Dr. Alexander G. Truesdell is an interventional cardiologist and cardiac intensive care unit attending at Virginia Heart and the Inova Schar Heart and Vascular Institute in Northern Virginia. He specializes in complex coronary interventions, coronary chronic total occlusions, mechanical circulatory support, cardiac critical care, and cardiogenic shock. He is also widely published on a variety of cardiovascular topics and is a regular speaker at national and international scientific conferences. An Army combat veteran, he has also served in Infantry, Intelligence, and Special Operations units across the United States, Europe, the Balkans, Iraq, and Afghanistan.
Looking back to when you first completed your medical training, is there a specific clinical area you wish you had received more exposure to? Alternatively, for fellows and younger physicians you work with now, is there a topic you believe deserves more emphasis?
Great question. My perspective might be a bit different, so let me provide some background first. I always like to joke that I took the long way around the barn in training. I spent a decade in the army, which interrupted my training multiple times. I'd begin training, deploy, return, deploy again, then return to training. Medicine evolved a lot during that time, and I changed specialties multiple times, from general surgery to internal medicine. I also considered critical care, but ultimately landed in cardiology and interventional cardiology.
Looking back, picking a single niche skill wouldn’t have been good for me. I received a strong foundation—and I’m thankful to my training programs for teaching me critical thinking skills during my residency and fellowship. For fellows, I would say a good foundation prepares you for anything. After all, if you’re not adapting at least 50% of what you do every five years, you'll lag behind.
That's how I encourage trainees to think about their training. In hindsight, I wish I had more training in CT coronary angiography, but again, the field has evolved so much that focusing on that specifically wouldn't have been as beneficial back then.
There are foundational principles within each niche, but learning how to learn, developing an appetite for lifelong learning, critical thinking, getting patient care experience, and just being a hands-on doctor will carry anyone through whatever comes in the future.
You're published extensively in the interventional cardiology field, especially on high-risk PCI. What advice would you give younger physicians on how to get started?
While some physicians have dedicated research backgrounds, for the vast majority, I'd say to ask yourself, ‘What am I interested in?’. Do you have a specific question you'd like to answer? For example, almost none of my research involves basic science. Most of it was just quality assurance and quality improvement.
The key is to ask yourself, "How can I improve patient care?" Find colleagues, both within and outside your specialty, who share your interests. For instance, the research I'm likely best known for – on cardiogenic shock – began purely as a quality improvement initiative. Similarly, the Detroit and National Cardiogenic Shock Initiatives, which I was fortunate to be a part of, were the same.
So, I would say find what interests you, identify a question, and find collaborators. It will happen quite naturally. Most people would be pleasantly surprised to learn how effective this approach can be.
Given that there are various ways to treat calcific plaque, each with its own pros and cons, and every patient is different, do you have a default algorithm that you typically use when you see calcium in a coronary artery?
The absolute priority, and I cannot emphasize this enough, is intracoronary imaging. This informs all subsequent decisions. Once imaging is complete, the next questions in my mind are device selection and is the lesion wire-crossable or balloon-crossable?
When you consider the devices out there – laser, intravascular lithotripsy (IVL), rotational atherectomy, or orbital atherectomy – I think IVL has been a game-changer. However, its effectiveness hinges on proper device selection guided by intracoronary imaging.
There are nuances we don't fully understand about which device to use. But to me, if you can't get a wire across or a balloon across, you're probably looking at rotational atherectomy, orbital atherectomy, or laser. If you can get those devices across, then IVL is super user-friendly and super effective.
There’s value in getting used to various devices. Sometimes I intentionally mix things up, to build experience and comfort. You don’t want to pick a device just because it’s the one you’re comfortable with. This takes intentional effort and thought.
I first heard the term "purposeful practice" from Dr. Bill Lombardi. I know he didn’t invent the term, but the idea of practicing purposefully so that you’re ready when the time comes definitely spoke to me - and aligned with my prior military experiences.
Overall, if you can get an IVL balloon down, it’s been such a game-changer. Everyone knows how to use a wire and balloon, and everyone’s comfortable with them. And using guide extension catheters for delivery probably makes IVL even more accessible. But it all starts with the foundation of intracoronary imaging.
Let’s move on to more business-oriented questions. Based on your own experience, whether during your training, your time in the Army, or with the fellows and residents you work with now, are there business topics you wish you had a better understanding of or that you think younger physicians should be more knowledgeable about?
In all honesty, I might not be the best person for business advice – I still have a lot to learn. However, I believe the cliche "do the right thing, and it'll all work out" holds some truth. Also, knowing myself, I have more hard skills than soft skills, and I have to be aware of that so I can temper my strengths and use the appropriate ones in the right situations.
From a patient care and patient safety standpoint, I've pushed hard and aggressively for things I believe in. But I've also thought about who can help me get those things across the finish line because that's reality.
In other words, I think about money as a reality. If I'm proposing a new program that helps people, it can't just be throwing money away. While I don't have a ton of expertise in this area, I've tried to be aware of it and think about who can partner with me to help. Finding the right people to push ideas ahead has been crucial because I'm pretty good with ideas and knowing what's right, but I can’t do it without the right advocates.
One financial aspect that concerns me – though I don't have a solution – is that when I hear a lot of finance discussions, particularly about new products from hospitals and administration, they focus on the immediate cost. What if improved outcomes lead to long-term cost reductions over years or even decades? We need to consider the entire patient journey and treatment lifespan. While some interventions might seem expensive initially, I don't necessarily believe that's the case. However, I lack the expertise to definitively prove it.
For example, there’s interesting accumulating data from places like Australia and the UK showing that intracoronary imaging, is a money-saver over the lifetime of a patient in a socialized health system, even if it's a cost upfront. This is a good example of how even the experts might not have all the answers yet.
Dr. Alexander G. Truesdell is an interventional cardiologist and cardiac intensive care unit attending at Virginia Heart and the Inova Schar Heart and Vascular Institute in Northern Virginia. He specializes in complex coronary interventions, coronary chronic total occlusions, mechanical circulatory support, cardiac critical care, and cardiogenic shock. He is also widely published on a variety of cardiovascular topics and is a regular speaker at national and international scientific conferences. An Army combat veteran, he has also served in Infantry, Intelligence, and Special Operations units across the United States, Europe, the Balkans, Iraq, and Afghanistan.
Looking back to when you first completed your medical training, is there a specific clinical area you wish you had received more exposure to? Alternatively, for fellows and younger physicians you work with now, is there a topic you believe deserves more emphasis?
Great question. My perspective might be a bit different, so let me provide some background first. I always like to joke that I took the long way around the barn in training. I spent a decade in the army, which interrupted my training multiple times. I'd begin training, deploy, return, deploy again, then return to training. Medicine evolved a lot during that time, and I changed specialties multiple times, from general surgery to internal medicine. I also considered critical care, but ultimately landed in cardiology and interventional cardiology.
Looking back, picking a single niche skill wouldn’t have been good for me. I received a strong foundation—and I’m thankful to my training programs for teaching me critical thinking skills during my residency and fellowship. For fellows, I would say a good foundation prepares you for anything. After all, if you’re not adapting at least 50% of what you do every five years, you'll lag behind.
That's how I encourage trainees to think about their training. In hindsight, I wish I had more training in CT coronary angiography, but again, the field has evolved so much that focusing on that specifically wouldn't have been as beneficial back then.
There are foundational principles within each niche, but learning how to learn, developing an appetite for lifelong learning, critical thinking, getting patient care experience, and just being a hands-on doctor will carry anyone through whatever comes in the future.
You're published extensively in the interventional cardiology field, especially on high-risk PCI. What advice would you give younger physicians on how to get started?
While some physicians have dedicated research backgrounds, for the vast majority, I'd say to ask yourself, ‘What am I interested in?’. Do you have a specific question you'd like to answer? For example, almost none of my research involves basic science. Most of it was just quality assurance and quality improvement.
The key is to ask yourself, "How can I improve patient care?" Find colleagues, both within and outside your specialty, who share your interests. For instance, the research I'm likely best known for – on cardiogenic shock – began purely as a quality improvement initiative. Similarly, the Detroit and National Cardiogenic Shock Initiatives, which I was fortunate to be a part of, were the same.
So, I would say find what interests you, identify a question, and find collaborators. It will happen quite naturally. Most people would be pleasantly surprised to learn how effective this approach can be.
Given that there are various ways to treat calcific plaque, each with its own pros and cons, and every patient is different, do you have a default algorithm that you typically use when you see calcium in a coronary artery?
The absolute priority, and I cannot emphasize this enough, is intracoronary imaging. This informs all subsequent decisions. Once imaging is complete, the next questions in my mind are device selection and is the lesion wire-crossable or balloon-crossable?
When you consider the devices out there – laser, intravascular lithotripsy (IVL), rotational atherectomy, or orbital atherectomy – I think IVL has been a game-changer. However, its effectiveness hinges on proper device selection guided by intracoronary imaging.
There are nuances we don't fully understand about which device to use. But to me, if you can't get a wire across or a balloon across, you're probably looking at rotational atherectomy, orbital atherectomy, or laser. If you can get those devices across, then IVL is super user-friendly and super effective.
There’s value in getting used to various devices. Sometimes I intentionally mix things up, to build experience and comfort. You don’t want to pick a device just because it’s the one you’re comfortable with. This takes intentional effort and thought.
I first heard the term "purposeful practice" from Dr. Bill Lombardi. I know he didn’t invent the term, but the idea of practicing purposefully so that you’re ready when the time comes definitely spoke to me - and aligned with my prior military experiences.
Overall, if you can get an IVL balloon down, it’s been such a game-changer. Everyone knows how to use a wire and balloon, and everyone’s comfortable with them. And using guide extension catheters for delivery probably makes IVL even more accessible. But it all starts with the foundation of intracoronary imaging.
Let’s move on to more business-oriented questions. Based on your own experience, whether during your training, your time in the Army, or with the fellows and residents you work with now, are there business topics you wish you had a better understanding of or that you think younger physicians should be more knowledgeable about?
In all honesty, I might not be the best person for business advice – I still have a lot to learn. However, I believe the cliche "do the right thing, and it'll all work out" holds some truth. Also, knowing myself, I have more hard skills than soft skills, and I have to be aware of that so I can temper my strengths and use the appropriate ones in the right situations.
From a patient care and patient safety standpoint, I've pushed hard and aggressively for things I believe in. But I've also thought about who can help me get those things across the finish line because that's reality.
In other words, I think about money as a reality. If I'm proposing a new program that helps people, it can't just be throwing money away. While I don't have a ton of expertise in this area, I've tried to be aware of it and think about who can partner with me to help. Finding the right people to push ideas ahead has been crucial because I'm pretty good with ideas and knowing what's right, but I can’t do it without the right advocates.
One financial aspect that concerns me – though I don't have a solution – is that when I hear a lot of finance discussions, particularly about new products from hospitals and administration, they focus on the immediate cost. What if improved outcomes lead to long-term cost reductions over years or even decades? We need to consider the entire patient journey and treatment lifespan. While some interventions might seem expensive initially, I don't necessarily believe that's the case. However, I lack the expertise to definitively prove it.
For example, there’s interesting accumulating data from places like Australia and the UK showing that intracoronary imaging, is a money-saver over the lifetime of a patient in a socialized health system, even if it's a cost upfront. This is a good example of how even the experts might not have all the answers yet.
Dr. Alexander G. Truesdell is an interventional cardiologist and cardiac intensive care unit attending at Virginia Heart and the Inova Schar Heart and Vascular Institute in Northern Virginia. He specializes in complex coronary interventions, coronary chronic total occlusions, mechanical circulatory support, cardiac critical care, and cardiogenic shock. He is also widely published on a variety of cardiovascular topics and is a regular speaker at national and international scientific conferences. An Army combat veteran, he has also served in Infantry, Intelligence, and Special Operations units across the United States, Europe, the Balkans, Iraq, and Afghanistan.
Looking back to when you first completed your medical training, is there a specific clinical area you wish you had received more exposure to? Alternatively, for fellows and younger physicians you work with now, is there a topic you believe deserves more emphasis?
Great question. My perspective might be a bit different, so let me provide some background first. I always like to joke that I took the long way around the barn in training. I spent a decade in the army, which interrupted my training multiple times. I'd begin training, deploy, return, deploy again, then return to training. Medicine evolved a lot during that time, and I changed specialties multiple times, from general surgery to internal medicine. I also considered critical care, but ultimately landed in cardiology and interventional cardiology.
Looking back, picking a single niche skill wouldn’t have been good for me. I received a strong foundation—and I’m thankful to my training programs for teaching me critical thinking skills during my residency and fellowship. For fellows, I would say a good foundation prepares you for anything. After all, if you’re not adapting at least 50% of what you do every five years, you'll lag behind.
That's how I encourage trainees to think about their training. In hindsight, I wish I had more training in CT coronary angiography, but again, the field has evolved so much that focusing on that specifically wouldn't have been as beneficial back then.
There are foundational principles within each niche, but learning how to learn, developing an appetite for lifelong learning, critical thinking, getting patient care experience, and just being a hands-on doctor will carry anyone through whatever comes in the future.
You're published extensively in the interventional cardiology field, especially on high-risk PCI. What advice would you give younger physicians on how to get started?
While some physicians have dedicated research backgrounds, for the vast majority, I'd say to ask yourself, ‘What am I interested in?’. Do you have a specific question you'd like to answer? For example, almost none of my research involves basic science. Most of it was just quality assurance and quality improvement.
The key is to ask yourself, "How can I improve patient care?" Find colleagues, both within and outside your specialty, who share your interests. For instance, the research I'm likely best known for – on cardiogenic shock – began purely as a quality improvement initiative. Similarly, the Detroit and National Cardiogenic Shock Initiatives, which I was fortunate to be a part of, were the same.
So, I would say find what interests you, identify a question, and find collaborators. It will happen quite naturally. Most people would be pleasantly surprised to learn how effective this approach can be.
Given that there are various ways to treat calcific plaque, each with its own pros and cons, and every patient is different, do you have a default algorithm that you typically use when you see calcium in a coronary artery?
The absolute priority, and I cannot emphasize this enough, is intracoronary imaging. This informs all subsequent decisions. Once imaging is complete, the next questions in my mind are device selection and is the lesion wire-crossable or balloon-crossable?
When you consider the devices out there – laser, intravascular lithotripsy (IVL), rotational atherectomy, or orbital atherectomy – I think IVL has been a game-changer. However, its effectiveness hinges on proper device selection guided by intracoronary imaging.
There are nuances we don't fully understand about which device to use. But to me, if you can't get a wire across or a balloon across, you're probably looking at rotational atherectomy, orbital atherectomy, or laser. If you can get those devices across, then IVL is super user-friendly and super effective.
There’s value in getting used to various devices. Sometimes I intentionally mix things up, to build experience and comfort. You don’t want to pick a device just because it’s the one you’re comfortable with. This takes intentional effort and thought.
I first heard the term "purposeful practice" from Dr. Bill Lombardi. I know he didn’t invent the term, but the idea of practicing purposefully so that you’re ready when the time comes definitely spoke to me - and aligned with my prior military experiences.
Overall, if you can get an IVL balloon down, it’s been such a game-changer. Everyone knows how to use a wire and balloon, and everyone’s comfortable with them. And using guide extension catheters for delivery probably makes IVL even more accessible. But it all starts with the foundation of intracoronary imaging.
Let’s move on to more business-oriented questions. Based on your own experience, whether during your training, your time in the Army, or with the fellows and residents you work with now, are there business topics you wish you had a better understanding of or that you think younger physicians should be more knowledgeable about?
In all honesty, I might not be the best person for business advice – I still have a lot to learn. However, I believe the cliche "do the right thing, and it'll all work out" holds some truth. Also, knowing myself, I have more hard skills than soft skills, and I have to be aware of that so I can temper my strengths and use the appropriate ones in the right situations.
From a patient care and patient safety standpoint, I've pushed hard and aggressively for things I believe in. But I've also thought about who can help me get those things across the finish line because that's reality.
In other words, I think about money as a reality. If I'm proposing a new program that helps people, it can't just be throwing money away. While I don't have a ton of expertise in this area, I've tried to be aware of it and think about who can partner with me to help. Finding the right people to push ideas ahead has been crucial because I'm pretty good with ideas and knowing what's right, but I can’t do it without the right advocates.
One financial aspect that concerns me – though I don't have a solution – is that when I hear a lot of finance discussions, particularly about new products from hospitals and administration, they focus on the immediate cost. What if improved outcomes lead to long-term cost reductions over years or even decades? We need to consider the entire patient journey and treatment lifespan. While some interventions might seem expensive initially, I don't necessarily believe that's the case. However, I lack the expertise to definitively prove it.
For example, there’s interesting accumulating data from places like Australia and the UK showing that intracoronary imaging, is a money-saver over the lifetime of a patient in a socialized health system, even if it's a cost upfront. This is a good example of how even the experts might not have all the answers yet.
Fun, Insightful Interviews with the
World's Brightest Physicians
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Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
As an Army combat veteran, broadly speaking, can you elaborate on some leadership intangibles you honed in the military that have translated to your work in medicine? How have they impacted you, whether it's presenting on podium, conducting physician training, or leading in your local geography?
I touched on some of this before, but I was well-suited to the hard skills and direct leadership style, which were the traits of the leaders I was surrounded by, especially during sustained combat operations. Some of that did require retraining because the rest of the world doesn't operate with the same level of intensity and directness. As I've spent more time with people, they appreciate my style, but I had to realize that on a first interaction, soft skills are important. Those are very different from hard skills and that's something I've certainly worked on.
A big lesson for me has been about finding the right people in positions of authority within health organizations who are connected politically and leadership-wise, which allows them to help me get things done. Having a good idea or being right isn't enough. In other words, it isn't enough if you’re right, but you can’t get it done. For me, pushing forward complex, high-risk PCI, helping to grow the CTO program, our cardiogenic shock program, our mechanical circulatory support program, pushing for more radial access, and intracoronary imaging – all of it required finding partners to shore up my leadership weaknesses in that environment.
Can you share some insights on building relationships and networking in cardiology, either from a multidisciplinary perspective, or within the field itself? What advice would you offer younger physicians embarking on their careers?
My number one piece of advice is this: don't be afraid of asking or cold calling. In medicine, many are introverts, but you’d be surprised how they might all be standing next to each other and hoping for someone to initiate a conversation or ask a question. It just takes one spark to move people forward.
Some of my best friendships in cardiology, critical care, and cardiothoracic surgery started with scientific collaborations. They began with, "Hey, I noticed your interest in this. What do you think about that?" A lot of significant, important friendships have blossomed from what started as professional collaboration. So, I would say reach out to people – attendings, other fellows, on social media, by email, in person, at meetings, etc.
Now, fellows are really lucky because there are organizations like CardioNerds designed to raise them up and build a community. So, just take that first scary step, reach out to someone, and find like-minded people. One thing will lead to another very naturally.
Here are some fun, rapid-fire questions to wrap things up. In the cath lab, do you listen to music? If so, are there any favorites on your playlist?
So I love, love, love music, and, actually, silence is very awkward for me. Since I was a kid, I've always had music playing in the background. It helps me think, focus, and perform better, whether it's during exercise, chores, or even procedures.
I have a pretty eclectic taste and I often let the techs choose the genre. It just can’t be anything hardcore that might scare the patient. And it has to be something everyone’s okay with, not divisive or exclusive. That leaves the team with about 400 good channels to choose from.
My go-to, on the rare moments where I get to choose, is the Chill channel on SiriusXM. It’s nice background music with a good vibe that meshes well with the flow of work in complex PCI. But like I said, I’m pretty non-picky and open to whatever the techs want.
How about movies? Any all-time favorites that, if you're off on a weekend with no call and you see it on TV, you might sit and watch?
I'm a cinephile by nature. My daughter has composed a list of hundreds of “must-watch” films, so she's kind of working through them, and I’m following along. A lot of my favorites are really odd, esoteric films. But if you forced me to pick three instead of the 300 that I've watched a hundred times, they’d be pretty bland, feel-good vibe movies. One of those would be Tommy Boy. Ronin is another – I actually use tons of quotes from Ronin about PCI; there are a lot of gems in there. And then Magnolia is another movie I absolutely love and rewatch repeatedly.
I think it's funny because it's almost what I did when I was my daughter's age. There are movies or books that are must-watches or must-reads – the classics. I would work my way through them. Now, it’s easier for her to get them.
Let's circle back to maybe your mid to late twenties. Is there one thing you would tell the younger Alex at that point in time?
I don't think so because I probably would have been wrong. I think about it like the butterfly effect – you change one thing, it changes everything. What I tried to do, and would tell myself to do better, is to be very thoughtful and intentional about decision-making. Make a decision, but make a considered decision, and then see it through. If it's not working out, then reevaluate, make another well-considered decision, and change gears. I've changed gears a lot, and it all worked out. But I've never found myself down a road that I just kept going on and ended up where I didn't want to be. So that would be my advice to myself, which I tried to actually follow, and my advice to others. None of us can predict the future, but as long as we're constantly reevaluating, I think we'll all be okay.
Any events, congresses, or research data that you want to highlight or call attention to?
I'm super excited about the annual Cardiovascular Research Foundation and University of Washington Complications Course. I'm impressed by their focus on comprehensive complication management in the cath lab. You should never walk into a cath lab without being able to deal with every single complication. You need to be thoughtful about what you're doing, push yourself harder, and learn new skills.
When you look at the faculty and attendees, these are all people pushing themselves and each other forward. When you surround yourself with people like that, it's hard not to get better.
As an Army combat veteran, broadly speaking, can you elaborate on some leadership intangibles you honed in the military that have translated to your work in medicine? How have they impacted you, whether it's presenting on podium, conducting physician training, or leading in your local geography?
I touched on some of this before, but I was well-suited to the hard skills and direct leadership style, which were the traits of the leaders I was surrounded by, especially during sustained combat operations. Some of that did require retraining because the rest of the world doesn't operate with the same level of intensity and directness. As I've spent more time with people, they appreciate my style, but I had to realize that on a first interaction, soft skills are important. Those are very different from hard skills and that's something I've certainly worked on.
A big lesson for me has been about finding the right people in positions of authority within health organizations who are connected politically and leadership-wise, which allows them to help me get things done. Having a good idea or being right isn't enough. In other words, it isn't enough if you’re right, but you can’t get it done. For me, pushing forward complex, high-risk PCI, helping to grow the CTO program, our cardiogenic shock program, our mechanical circulatory support program, pushing for more radial access, and intracoronary imaging – all of it required finding partners to shore up my leadership weaknesses in that environment.
Can you share some insights on building relationships and networking in cardiology, either from a multidisciplinary perspective, or within the field itself? What advice would you offer younger physicians embarking on their careers?
My number one piece of advice is this: don't be afraid of asking or cold calling. In medicine, many are introverts, but you’d be surprised how they might all be standing next to each other and hoping for someone to initiate a conversation or ask a question. It just takes one spark to move people forward.
Some of my best friendships in cardiology, critical care, and cardiothoracic surgery started with scientific collaborations. They began with, "Hey, I noticed your interest in this. What do you think about that?" A lot of significant, important friendships have blossomed from what started as professional collaboration. So, I would say reach out to people – attendings, other fellows, on social media, by email, in person, at meetings, etc.
Now, fellows are really lucky because there are organizations like CardioNerds designed to raise them up and build a community. So, just take that first scary step, reach out to someone, and find like-minded people. One thing will lead to another very naturally.
Here are some fun, rapid-fire questions to wrap things up. In the cath lab, do you listen to music? If so, are there any favorites on your playlist?
So I love, love, love music, and, actually, silence is very awkward for me. Since I was a kid, I've always had music playing in the background. It helps me think, focus, and perform better, whether it's during exercise, chores, or even procedures.
I have a pretty eclectic taste and I often let the techs choose the genre. It just can’t be anything hardcore that might scare the patient. And it has to be something everyone’s okay with, not divisive or exclusive. That leaves the team with about 400 good channels to choose from.
My go-to, on the rare moments where I get to choose, is the Chill channel on SiriusXM. It’s nice background music with a good vibe that meshes well with the flow of work in complex PCI. But like I said, I’m pretty non-picky and open to whatever the techs want.
How about movies? Any all-time favorites that, if you're off on a weekend with no call and you see it on TV, you might sit and watch?
I'm a cinephile by nature. My daughter has composed a list of hundreds of “must-watch” films, so she's kind of working through them, and I’m following along. A lot of my favorites are really odd, esoteric films. But if you forced me to pick three instead of the 300 that I've watched a hundred times, they’d be pretty bland, feel-good vibe movies. One of those would be Tommy Boy. Ronin is another – I actually use tons of quotes from Ronin about PCI; there are a lot of gems in there. And then Magnolia is another movie I absolutely love and rewatch repeatedly.
I think it's funny because it's almost what I did when I was my daughter's age. There are movies or books that are must-watches or must-reads – the classics. I would work my way through them. Now, it’s easier for her to get them.
Let's circle back to maybe your mid to late twenties. Is there one thing you would tell the younger Alex at that point in time?
I don't think so because I probably would have been wrong. I think about it like the butterfly effect – you change one thing, it changes everything. What I tried to do, and would tell myself to do better, is to be very thoughtful and intentional about decision-making. Make a decision, but make a considered decision, and then see it through. If it's not working out, then reevaluate, make another well-considered decision, and change gears. I've changed gears a lot, and it all worked out. But I've never found myself down a road that I just kept going on and ended up where I didn't want to be. So that would be my advice to myself, which I tried to actually follow, and my advice to others. None of us can predict the future, but as long as we're constantly reevaluating, I think we'll all be okay.
Any events, congresses, or research data that you want to highlight or call attention to?
I'm super excited about the annual Cardiovascular Research Foundation and University of Washington Complications Course. I'm impressed by their focus on comprehensive complication management in the cath lab. You should never walk into a cath lab without being able to deal with every single complication. You need to be thoughtful about what you're doing, push yourself harder, and learn new skills.
When you look at the faculty and attendees, these are all people pushing themselves and each other forward. When you surround yourself with people like that, it's hard not to get better.
As an Army combat veteran, broadly speaking, can you elaborate on some leadership intangibles you honed in the military that have translated to your work in medicine? How have they impacted you, whether it's presenting on podium, conducting physician training, or leading in your local geography?
I touched on some of this before, but I was well-suited to the hard skills and direct leadership style, which were the traits of the leaders I was surrounded by, especially during sustained combat operations. Some of that did require retraining because the rest of the world doesn't operate with the same level of intensity and directness. As I've spent more time with people, they appreciate my style, but I had to realize that on a first interaction, soft skills are important. Those are very different from hard skills and that's something I've certainly worked on.
A big lesson for me has been about finding the right people in positions of authority within health organizations who are connected politically and leadership-wise, which allows them to help me get things done. Having a good idea or being right isn't enough. In other words, it isn't enough if you’re right, but you can’t get it done. For me, pushing forward complex, high-risk PCI, helping to grow the CTO program, our cardiogenic shock program, our mechanical circulatory support program, pushing for more radial access, and intracoronary imaging – all of it required finding partners to shore up my leadership weaknesses in that environment.
Can you share some insights on building relationships and networking in cardiology, either from a multidisciplinary perspective, or within the field itself? What advice would you offer younger physicians embarking on their careers?
My number one piece of advice is this: don't be afraid of asking or cold calling. In medicine, many are introverts, but you’d be surprised how they might all be standing next to each other and hoping for someone to initiate a conversation or ask a question. It just takes one spark to move people forward.
Some of my best friendships in cardiology, critical care, and cardiothoracic surgery started with scientific collaborations. They began with, "Hey, I noticed your interest in this. What do you think about that?" A lot of significant, important friendships have blossomed from what started as professional collaboration. So, I would say reach out to people – attendings, other fellows, on social media, by email, in person, at meetings, etc.
Now, fellows are really lucky because there are organizations like CardioNerds designed to raise them up and build a community. So, just take that first scary step, reach out to someone, and find like-minded people. One thing will lead to another very naturally.
Here are some fun, rapid-fire questions to wrap things up. In the cath lab, do you listen to music? If so, are there any favorites on your playlist?
So I love, love, love music, and, actually, silence is very awkward for me. Since I was a kid, I've always had music playing in the background. It helps me think, focus, and perform better, whether it's during exercise, chores, or even procedures.
I have a pretty eclectic taste and I often let the techs choose the genre. It just can’t be anything hardcore that might scare the patient. And it has to be something everyone’s okay with, not divisive or exclusive. That leaves the team with about 400 good channels to choose from.
My go-to, on the rare moments where I get to choose, is the Chill channel on SiriusXM. It’s nice background music with a good vibe that meshes well with the flow of work in complex PCI. But like I said, I’m pretty non-picky and open to whatever the techs want.
How about movies? Any all-time favorites that, if you're off on a weekend with no call and you see it on TV, you might sit and watch?
I'm a cinephile by nature. My daughter has composed a list of hundreds of “must-watch” films, so she's kind of working through them, and I’m following along. A lot of my favorites are really odd, esoteric films. But if you forced me to pick three instead of the 300 that I've watched a hundred times, they’d be pretty bland, feel-good vibe movies. One of those would be Tommy Boy. Ronin is another – I actually use tons of quotes from Ronin about PCI; there are a lot of gems in there. And then Magnolia is another movie I absolutely love and rewatch repeatedly.
I think it's funny because it's almost what I did when I was my daughter's age. There are movies or books that are must-watches or must-reads – the classics. I would work my way through them. Now, it’s easier for her to get them.
Let's circle back to maybe your mid to late twenties. Is there one thing you would tell the younger Alex at that point in time?
I don't think so because I probably would have been wrong. I think about it like the butterfly effect – you change one thing, it changes everything. What I tried to do, and would tell myself to do better, is to be very thoughtful and intentional about decision-making. Make a decision, but make a considered decision, and then see it through. If it's not working out, then reevaluate, make another well-considered decision, and change gears. I've changed gears a lot, and it all worked out. But I've never found myself down a road that I just kept going on and ended up where I didn't want to be. So that would be my advice to myself, which I tried to actually follow, and my advice to others. None of us can predict the future, but as long as we're constantly reevaluating, I think we'll all be okay.
Any events, congresses, or research data that you want to highlight or call attention to?
I'm super excited about the annual Cardiovascular Research Foundation and University of Washington Complications Course. I'm impressed by their focus on comprehensive complication management in the cath lab. You should never walk into a cath lab without being able to deal with every single complication. You need to be thoughtful about what you're doing, push yourself harder, and learn new skills.
When you look at the faculty and attendees, these are all people pushing themselves and each other forward. When you surround yourself with people like that, it's hard not to get better.
