Should Doctors Be Role Models For Their Patients “Showing, Rather Than Just Telling”

Last year, the grand round speaker was a renowned physician in his field. He gave us an excellent presentation related to heart disease prevention and lipid management. However, the audience were surprised with the fact that the speaker was obese, at least 50 lb. overweight. I invoke this anecdote to buttress my argument that physicians need to be role models to inspire confidence in their patients. It is a fact that healthy physicians make better role models for patients. Whether doctors avoid smoking, eat right, exercise, or maintain a proper weight can influence how they talk with patients about making lifestyle choices.

As an interventional cardiology fellow, I advise the importance of maintaining a healthy lifestyle to my patients on daily basis. However, the majority of us fall guilty of neglecting what the American Heart Association recommends of 30 minutes aerobic activity five times a week. One of the biggest reasons for not maintaining a healthy life style is time! Long working hours, interrupted sleep, travel, deadlines, and lack of proper work/life balance, are all obstacles that prevent from leading a healthy lifestyle.

How can we maintain healthy lifestyle with limited hours in a day? We often set unrealistic goals (i.e. losing a certain number of pounds at the end of the year, increase muscle mass to 40%, decrease waist size by 4 inches in 6 months, etc.). Therefore, setting up short-term goals is measurable and more effective. Also, changing a few habits throughout the day can have a remarkable impact on your health and fitness. In general, doing little things on a regular basis is better than nothing.

At work, try to park at the farthest spot in the lot or parking garage to gain few extra steps, use the stairs instead of the escalator, avoid high-carbohydrate diet and snacks, and protein shakes for snack and between meals. The “power of 5-minutes;” if you are in the cath lab or clinic, try to take 5 minutes for lunges, burpees, squats, sit ups, or pushups in an empty patient room or locker room. Don’t leave work at rush hour! Instead, find a place in the hospital to do 30 minutes of exercises until traffic is better then leave to go home.

At home, try not to eat 3 hours before bedtime. Avoid high-carbohydrate snacks between dinner and bedtime. Try to avoid checking your phone or answering emails after 8 pm. Go to bed early, get up 30 minutes earlier than usual and do quick morning exercises. If you have a gym membership and you never had the time to go, early morning before work is the best time.

The majority, if not all, of the cardiologists go to meetings and conferences. I find a lot of downtime during conferences that can be used to exercise. Before starting your day, spend one hour in the gym. This can be done almost at the end of the day if you are not a morning person. Have protein bars, nuts in your bag so you can snack on during the day. Avoid muffins, cakes, and candies that are often served at the exhibit halls. We have seen multiple photos on social media tagged with the hashtag “#EscalatorShame” with escalators packed with cardiologist! Use the stairs not the escalators at the convention center.

Don’t expect immediate results! Do little things when you can, as much as you could, and I guarantee outstanding results. So next time we tell our patients to exercise or lose weight, we can reflect on our personal experience and give them the best advice.

 Chadi Alraies Headshot

M Chadi Alraies, MD is an interventional fellow and vice chair of Council on Clinical Cardiology Fellow-In-Training & Early Career Committee of American Heart Association.



The Potential Of Social Media For Cardiologists

Social media through its inherent quality of personal engagement has changed the way we follow current events, learn about new advances in cardiovascular advancements, and communicate within our personal and professional lives. Cardiologists are enthusiastic to embrace new advancements in medical devices, therapies and technologies, but as a whole they tend to be late adopters when it comes to progressive communication tools such as social media. While many cardiologists consider social media a distraction, others think it is a liability threat.

Every day, the social media networks put thousands of posts related to healthcare. In recent years, cardiologists started using social media to learn what is new in cardiology, educate others, discuss challenging cases, promote practice, and even interact with patients to answer questions. Leaders in the field of cardiology think of social media as extension of the doctor-patient relationship.

Why Cardiologist Should Be on Social Media?

Social media is the perfect vehicle for educators, clinicians, and researchers to communicate and stay connected with each other. Instead of waiting to discuss new research in-person with a handful of colleagues at a conference, social media permit virtual discussion with many professionals across the globe giving feedback instantly. When you look at the data, it shows that as a cardiologist, you can have a much broader impact on social media than you normally would by word of mouth. Several areas have been defined where online engagement proved to be a viable platform which includes;

  • Better interaction with colleagues
  • Better access to information, particularly specialized info
  • Wider access to medical and health information
  • Increased support for patients and from peers
  • Improved surveillance for public health issues
  • Increased possibility of influencing healthcare policies

It worth noticing that when social media is used correctly, there are many important ways that it can improve the medical field. Not only can you spread information faster and engage in a wider discussion with other cardiologist, but you may also be able to influence public opinion and help shape policies that affect the entire medical field. We have to always keep in mind that, elected officials are online just as much as anyone, meaning that they can be exposed to new studies and information that they would otherwise ignore.

Limitations of Social Media

Despite the advantage of being dynamic and accessible to public, social media has certain limitations in the medical field. In certain instances, it is hard to control the discussions with potential to deviate from the main objective of the post that was published. Different from peer-review process, users do not have to declare relevant conflicts of interest that could give wrong impression to public who are not expert in the field. Last and for most, the presence of researchers and clinicians on social media is low in comparison with other segments of the population. Thus, there is urgent need for experts available to review social media posts and give their expert unbiased opinion to help the general public make the right choice and get the right impression.

Whether we realize it or not, social media is going to change the way we learn new science, ask questions, advocate for practice or patients, discuss science and share medical onion. Social media is as powerful a tool as we make it. Using social media, we can engage in various interactions in a much easier way than ever before. This can not only help keep us up to date, but also has the potential to save lives.

Chadi Alraies Headshot
M Chadi Alraies, MD is an interventional fellow and vice chair of Council on Clinical Cardiology Fellow-In-Training & Early Career Committee of American Heart Association.


A Personal Take On The Interventional Trials At AHA Scientific Sessions

American Heart Association Scientific Sessions always been inclusive of all cardiology specialties. Despite this breadth of science, each subspecialty in cardiology get enough depth to improve patient’s outcome.

Trials of interventional nature had big presence at the Scientific Sessions 2017. The PRESERVE trial was one of the landmark studies presented at the sessions. The study was run by VA which show the Among patients undergoing coronary angiography with chronic kidney disease, a strategy of IV sodium bicarbonate or oral acetylcysteine yielded no additional benefit for the prevention of death, dialysis or persistent kidney impairment at 90 days. This study put to rest a long debate of IV sodium bicarbonate or oral acetylcysteine use for prevention of acute kidney injury showing no benefit in either strategy. Going forward, interventionalist should feel comfortable not to use either strategies which will decrease complexity of care and cost. This study prove that Veterans Affairs Health System is able to deliver an important study to answer critical and practice changing question.

COMPASS trial is another interventional-related study which has been published before and showed decreased cardiovascular events in patients randomized to ASA plus low dose atherosclerosis versus aspirin alone. in patients with stable atherosclerosis. At the Scientific Sessions, the cost analysis showed decreased cost with ASA plus low dose rivaroxaban compared with ASA alone driven by the lower ischemic events in both CAD and PAD patients, as well the decrease in number of procedures required (i.e. angiogram, intervention, amputations, etc.). However, since the actual cost of this dose of the drug is yet unknown, overall cost savings and cost-effectiveness analyses are unavailable at this time.

Moving along, another important study looking into the antithrombotic regimen for patients with indication for anticoagulation undergoing coronary intervention. The RE-DUAL PCI trial was already published, but what presented at the sessions is sub-group analysis that focused on patients with acute coronary syndrome (ACS) and non-ACS at index event. Majority of patients received clopidogrel, while 12% of the patients received ticagrelor either as part of dabigatran dual therapy or warfarin triple therapy. The dabigatran dual therapy regimen used dabigatran and a P2Y12 platelet antagonist, while warfarin triple therapy combined warfarin, aspirin and a P2Y12 platelet antagonist.  In the study, 83% of cases, DES was used, and were similar in patients with ACS and non-ACS. The study showed, that dabigatran with P2Y12 inhibitor is superior to triple antithrombotic strategy. More bleeding, obviously in the triple therapy group with no efficacy in terms of lower ischemic complications.

Another study that provided evidence for what we do in practice was the POISE-2 trials. The goal of the trial was to evaluate perioperative aspirin compared with placebo and perioperative clonidine compared with placebo among patients undergoing non-cardiac surgery. The POISE-2 trial showed that among unselected patients undergoing non-cardiac surgical procedures, neither the perioperative use of aspirin, nor clonidine, was beneficial in reducing the incidence of death or myocardial infarction. However, benefit was observed with aspirin among patients with prior stenting. This is consistent with what most cardiologists are practicing, where they recommend ASA continuation throughout the non-cardiac surgery for patients with previous PCI.

Different studies with different aims related to interventional cardiology presented at the sessions.  AHA Scientific Sessions continues to support all cardiovascular specialties bringing science to practicing cardiologist that answer practice-based clinical questions and, more importantly, saves lives.

Chadi Alraies Headshot
M Chadi Alraies, MD is an interventional fellow and vice chair of Council on Clinical Cardiology Fellow-In-Training & Early Career Committee of American Heart Association.