Bill Lombardi welcomes Dr. Jasleen Tiwana, an interventional cardiologist practicing in Alaska who completed her high-risk PCI fellowship at the University of Washington, to discuss her journey from training to building a successful practice while balancing professional excellence and family life.

• Dr. Tiwana's drive to become "the best" led her to pursue additional training in complex coronary interventions
• The personality type that succeeds in high-risk PCI is one that "can't quite let it go" when faced with difficult cases
• Learning to "fail fast" became a valuable principle both in the cath lab and in personal life
• The myth that women cannot succeed in interventional cardiology while having children is firmly debunked
• Building a community of supportive colleagues helps process challenges and complications
• Advocating for personal needs in the workplace (like mini-fridges for breast milk) benefits everyone
• Finding grace for yourself and your partner is essential when balancing two demanding careers with family life
• Self-motivation techniques include speaking aloud during cases and setting time limits for strategies
• Planning for potential complications creates a "safety blanket" that allows for bolder procedural approaches
• Continued growth professionally and personally remains Dr. Tiwana's focus for the future

@JTiwanaMD

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Dr. Greg Witkop shares his journey from Army ophthalmologist to DARPA researcher, developing innovative approaches to mental health by combining neuroscience, psychology, and sleep medicine to heal trauma-affected brains. The conversation explores how trauma changes neural circuits and how we might reverse those changes to build resilience in military personnel, physicians, and first responders.

• Loss of a military godson to suicide prompted Greg's deep dive into brain science and mental health
• Military lost 7,057 troops in combat during 20 years of war since 9/11 but 30,000+ to suicide
• Physicians are twice as likely to die by suicide than the general population
• DARPA takes "home run swings" in research, attempting transformational rather than incremental change
• Combining transcranial magnetic stimulation with cognitive behavioral therapy shows promising results
• Sleep augmentation and meditation can create lasting improvements in brain function
• Breaking down silos between neuroscience, psychology, and psychiatry is essential for progress
• Purpose distinguishes pain (inevitable) from suffering (a choice)
• The "stop, drop, and roll" approach for managing acute suicidal thoughts: stop making decisions, drop body temperature, roll toward social support
• Creating cultures where vulnerability is safe requires true leadership, not just management

If you like the show, share it with others. Reviews on Apple and Spotify help us get out to more people. Good luck on your journey and I hope this helps you be a little bit better.

**Show Note**
Wright Brothers’ first flight was December 17, 1903.

https://www.darpa.mil/about/people/greg-witkop

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Primero Ng, a recent high-risk PCI graduate who trained with Bill at UW, shares his experience transitioning back to practice in Australia and the challenges of building a complex cardiac program in a different healthcare system. Their conversation explores the differences between healthcare cultures, the importance of patient-centered care, and the personal growth that comes from stepping outside your comfort zone.

• Moving between healthcare systems with different approaches to patient care
• Developing a truly patient-centered approach where indications guide decisions rather than angiogram appearances
• Building a complex PCI program from scratch requires focusing on culture, relationships, and small wins
• The importance of deliberate practice and ongoing coaching even after formal training ends
• Creating collaborative relationships with surgeons and the heart team
• Finding work-life balance and keeping family priorities in perspective
• Setting realistic expectations: building a program takes 3-5 years of consistent effort
• The value of vulnerability and open communication in creating cultural change
• Measuring success by process improvement rather than outcomes alone

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Dr. Rhian Davies shares her journey from cardiology fellowship to becoming an interventionist specializing in complex high-risk PCIs and CTOs while balancing her passion for competitive horseback jumping.

• Meeting Dr. Lombardi at a fellows course in 2018 despite initial intimidation
• Transitioning from fellowship to practice and dealing with being the first female interventionist in her practice
• Finding balance between professional responsibilities and personal passions
• Mental and physical parallels between competitive jumping and performing complex interventions
• Navigating a devastating elbow injury that threatened both career and personal identity
• Learning to communicate honestly about struggles rather than suppressing emotions
• Building genuine relationships with colleagues and creating community support systems
• Developing mental preparation techniques for both riding competitions and complex cardiac cases
• Recognizing the importance of maintaining passions outside of medicine for mental well-being

"To truly enjoy this career, you have to be ready for not every case going as planned. This field is unbelievably rewarding, and the cases that go amazing and save lives are wonderful, but there are those that don't, and being prepared for that is important."

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Dr. Jesse Kane shares his journey from interventional cardiology fellow to attending physician at the University of Vermont, exploring how his diverse training experiences shaped his approach to medicine and patient care.

• Moving between different institutions exposes physicians to varying approaches and helps identify best practices
• Redefining success means focusing on helping patients and being a good teacher rather than case volumes or technical metrics
• Physical manifestations of stress during complex procedures can include tension headaches and pain
• Building a supportive community of colleagues is essential for managing the psychological challenges of high-risk interventions
• Creating clear boundaries between work and home life becomes increasingly important, especially when starting a family
• Cultivating a team-oriented culture in medicine promotes innovation and growth
• Simple strategies like keeping your phone out of reach at home can improve presence with loved ones
• Medicine needs to preserve space for innovation and pushing boundaries, even when success isn't guaranteed

If you're interested in joining this conversation or sharing your own journey, please subscribe to the podcast and share it with others who might benefit.

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After cardiology fellowship, physicians face critical career decisions balancing technical skills, personal fulfillment, and family demands that shape their professional trajectories. Dr. Amy Cheney shares her journey from UW fellowship to community practice, revealing insights about transitioning from academic to private practice settings.

• COVID disruptions during fellowship created uncertainty but built valuable adaptability skills
• First job after training wasn't the right fit despite appearing aligned with career goals
• Finding practice partners with shared clinical philosophy proved essential for professional satisfaction
• Working with another high-risk PCI operator provides both technical collaboration and emotional support
• Learning to establish boundaries between work and home life requires intentional practice
• Two-physician marriages need structured communication about schedules and childcare responsibilities
• Women in interventional cardiology face unique challenges requiring confidence and resilience
• Personal tragedy can ultimately enhance professional empathy and perspective
• Finding mentors who share similar life circumstances provides crucial guidance
• Academic concepts translate differently to community practice but remain valuable foundations

We need to maintain work sustainability through proper boundaries and prioritizing family time. The culture of medicine is changing to value physician wellbeing alongside technical excellence.

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Physicians aren't broken - the healthcare system is. Dr. Gabe Charbonneau joins Bill to discuss physician burnout and the hopeful path forward through solidarity, boundaries, and reclaiming joy in medicine.

• Dr. Charbonneau shares his journey from rural Idaho inspiration to experiencing severe burnout in his first post-residency position
• Medicine Forward was born from collaboration with Dr. Eric Topol to create a physician organization focused on the doctor-patient relationship and humanity in medicine
• Two essential paths exist for tackling burnout: the inner path (personal boundaries and wellness) and system advocacy (changing the broken structures)
• Perfectionism in medicine creates isolation and "terminal uniqueness" where physicians suffer alone rather than supporting each other
• Physicians must learn to care for each other and model the compassionate behavior they want to see in healthcare
• Current Medicine Forward initiatives include a documentary, coaching programs, and building communities of support for physicians
• True leadership requires caring about people rather than just managing them - a critical missing element in healthcare systems

To learn more or join the movement, visit medicineforward.org where you can become a member for $5 per year and connect with others working to fight burnout and reclaim the joy in medicine.

https://x.com/gabrieldane

https://www.linkedin.com/in/gabe-charbonneau-md-66978449/

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Dr. Bill Lombardi celebrates his 100th podcast episode by reversing roles, allowing his early guests Dr. Aaron Grantham and Dr. Jared Frizzell to interview him about his personal transformation and journey to better.

• Discussing the "two steps forward, one step back" reality of personal growth and how to prevent falling all the way back
• Recognizing physiological triggers when slipping into old patterns and using mantras like "I'm a good and worthy man" to reset
• Moving from external validation to intrinsic worth by developing radical acceptance and forgiveness
• Confronting past trauma, particularly from his relationship with his perfectionist father
• Changing his approach to parenting by no longer defining success through academic achievement and finances
• Evolution of the CTO space in interventional cardiology and recognizing the importance of psychological well-being
• Finding purpose in serving others rather than in technical achievements
• The importance of vulnerability and having supportive relationships when facing life's challenges
• Recognizing that worthiness comes from within rather than external achievements

I hope this episode helps you get a little bit better and I look forward to seeing you for episode 101. Good luck this week on your journey to better.

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