DGTL Voices with Ed Marx - Servant Leadership and Heart Health (ft. Dermot Phelan)

Episode Date: October 2, 2024

On this episode of DGTL Voices, Ed welcomes Dr. Dermot Phelan, a renowned sports cardiologist with Atrium Health and a key medical figure for professional athletes. Dr. Phelan shares insights from his roles of caring for elite athletes as the team cardiologist for the Carolina Panthers and Charlotte FC, as well as serving as the NFL’s cardiology consultant. He also discusses the importance of servant leadership in healthcare and the lessons it offers for improving patient outcomes. Listen now to hear more about Dr. Phelan's perspective on sports cardiology, his work with the NFL, and his tips for improving your own heart health.

Thanks for tuning to Digital Voices Podcast, where we chat digital transformation, challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marks. Hey, welcome to another edition of Digital Voices. It's great to have you. I know you have a lot of different choices of things that you can listen to and you've chosen us. And I'm giving you another good reason why you should do that. So today, our guest is Dr. Dermott-Fieland. Dr. Phelan, welcome to Digital Voices. Thanks, Ed. Pleasure to be here with you.

It's so exciting, and we'll get into why I'm super excited about having you in particular as a guest, and we'll jump into your background and things like that. But first, how we first met, we met in 2018. We were both at Cleveland Clinic, and I had an heart issue, and they couldn't figure out, after I got healed up a little bit, they couldn't figure out what to do with me next. So they're like, oh, let's bring them. forward to Dermit and Dermit can help decipher what's going on and should Ed continue in his

triathlon career. So anyways, that's how we first met and it was a very emotional experience for me, but we may or may not get into that. But that's how we first met. And so I followed you since then, obviously. And so now you're at your sports cardiologist at Atrium Health, Sanger, Heart, and Vascular Institute. That's right. That's right. In Charlotte, North Carolina. Yeah, so you made a big boom because the weather's a little bit different in North Carolina than it is in Cleveland, Ohio. That's right. Exactly right.

So the most important question that my audience typically enjoys hearing the answer to is what are the songs on your playlist? So when you have downtime or whatever you're doing, what do you like to listen to? Pretty much rock. Any era, so 70s, you know, Zeppelin, the Stones, and the 80s,

you two and the boss, and then the 90s, 2000s. I heard recently OASIS are getting back together again, so I've been playing back a little bit of OASIS, so pretty much any form of rock. Yeah, no, that's great. And what about your life message or mantra? Are there words that you sort of live by

or help guide who you are? I don't think I've got a single. I have to mature a little bit more, Ed. I have to get a little older, a few more gray hairs before I have a single sentence that sums it all up for me. but I've been listening to a lot of stoicism recently, a lot of the philosophers.

I know a lot of people are doing that right now. They've become quite popular. And I think those, the four virtues, so wisdom, courage, justice, and temperance. Those are the four virtues, I think, are important to try and live by. Yeah, love it. But yeah, tell us a little bit about yourself leading up to today.

So originally from Ireland, you got the accent, all right. So grew up in a very small farming town in Ireland, one traffic light town, one of five children, and went to college in Dublin and then did most of my training in medicine in Dublin before moving to Cleveland, Ohio to do two years of advanced training in cardiovascular imaging. And initially the intention was to go back to Ireland, but we ended up deciding to stay in Cleveland, so work better. where we met for about 10 years before moving down to Charlotte in 2020. So I've been here since 2020. I'm married four young kids, so life is good. Yeah, that's awesome. Do they have an accent, or were they all born in the U.S.? So my oldest was one in Ireland.

So the rest of them were born, the other three were born here. But very interestingly, people still say that they, particularly my oldest, who was only one when he moved over here, people say that he has an Irish accent. So they certainly come out with some mom and dad's Irishisms in their conversation. But yeah, I'm sure that will go over time. Yeah, that's super interesting. And did you come up with Irish names or did you use sort of North American type names? Well, actually, the first, the oldest, it's James, Amelia, Luke.

so they're not Irish names. But the last was, the youngest is Lincoln. So Lincoln was, at the time, I was reading a lot about Abraham Lincoln, and he's one of my heroes. So he was named after him. Yeah, that's great. And let's just dive into your career then. When did you know that you wanted to be a physician?

So you're growing up in a small town, one traffic light town. Was it there that you discovered, hey, I like to grow up and be a doctor? Well, I was mad in sports. The sports I loved was rugby and a sport called Gaelic football, which has not played anywhere else. And unfortunately, both of them are fairly violent sports. So I ended up more time in hospital than I did actually playing the sport. And I had one particular orthopedic surgeon who operated on multiple joints and bones on me over the years. And he was just the coolest guy ever. And I decided that's the guy I wanted to be. So that was my plan. I actually wanted to, when I went into medical school, I wanted to be a orthopedic surgeon.

So Gaelic football, is that more violent than rugby? Because I think everyone probably knows rugby and saw it recently on the Olympics and currently in the Paralympics. But is it more violent than that? No, and hard to be more violent than rugby, to be honest. It's, but it's up there. You get different types of injuries. So, yeah, they're both fairly, I needed to be built differently, I think, to play those sports. I'm afraid. Yeah, I'm going to look that out. super interesting. So you were inspired by an orthopedic surgeon, but ultimately you chose cardiology and specifically sports, because you mentioned your affinity for sports. So how'd that switch to cardiology come about? Yeah, you know, being in training as a surgeon really didn't rock my

boat, you know, standing in the OR holding back retractors for hours on end. It wasn't, it turned out that wasn't for me when I actually did it. And also when I started doing cardiology, I did cardiology as a rotation early on and I just thought it was the coolest thing ever. I just loved being at, you know, those kind of very rapid life and death situations where people are very, very sick and you can do something about it quickly. And I just love the physiology studying it. So I, you know, very early on realized that that was the track I was going to go down. But ultimately, always had that kind of desire to be working with athletes and being. involved in sports. And so that's where those two things kind of amalgamated, where I decided I was

going to do sports cardiology, which is obviously a fairly new area with not that many practitioners worldwide doing sports cardiology. Yeah, you get to do some cool things, which we're going to talk about here in a couple of minutes. What about yourself? So you started doing rugby and gay and football, but as you became older and physician and things like that, are there other sports that you're currently involved with or with four kids? That's probably all the sport that you might be able to handle right now. That's right. So I do, I try to stay fit. I mean, I work out and train, but not really playing any sports now at this stage. I'm afraid that those days are passed for me yet. I know that you're still competing. You were in the Team USA triathlon recently,

I understand. Yes. Yeah. So yeah, no, I'll have to, I'm not there yet, Ed. I'll have to follow in your footsteps. But, yeah, more focused on the kids' sports at this point. Yeah, no, I went through that same thing where I was super into sports. There are kids came along and it went way down. And then as they got older, you know, then I was able to get more back into it. So you're at Cleveland Clinic.

It's awesome, highly known for great cardiology care. And you make the move to Sanger. Tell us a little bit about that move and what sort of preempted that move. Yeah, so like a lot of things in life, it really comes down to the people that you meet. And, you know, I met with Dr. Jeff Rose, who's actually the president of Sanger, Hart Ambassador Institute. And we became close through an external organization, organization called the American Society of Echo. I'm also an imager, so do a lot of imaging. And so we ended up becoming close through that organization, and he invited me to come down to Sanger and give grand rounds.

And I did it purely out of courtesy to him without any intention of moving, because I loved working in Cleveland. But when I came down here and kind of saw what was happening in Charlotte and the growth in this city, And the dynamism in Sanger, that was when I decided I'd take the leap of faith and come down. Yeah, I was, I think the world of Atrium and, yeah, the city is pretty amazing. So it makes a lot of sense, especially raising kids and things like that. So you get to do very cool things and work with sports teams and elite athletes. What's that like? It's great.

I mean, it's a lot of fun. It's very different to most areas of cardiology. You know, I think when you see the people who are in my waiting room versus most of my colleagues' waiting room, they just look different. And they look different on the outside. They also look different on the inside. And so they've got very different questions, very different, you know, challenges in what they, face, a little bit like when you and I met, where, you know, it's someone who wants to really push the boundaries and yet have had a cardiac event, and so they're looking for that kind

of guidance. So it's really a lot of fun dealing with an athletic population, and it can also be extraordinarily stressful on the other hand. I mean, when you've got a, you know, multi-million dollar deal waiting for your approval on someone's heart health, or more importantly, someone who has had a major event and, you know, is really worried about returning to exercise or something bad happens to them while they exercise and they're looking to you for guidance. You know, that, that is, it's not, it's not for the faint heart. heart. Let's put it that way. Yeah. I want to, I do want to jump into a little bit about Sangha Hard and Vascular Institute, but before we get there, since we're sort of on this topic.

So I know we can't get specific and, you know, I think everyone understands why. But you get to work with some NFL teams in general, right? Yeah, yeah. So, yeah, I do a number of roles within the NFL and some of the other national sporting organization. So I go to the NFL Combine every year. I've done that since 2014, where basically I go and review all of the testing that they get done, all the players there, all the cardiac testing, that is, and then decide if anyone else needs

additional testing and kind of give advice to the teams on what the findings are. I'm also the cardiologist for the Panthers here locally, and then I serve as the chair of the NFL cardiovascular task force, so kind of trying to give guidance for the best way to manage the care of these elite athletes. So a number of different roles within the NFL. Yeah, that's pretty cool. Yeah, and of course, cardiology came into prominence a couple of seasons ago, right, when someone had one of the athletes had a cardiac event. And so I think people got to understand just how critical this is and how important

someone like you is to the health of these elite athletes. So that's very cool. Do you leverage digital tech at all in your practice? I mean, obviously the echo and imaging. Is there any other sort of tech that you leverage? Yeah, I mean, obviously, there's all of the medical tech that we leverage. And I mean, I think for me, the most important part of that is the cardiovascular imaging, which is nowadays absolutely spectacular when you can actually get almost to a cellular level looking at the heart muscle.

I think what you're probably more referring to is the more widely consumer-based stuff, though. And so, yeah, absolutely. I mean, you know, every middle-aged and older cyclist, they come in with their chest strap data and all of the different wearable technologies that they use. And, you know, it's very useful. And we spend some time going through that and looking through, you know, their heart rate ranges and their training schedules and stuff like that. So, yeah, we use, I use all of that data. That's cool. Well, any recommendations you might have, you know, our average listener is an executive in health care.

And, you know, middle age, there's definitely some in the audience that are sort of up and coming next generation leaders. But, you know, as we age, we may get a little complacent with our fitness and our overall health. But from a cardiology point of view, any basic recommendations you might have for our listeners to, like, hey, at least do, you know, X every week in order to main some sort of cardiac health. health? Yeah, I think the thing for people to remember is even a little bit of exercise has a dramatic effect on overall benefit, right? So if you think about your risk of cardiac disease being high and you look at this compared to exercise, even not just a little bit of exercise, drops that risk down dramatically. And, you know, doing more will continue to drop it down, but the benefit gradually kind of levels off as you get into high levels of exercise. So

just do some exercise. I mean, the guideline recommends 150 minutes in the week, so that of moderate intensity exercise, so that's 30 minutes, five days a week. That's a kind of minimum that the guideline recommendations are. I think the other thing is that people, as they try to return to exercise, is they think about what they were when they were 20, and they want to do that straight away. And that just doesn't work when you're 50 or 60. So, you know, I think recognizing where you are in life and building up, don't try and go out there and go, I'm going to go for a 20-mile run or even a 5K run if you haven't done it for a while.

You know, do five minutes of exercise and build up to 10 minutes and 20 minutes and gradually build up and not kill yourself. You know, a lot of the benefits that you get from the heart health benefits is in Zone 2 training, right? That's where, you know, you know that the top Olympic athletes, they do most of their training in Zone 2, right? They're not like all of us amateurs that go out there and do high intensity interval training every day, five days a week. And then we get injured and then we can't do anything for a month. And, you know, so Zone 2 training with some high intensity interval training in there, build up slowly is the message. Yeah, I'll try and drop a couple of links about Zone 2 training for those who might not be as familiar. But yeah, it's actually good dues.

It's easier and it's better for you. But, you know, it just made me think, Dermit, you know, about that mindset about, oh, I want to go out there. I do that with a tennis. Like, I think I'm going to play at the level that I did, you know, when I was super young. I have it all in my head. But, you know, on, you know, because you mentioned the TNOSA Trathlon, the, there are men and women, but the men in particular that I compete against, they're still running like five, five and a half minute miles. It's just crazy.

But it's very inspirational and aspirational is what the body can do, right, if you train appropriately and keep good care of yourself. Let's jump into Sanger a bit. Can you share a little bit about the mission and vision of the Institute? Yeah, so Sanger traditionally came from a private practice model. And they had some very well-known, famous nationally and internationally famous, but it was a smaller practice. And over the last 20 years, they've evolved. And now we've become part of Atrium Health and are a much bigger and larger sophisticated

practice. And I mean, even, and this was one of the reasons I moved here because I could see just how incredibly dynamic the practice is. And so even since I started in 2020, Atrium Health, Sangha Heart Ambassador Institute was really a Charlotte. everyone in Charlotte knew them. They're a very, very strong presence there. But now we have joined with Wake Forest.

We've joined with Advocate Aurora in the Midwest. We're now the fifth largest healthcare system in the country. And that's over the past five years. So become a very, very large, sophisticated organization. And I think the thing, what Sanger really try to do, and I think do with a lot of success, is the stuff that other people can't do, right? So there's a lot of great cardiologists locally,

but, you know, they're dealing more with the primary preventative stuff and the more straightforward stuff. What we differentiate ourselves is on the much more complex stuff. So if you, you know, need a heart transplant or mechanical support, that's the stuff we can do. Or, you know, focusing on very sophisticated or niche, areas like sports cardiology, for example. Or if you've got advanced valetal disease, doing more advanced structural stuff. So a little bit similar, I would say, to the Cleveland Clinic style

model where you've got sub-specialists in niche areas of cardiology that can provide top-class care. Yeah. No, that's awesome. And it's cool that it's sort of becoming national, you know, given the atrium, the size of atrium. And I think the reputation, that you're all gaining in the industry. So very cool. I know that if I ever need more, hope I don't, but if I need more sports cardiology, I know where I'm going, for sure.

So let's dive into leadership a little bit. Obviously, you're a leader, you're a national, international leader in sports cardiology. What is one best piece of advice you ever received? So it doesn't have to be medical or anything. It could be anything, but what's one piece of advice? So I think the best piece of advice, again, comes from Jeff Rose, who I work with now. And it's really to focus on being a servant leader and what that means. And obviously there's a whole lot to what that means. But I think that that's the kind of the leader that we're looking for in healthcare. And I think across the board being a servant leader, someone who, you know, where there's a huge emphasis on integrity, on humility. empathy for your patients, but also your poll workers,

and, you know, a willingness to do the work that you're going to ask other people to do. I think that that's the type of leader that is needed in healthcare and that I certainly strive to be and others I think should be striving to be. That's good stuff. Any advice that you might give? So again, a good portion of the audience will be have a technical, digital bent, and they work with clinicians such as yourself. Is there any sort of advice that you wish, like people like when I, you know, when we were together, I was the CIO Cleveland Clinic, do you wish CIOs or tech leaders knew about working with clinicians? It's a really good question.

I think for tech leaders, it's really to understand the clinical questions. that the physician is struggling to answer. So, you know, oftentimes we kind of see technology that is created purely for the consumer and for consumer work, but really what are the key pieces of that information that the physician needs? And I think the only way you can get to that answer is to actually spend time with physicians. And that's where I see the really successful people in IT or in any other aspect of, you know, whether it's the pharmaceutical industry, IT industry, the people that actually spend time, you know, at the bedside with the physicians and sees the challenges that they're

trying to solve for are the ones that come up with the solutions. Yeah, that's really good advice. I wanted to ask you about one thing that you shared with me when we worked together when I was your patient. And we had gone through sort of my, I did another battery of testing. I don't really know or remember what the results were. But I do remember this question you asked me. And I remember the philosophy around which you were asking. But you said, why? Why do you want to do, you know, extreme?

I was in extreme sports like these long. long distance triathlons, iron man, things like that. And you asked me that question. I responded, I know it was very emotional for me. And then you talked about why the mental part is perhaps, I don't put words in your mouth, but maybe as important as the physical. Can you speak to that a little bit? Yeah, absolutely.

And I think you've really hit the nail on the head. I'm glad that actually you remember that part of the conversation. You know, it's, I think, a question that, we probably are guilty of not asking enough in the medical profession as to why people want to do the things they're doing. Unless you directly ask the question, you know, you'll make assumptions that are wrong. And so if someone has a heart condition and they want to do some form of sport or exercise, you know, assuming that they're willing to risk everything for that is a mistake or assuming that their longevity is the most important thing for them is a mistake.

So some people, they'll come to me and say, look, I have this heart condition, and I do these sports and exercise. And the main reason I do them is because I want to be healthy and live as long, want my heart to be healthy and I want to live as long as I possibly can for my children, my family. I will say, okay, well, that's great. That's exactly what I need to know, because we can build. build an exercise program with those priorities in mind, where we're going to absolutely

minimize your risk of anything bad happening and maximize your benefits. So that's where we'll focus on our return to exercise. You'll have other people who come in and really, and I hear this a lot, and I'm sure you've come across this, where people kind of say, look, the only thing that keeps me sane in life is my ability to exercise and exercise hard. And my life will fall apart. And I mean, I know it sounds, and for some people, they kind of laugh when they hear that. But for many people, that is really, really true. I mean, they actually are not able to function unless they can do this exercise.

And I've seen people who have kind of automatically being restricted for their lives have fallen apart. Yeah. And, you know, some people have seen people turn to alcoholism and depressed. and gain weight and all of these terrible things in their life occur because they've been told they can't exercise, they can't do that thing. And so in that case, we talk about, well, okay, this is how important is. Let's talk about what the risk is if you are to exercise and compete at this highest level. And what can we do to try and mitigate that risk? What are the things that

we can put in place to try and keep you as safe as possible? So I think understanding the mindset of the patient is absolutely paramount importance for you to be able to give that care. But the mental health part of things is absolutely vital. I mean, there are times where I tell people that, you know, you just, I would advise you if you were my loved one, my brother, my, you know, partner, my parent, I would tell you not to exercise because this is really, really high risk right now. And some people really find that very hard to accept. And so you have to put sufficient support structures in there for those people who are really high risk.

And oftentimes it's just for a period of time. It's just don't exercise for this period of time. And we can get you back after that. So, yeah, the mental health part of it, I think, is really, really important, particularly for athletes. Yeah, I'll never forget that. Look, we spoke about a lot of different things. Dermit, you're growing up in Ireland. And of course, you mentioned you too, which I didn't want to be stereotypical, but I figured that might come up when you were talking about your music.

And a lot about your career and why you decided to go into sports cardiology. We talked a lot about leadership, a lot about sangor, a lot of practical things for people like, you know, myself, our listeners, you know, on exercise and sort of the mental aspect of that as well. What did we miss or is there anything you'd like to double down on? I'll give you the last word. Well, first of all, I want to thank you, Ed, for taking a time to chat me today. It's super to catch up with you again. The gentleman you were trying to remember the NFL athlete who had a sudden cardiac arrest in the field was Demar Hamlin. And so, Damar's resuscitation actually has led to a huge amount of advocacy in the space of sports cardiology. I think where I like to focus my effort is, is, not on telling people they can't play, but on providing safe environments for them to play. And part of that is having AEDs available and having emergency action plans available. There's a lot of legislation going on right now.

There's something called the Spartars Coalition, where they're working to try and make sure that states have legislation in place to make sure that these safeguards are in place for people who play. So I think that's just one thing I just wanted to highlight. you reminded me as you mentioned his name. I think it's important for us all to support these efforts. But look, I thank you so much for having me on today. And I really enjoyed catching up with you.

Yeah. Thank you again for being my guest and for helping improve the quality of my life. So that wraps up this edition of Digital Voices. Thanks for listening. Thank you for listening to Digital Voices podcast with Ed Mart. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.