Session 84 Dr. Edward Schloss joined me to talk about his journey to Cardiac Electrophysiology, what 17 years in the field looks like, and his likes and dislikes of his specialty. If you're a premed student, go check out all our other resources on MedEd Media Network. If you're a medical student, go check out our newest Board Rounds Podcast. [01:17] Interest in Cardiac Electrophysiology Coming out of undergrad as an engineer, Edward wasn't sure he wanted to be a doctor and only found out as he got further along. It was during second year of med school that he had an ECG class and they were already problem-solving instead of just plain memorization. He also got through different phases such as rheumatology, nephrology, and primary care. In fact, he recalls telling himself one evening that he wasn't going to be a cardiologist. He actually got interested in serial drug testing back in the old days, where they would take people who had cardiac arrest into a lab and they would pace their hearts in order to induce the arrhythmia. They would start the medication and bring them back and do it again. Until he got to the people that did electrophysiology and got mentorship. [04:05] Traits that Lead to Becoming a Good Electrophysiologist Edward says you have to be analytic. You have to be able to look at data objectively and there are going to be mountains of data and you have to sort through the good and the bad. In the lab, you have to be highly meticulous. You have to be focused and meticulous for hours on your feet to be able to get through that. Moreover, establishing relationships with patients is also super important. They don't meet patients on the table, but they meet them ahead of time. They deal with people that are very vulnerable and intimidated. Many of them have been through something life-changing. They're facing the risk of cardiac arrest or they've been through it. Or they're scared to death about their arrhythmias. So you need to humanize it and gather their trust before they hit the lab. And for many of these patients, you follow them for many years. Having a lot of device patients, they have metal in their body that he's responsible for, for the rest of their life. "These people have a hunk of metal in their body that I'm responsible for for the rest of their life so they're kind of married to me professionally." [06:10] Types of Patients and Diseases Edward illustrates a mix of patients coming in. There are young people with palpitations, fainting episodes, which are common. As they get older, you start to see patients who may be healthy but have developed atrial fibrillation from a variety of causes. As you go further to the older population, you'd see patients with myocardial infarction and then you get to the heart failure population as they get older. Edwards favorite is the 90-year-olds who may have a heart block and fainting episode and you put a pacer in them and they're good to go. Edward has a good number of referring physicians, mostly his own partners. When patients hit the door, it's not unusual for them to be ready to go. So they've probably had their echo or their medications, etc. A lot of times, they don't know what they need which is pretty common. So it's common for Edward that he'd have to craft the patients' expectations a little differently. "If they think they know what they need, much of the time they're wrong. That's not because they're not good doctors. It's just our field is so highly specialized." [08:55] Typical Day Edward arrives before 7 am, depending on how much is going on in the hospital. He runs around and sees his post ops. It's very important to see people the day after their procedure personally to cement the relationship. Then he makes it to the lab or the office by 8 am. His days are generally either all day lab or all day office. On an office day, he'll see patients from 8-8:30 and from 8:39 to 5 or so, he sees his patients. Some days can be light, others can be busy. On a lab