Megan Kamath, MD – The Early Career Voice

Letting Go

March 20, 2018 Megan Kamath, MD

Recently, I was reminded of one of my unique roles as an advanced heart failure cardiologist.

As a physician in such a highly specialized field, I often have the opportunity to offer patients life-saving measures that can only be performed at highly trained qualified quaternary medical centers. This may span the gamut from a wireless hemodynamic monitor placed in the pulmonary artery to a temporary or durable ventricular assist device to an organ transplant.

I often think of the times that I have been able to be the first person to share with my patient and their family that we have finally found a suitable donor organ for them. The initial joy and sheer euphoria followed by the nervous anticipation for the next step of the journey that began often several years prior. I remember the tight hug of the patient’s wife, the embrace from a usually stoic patient, the high five from the patient who loves sports analyses. Burned into my memory, each of these patient’s experiences have been a beautiful addition to my own formation as a physician, clinician, and truly, as a human being.

Frequently, however, are times where I have to traverse a path of palliation with patient and families. In this role, I help to guide families through quite literally the worst times of their lives.

While we have the invaluable assistance of specially trained palliative care and hospice providers, I have also found in my experience that patients’ families truly value the input and guidance from our heart failure team whom they have often had continuity with spanning both inpatient and outpatient care. I have witnessed tears and raw emotion from the healthcare teams who have invested so much of themselves in the care of the patient and are connected like family.

The depths of these emotions however, the unparalleled highs tempered by the valleys of sadness, have molded me; sometimes shaken me to my core. Along my own journey forward I carry with me the stories and teachings of those who we have helped survive and those who we have helped to die with dignity. It is in these times, where the lines between medicine and humanity are blurred, that I am reminded of my sacred privilege of being a physician.

Megan Kamath is a Fellow in Advanced Heart Failure and Transplant Cardiology at the University of California, Los Angeles. Her research interests include outcomes in advanced heart failure, decision making and relational medicine, and utilizing technology in healthcare. She is now tweeting @MeganKamath, so follow her on there!

Ride The Wave… Of Motivation

December 21, 2017 Megan Kamath, MD

At the conclusion of every conference I attend, I’m reminded of the need to keep the momentum and energy of the experience alive after the journey home. This year’s Scientific Sessions was no exception. I got to expand my knowledge base, connect with other fellow attendees and presenters, and learn new guidelines to take back home.

How do we keep the motivation alive to ensure conference success?

Without further ado, I will share my “Top Tips for Conference Success.” Many of these tips and tidbits are pieces of advice I’ve collected by attending sessions over the years. Give one (or more) of these a try at your next meeting (or suggest some of your own) and let me know what you think in the comments!

Turn the abstract into a manuscript while you are on the plane home

You know that poster that you created? The one that you spent 45 minutes standing next to during the conference? Start the manuscript while you are traveling home; the material is fresh in your mind.

Bring the learning back to your community… Pay it forward

Plan an educational session or a recap of the material covered for your own peers or organizations

Be inspired by what you have seen and come up with new ideas for future research

Innovate, innovate, innovate! Maybe you envision a collaboration! Go after it!

Follow up with the contacts you have made during the conference

Emails, LinkedIn, Twitter, regular phone calls, snail mail! Remember your business card if you meet in person!

Create action items for yourself when organizing your notes

Next steps, meeting details, follow up plans are important to keep in mind!

Takeaway points

Write down a few key points from each session

Pick the right sessions and plan your schedule in advance

Map out a tentative schedule of the highlights, and be sure to find time for the social events too! Don’t worry if you cannot make it to everything, it can be overwhelming, but having a plan certainly helps!

With these tips and tricks for success, you can maximize success for the conference and beyond!

Megan Kamath is a Fellow in Advanced Heart Failure and Transplant Cardiology at the University of California, Los Angeles. Her research interests include outcomes and decision making in advanced heart failure and utilizing technology in healthcare. She is now tweeting @MeganKamath, so follow her on there!

Hemodynamics Live: Lights, Cameras, Action!

November 17, 2017 Megan Kamath, MD

If a picture is worth a thousand words, then what does that make a live simulation worth? A million? I’d argue that the experience of seeing hemodynamics come to life was pretty much magical!

We’ve all had those times when we are struggling to understand the patient’s physiology.
The University of Arizona TAH/VAD simulator shared at Sessions by Drs. Jen Cook and Sophia Airhart, is a true #gamechanger when it comes to using simulation for medical education.

With the help of the dynamic duo VAD engineer team of Rich Smith and Eddie Betterton,
we were able to recreate scenarios to illustrate first-hand the effects of certain interventions on the patient.

During the LVAD session, we were able to use a scenario of the patient who had significantly elevated left sided pressures and right sided pressures as a technique for discussion on different ways to optimize LVAD patients: through unloading of the left ventricle by increasing the LVAD speed, while keeping in mind that pulmonary hypertension also needs to be treated. With a little movie magic (simple adjustments of the vials of water mounted on the buret stand) we could watch the PVR drop in response to vasodilator therapy.

Another unique aspect of the simulation was the group of panelists which had been carefully selected for each session. Each of these members were truly experts in the field and provoked thoughtful discussion among all attendees.

For the pulmonary hypertension simulation, we were treated to some great pearls to keep in mind when thinking about this unique population.

hemodynamics graphics

I think the beauty of the simulator lies in its ability to create virtually any hemodynamic situation AND display the waveforms in real time. Personally, I believe that this is a vital tool and should be a standard component of every cardiology fellow’s educational armamentarium. Studies have shown that employing multiple teaching methods enhances student learning.

So I Want To Be A #cardiopreneur

November 15, 2017 Megan Kamath, MD

As many of you may know, I recently joined twitter and am enjoying the challenge of learning a new (to me) social media tool. I must say, however, that I am always forgetting the hashtags on my tweets. So, I decided that there is no better way to remind myself than to make my own hashtag. Hence, the term #cardiopreneur. More on this to come, I promise. It will all connect in the end… keep reading on.

Today, as an attendee and blogger at the HealthTech Summit, I couldn’t help but feel like I was witnessing the birth of a new era with the intertwining of technology and healthcare. In the past, there has been ambivalence among members of the medical community with respect to embracing a role for technology. Perhaps this may have been related to fear of the unknown or thought that care may be less personalized with implementation of technology.

Some of the difficulties behind incorporating technology into healthcare have surrounded the standard practice in entrepreneurship thus far: 1. Come up with an idea for a device 2. Figure out how people can use said device. In healthcare, we need to employ end-user development in conjunction with our engineers and entrepreneurs to recognize the patient needs which are of utmost importance and then develop a device to meet this need.

When we connect systems of health record with systems of intelligence, engagement and networks for collaboration and work flow we will we be able to create change that will be accurate, precise, and scalable to a larger population. In the words of Dr. Jessica Mega, Chief Medical Officer at Verily Life Sciences, “Unless we understand how to apply artificial intelligence and automation, we will end up down the wrong road.” Our technology is only as good as the human who designs it and understands it. How do we create an infrastructure to support new disease insights through use of machine learning and artificial intelligence? Collaboration, organization, and action!

How do we best utilize a deep learning model that is both adaptable and good for complex, nonlinear data? Research presented by Dr. Rima Arnaout from UCSF showed that a deep learning model can be trained to classify among 15 standard transthoracic echo views, with the model taking just 21 milliseconds to classify each image. The model had a 91.7% accuracy on images compared with board certified echocardiographers who had 70.1-84% accuracy. Including video instead of still frames increased the accuracy of the model to 97.8%. Combining human ingenuity and understanding with machine learning and artificial intelligence will allow us to create rapid fire innovation to better serve the needs of our patients.

I had the chance to speak with David He, also of Verily Life Sciences, who demonstrated the Verily Study Watch with multiple physiological and environmental sensors about adaptation of these devices to my patients with adult congenital heart disease, left ventricular assist devices, and transplants. There is a need for creation of novel wearables for use in these most vulnerable patients. They stand to benefit the most from these types of innovations, underscoring the need for cardiologists as myself to keep this momentum moving.

So, back to #cardiopreneur… what does it mean? It’s a novel term (yes, I made it up… innovation starts small!), to reference cardiologists like me who are committed to innovation, entrepreneurship, and collaboration to advance healthcare technology in a way that has never been seen before. So, join me in starting the #cardiopreneur movement and embracing change… our patients will thank us for it!

AHA DAY 2: Strengthening The Sisterhood

November 13, 2017 Megan Kamath, MD

Another exhilarating day in sunny Anaheim is over!

Today, I was asked a powerful question, “What is one thing in cardiology that you want to change?” My first thought? I’d like to increase the number of women choosing cardiology as a specialty. I can’t help but think of the brilliant minds that we may be losing out on… the ones who may one day develop the next big clinical trials, the ones who will surely embrace technology and AI implementation in medicine. The ones who will challenge the status quo and become the leaders of the future.

So where do we start? Our approach today was simple, bringing together current women in cardiology, starting from Fellows in Training to Early Career Members to Legends in the field.
It was amazing to hear the diverse stories and backgrounds of everyone who came, unifying our bond as cardiology sisters.

Drs. Minnow Walsh and Malissa Wood gave us advice on actively seeking out leadership roles within our local, regional and national communities. Drs. Sharonne Hayes and Rekha Mankad aptly pointed out that when we all work together and lift each other up, we are at our strongest, while Drs. Laxmi Mehta and Dipti Itchhaporia, noted the importance of taking advantage of resources that are made available. What a treasure trove of pearls!

Dr. Annabelle Volgman even highlighted the networking power of social media, which helped inspire me to join Twitter! Find me now @MeganKamath—- can I reach 1,000 followers before the end of the meeting? Help me get there! #Ilooklikeacardiologist #cardiotwitter #blogger

A personal highlight for me was connecting with some of the people who have helped me in various ways throughout my own cardiology journey: Dr. Elisa Bradley who, during her congenital fellowship, helped me prepare for my own cardiology fellowship interviews; Dr. Nkechi Ijioma who helped connect me with the cardiology blogosphere; and Dr. Sophia Airhart whose advice has been invaluable as I have navigated the transition to advanced heart failure and transplant.

I left our session not only with an expanded reading list to tackle and new social media experimentation to try, but also with my energy once again renewed in the possibility that the women of today can recruit more bright women to continue the field tomorrow.

“She will rise. With a spine of steel and a roar like thunder, she will rise.” – Nicole Lyons

Day 1 Scientific Sessions: Creating Connections And Inspiring Innovation

November 12, 2017 Megan Kamath, MD

Walking down the halls of the Anaheim Convention Center, excitement is in the air. There is anticipation of knowledge to be shared and inspiration for research to be presented. The sense of camaraderie and being a part of a cardiology community committed to advancing clinical, basic, and translational research to benefit patients both now and in the future is pervasive.

Despite its global reach, the atmosphere at AHA makes you feel like you are part of a large family: uniting old colleagues and mentors and forming new relationships that carry well into the future. This was particularly apparent at the Early Career Luncheon with Legends, where current pioneers and trailblazers in both the clinical and research realms mingled with their future counterparts while breaking bread. Simply sitting in the presence of these amazing clinicians and being able to learn about their journey to their present position was invigorating and certainly inspired me to be able to pay it forward like this one day in the future. The willingness of today’s legends to participate speaks volumes about the importance of mentorship and the value that is placed on education for trainees.

While the first part of my day was focused on building connections and gaining advice for building and launching my career, the second part of the day was spent learning about innovative trends and incorporating technology in medicine. The last few years have seen an explosion of healthcare technology innovation ranging from wearable sensors to application development to utilizing smartphones to engage patients in data collections. Though still in its infancy, it became clear to me while listening to these presentations that it is not a matter of if technology and AI will be incorporated into my future practice, but simply how and when it will occur.

I was particularly intrigued to hear about utilization of Fitbit technology to count steps and help better define the progression of neuromuscular disease such as Multiple Sclerosis. At present, there are many pitfalls and obstacles to incorporating this technology into clinical practice (patchy data, no validation of accuracy); I can envision a collaborative system in which clinicians can gain real time data about a larger cohort of patients when fully implemented.

I came out of this session inspired to learn more about advancing technology in advanced heart failure which I think will be of utmost importance in our LVAD population. How will technology affect our sickest most vulnerable patients? How can we use technology to forecast advances and obstacles? How can we become more innovative in our day to day practice to create change on a single patient level or a population level?

With day one down, I am eagerly looking forward to continue being inspired over the next few days.