric cardiac critical care, the scope of practice and care delivery models can be different from center to center.  In some centers, there isn’t a dedicated cardiac ICU and pediatric intensivists care for cardiac patients at the same time as they manage traumatic brain injury and liver transplant patients.  In others, cardiologists primarily manage these patients with occasional consultation from critical care.  In such a diverse specialty, it’s actually quite difficult to say definitively what exactly a pediatric cardiac intensivist does.

However, our field is currently in the stage of development where we are striving for more standardized and formalized training curricula and well-defined competencies.  With more regionalization of care and new dedicated cardiac intensive care units opening up with the expectation in many centers for 24/7 in-house attending coverage, we will need more young physicians to commit to undergoing the training required to become pediatric cardiac intensivists.  And it may be difficult to convince people to train for 7-8 years after medical school without firm agreement on the legitimacy and scope of the field.

Accordingly, I am currently working with a team on a mixed-methods study to define entrustable professional activities for our field (essentially, the core responsibilities expected of those who practice independently).  Hopefully, soon we will have a well-established and broadly accepted answer to the question, “what does a pediatric cardiac intensivist do?

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Paradigm Shifts In Resuscitation

We go through a series of paradigm shifts during our childhood and development: the moments that change our outlook on the world around us and how we influence it.

  • “There’s a whole world outside of my home!”
  • “People can be really cruel!”
  • “Sharing is caring.”
  • “Chicken pox are contagious!”

Similar shifts occur in our development as physicians. I remember very distinctly the moment that the pathophysiology of heart failure finally just “clicked” in my mind.

A similar shift occurred as I reviewed a recent AHA news brief on survival in out-of-hospital cardiac arrest. Unconsciously, I had developed a thought-process around out-of-hospital cardiac arrest that was very skewed.

  • As a child, I thought of CPR as some sort of strange voodoo magic that only lifeguards and doctors could perform. It always worked and brought people back to life immediately with nothing but a residual cough (as they spit out water and seaweed, usually).
  • Then, as I trained to become a BLS instructor during medical school, I realized that anyone could do CPR, but it didn’t always work. There was no magic about it – it was pure science.
  • Through my years in medical school, residency, cardiology fellowship, and critical care fellowship, I saw patients who never recovered, or who had profoundly poor outcomes despite survival and I began to think of out-of-hospital cardiac arrest as sort of hopeless. Of course, there was the occasional patient who walked out of the ICU, but I felt like most of the time, if CPR was done outside the hospital, it was not going to end well.

However, after reading about the profound increase in survival and improved functional outcomes after bystanders used AEDs for patients with out-of-hospital cardiac arrest, I suddenly have much more hope. I look back on my own experiences and realize that those patients who did well were the ones who had immediate bystander CPR /- the AED, depending on the etiology of arrest. I think my learned pessimism made it more difficult for me to recognize this connection. But, studies like this show that the evolution in resuscitation science, public health and safety culture, and education can make huge differences in our world. It makes me more hopeful for the future and more thoughtful about ways that I can influence the health and safety of those around me. I think I’m more hopeful now that even small efforts towards improved public health, not just around resuscitation, but anything that makes a positive impact, are worthwhile.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Getting Sponsored – When Mentorship Isn’t Enough (Part II)

Remember my disappointing story from Part I of this post? Well, I have an uplifting story from the same meeting.  A different colleague from a different training program came to the conference with a different group of mentors.  Every time I bumped into her at the meeting, she was being introduced to leaders in her field at a variety of institutions by her mentors/sponsors.  She left that meeting with many more contacts, opportunities, and potential future bosses than she had going in.  Now, she had not asked for her sponsors to recommend her to these people, nor had she even asked these mentors to be her “sponsors.”  She was a hard-worker who always delivered consistently on her projects, and those that mentored her felt proud to be recommending her to their colleagues, because they knew that she would be reliable and reflect positively on them.

Similarly, I’ve been very lucky to have been surrounded by mentors who were often very natural sponsors.  As I’ve grown in my career, they’ve stayed in touch and have been eager to recommend me for committees or projects that I would not have otherwise had the opportunity to become involved in.  But in thinking about many of my friends and colleagues who are not lucky enough to have these people in their lives, I wanted to put together a list of things that may improve one’s chances of getting sponsored:

  • EARN IT – Unlike mentors, who may be assigned to you or whom you can choose based on mutual interests and/or a similar research, sponsors are not assigned, and you cannot simply ask someone to be your sponsor – if you have a good mentor, and you show them loyalty and build your trust/credibility with them, they will likely want to be your sponsor.
  • DEPENDABILITY PAYS OFF – When you make yourself visible within your own organization by becoming involved in projects or workgroups and by reliably getting things done on time, people will start to notice and will want you to expand your involvement. This will naturally expand the pool of leaders that you can work with and impress.
  • DIVERSIFY – While you don’t want to spread yourself too thin, it’s important not to put all your eggs in one basket. If you spend all your energies impressing a single mentor or leader in your institution, and they are a terrible sponsor, or they leave, or something else happens, then you’re unlikely to have them as a sponsor despite all your efforts. Have at least a couple mentors that you work well with and work hard to build trust with them.
  • BE THE ONE THAT YOU WANT – Behave like the protégé that you will someday be proud to sponsor – chances are, someone will notice and will be proud to sponsor you
  • DO YOUR HOMEWORK – If you want to learn more, there’s tons of books and articles out there on this topic. Take the time to read up. This article from the Harvard Business Review by Sylvia Ann Hewlett is one example.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Getting Sponsored – When Mentorship Isn’t Enough (Part I)

I recently witnessed something profoundly disappointing.  A close friend and former colleague who was finishing training at an excellent institution attended a large national meeting, accompanied by no less than 3 personal mentors, with the eager hopes of being connected with potential future employers.  As with most graduating trainees, he was expecting his mentors to help offer meaningful networking opportunities to get his “foot in the door” for some of the very few academic positions available in his chosen subspecialty.  I watched him struggle for several days before going home with no new contacts, no new prospects, and no job interviews.  His mentors, despite helping him excel in research and helping him develop a work-product to present at a huge meeting, ultimately failed him at the meeting in question.  In that moment, I realized that not all mentors are good sponsors. 

Sponsorship is very different from mentorship, though sometimes a great mentor will naturally be an excellent sponsor as well.  Sponsorship has been more recognized in the business world over the last decade after a study published in the Harvard Business Review, “The Sponsor Effect” highlighted the role that sponsorship has in advancing careers.  Specifically, they showed that more than 2/3 of participants who had a sponsor reported satisfaction in their career advancement, while greater than 2/3 of participants who did not have a sponsor resisted advocating for a raise for themselves.  The study also showed that sponsors can confer a 22-30% statistical career benefit.  However, sponsorship is only recently becoming more and more recognized as a key factor in advancing careers in academic medicine as well. 

What is a sponsor?  I think the following graphic from Stanford University does the best job of explaining the difference between a mentor and a sponsor

 

I think the bottom line is that sponsors are personally and professionally tied to the success of their protégé’s and make it a point to ensure that their protégé’s are connected to the people that will help them achieve their career goals and advance to bigger and better things.  Yes, traditionally, in the business world, this would be primarily within their own organization.  However, in the world of academic medicine, where so much of our career trajectories and growth opportunities (and promotions) are dependent on how we’re seen by people outside of our current institution, either at other programs, or within national societies/committees, I think a major part of sponsorship in academic medicine is active networking.

As I reflect on my own mentoring relationships, I see in hindsight the difference between my mentors and my sponsors.  While much of my personal and professional development is attributable to the advice and guidance of my mentors, I can now see that most of my current career, administrative, research, and educational opportunities have been directly because of my sponsors (even though I didn’t know it at the time).  I was extremely lucky to have these individuals take a vested interest in my personal success, without me ever asking.  But for those of us who are not lucky enough to have sponsors fortuitously arrive in our lives, there are a few ways to increase the chance of getting a good sponsor…  Stay tuned for Part II.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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New Hypertension Guidelines: Should They Inform The Way We Care For Pediatric Cardiology Patients?

In reflecting on my time at the 2017 AHA Scientific Sessions, I can summarize my thought process about the new AHA Hypertension Guidelines as a complete 180.  When I first heard about the guidelines, my inner monologue went something like this:

“I don’t need to pay attention to these guidelines – they don’t affect me or my patients.  We already have separate pediatric guidelines.  Wasn’t there a new set of guidelines this year?  Maybe I should look at them a little closer…”

After reviewing the 2017 pediatric hypertension guidelines, I was pleasantly surprised how well they align with the AHA adult guidelines.  Of course, the pediatric guidelines are a little more complicated, since all of our patients have different cutoffs based on age, gender, and height.  And the cutoffs are now lower, due to the exclusion of overweight/obese children in the normative data.  But once our patients become adolescents, the cutoffs are the same as the new AHA adult guidelines.
After hearing that now nearly half of all U.S. adults will meet the diagnostic criteria for hypertension under the new guidelines, I realized: “OMG! Almost all of my patients are going to turn 13 and be hypertensive!”

Of course, as pediatric cardiologists, our patients are at especially high risk of cardiac events in adulthood, and the adult congenital heart disease population continues to grow every day, so we should be even more aware of hypertension as a significant risk factor for these children.  As Bradley Marino, MD (Chair of the Council on Cardiovascular Disease in the Young) stated during the CVDY Council Dinner, in light of current changes in the hypertension guidelines and national trends in increasing rates of obesity and heart disease-related morbidity, our role as pediatricians and cardiologists in prevention is becoming more and more important.

By the end of Scientific Sessions and in the weeks thereafter, I have become more cognizant and appreciative of my role in preventing my own patients from becoming hypertensive.  Of course, my ability to encourage lifestyle changes and long-term nutritional improvements is quite limited in the CVICU, but I am much more appreciative of my colleagues in the outpatient world and those who specialize in preventative pediatric cardiology.  I have also made a few lifestyle changes myself, since I am now uncomfortably close to meeting hypertension criteria.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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The Pediatric Side Of AHA17: Advice And Lessons-Learned From The Council On Cardiovascular Disease In The Young (CVDY) Early Career Networking Luncheon

At large meetings like the AHA Scientific Sessions, the pediatric presence is usually smaller and less ubiquitous than our adult counterparts.  For trainees and junior faculty, it can be intimidating to navigate for the first time, but the CVDY Early Career Networking Luncheon is a great way to ease into it.  Not only do you get ample opportunities to meet leaders in our field, but they are open, accessible, and eager to give out free advice. 

There were faculty represented from almost every sub-discipline within pediatric cardiology (cath, echo, ICU, transplant, etc), and also representing nearly every type of career niche (division chiefs, program directors, researchers, clinicians, educators, etc).  We were able to sit in small groups and have round-table discussions about assorted topics.

Here are a few (paraphrased) nuggets I picked up from the round-tables:

  1. Dr. Peter Lang on Finding What You Love: No matter what you think you want to do within pediatric cardiology, you never know where you’re going to end up…you may love more than one thing…keep an open mind… it’s not completely crazy to change what you’re doing.
  2. Dr. Katie Bates on Finding Your First Job: You shouldn’t expect perfection – this probably won’t be the last job you ever have.It’s unreasonable to expect your perfect job in the perfect location, but it does seem to work out most of the time. As far as waiting to hear back from programs, you should not freak out if you don’t get immediate feedback. There is a big priority gap between you as the applicant and the program that’s potentially hiring you, and a great deal of things are going on behind-the-scenes, so it’s a slow process to get an offer. Once you have an offer, have mentors help you out, and consider reading a book about negotiation. Her suggestion is Getting To Yes by Roger Fisher and William Ury.
  3. Dr. Daniel Penny on Work-Life Balance: Finding interesting or exciting things to occupy your time outside of work will actually enhance your ability to do more productive work rather than detracting from it. Mindfulness can be very helpful, but it’s also important to find a hobby that you love and devote some time to it.

After the round-tables, we were able to hear take-home points from around the room.   Here’s just a small selection:

  1. There’s never a good time to have kids – just do it
  2. Be adaptable in your first job, but don’t say yes to things that you aren’t going to be able to honestly put your best efforts towards
  3. Find a mentor early and it’s ok to have more than one
  4. You can’t always control circumstances at your new job, as things can change, but you can leverage some challenges into opportunities for growth
  5. Make clear priorities – make time for things that are important (including schedule requests for things like spouse birthdays well ahead of time, etc.)

And finally, here are a few tips regarding involvement in AHA and time spent at Scientific Sessions:

  1. AHA and CVDY are full of opportunities for interested people; you just have to seek them out
  2. You can get involved in committees and find collaborators even very early in your career
  3. Don’t be afraid to introduce yourself – people are here to meet their colleagues and exchange ideas
  4. Everyone you meet is potentially a future colleague, friend, mentor, or boss
  5. Getting involved with the AHA has great potential to shape your career and long-term engagement in CVDY can be extremely rewarding

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.