Cardiac Rhythm Management
Articles Articles 2015 January

Interview With Brian Olshansky, MD

DOI: 10.19102/icrm.2015.060102

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Dr. Brian Olshansky, a renowned electrophysiologist and professor emeritus at the University of Iowa Hospitals, has directed the Clinical Cardiac Electrophysiology and the Fellowship Training Programs at University of Iowa, Iowa City and Loyola University, Maywood, Illinois. Dr. Olshansky may masquerade as a “simple country electrophysiologist” in practice at Mercy Medical Center-North Iowa in Mason City but, at heart, he is the “id” of EP.

Dr. Olshansky has a unique role in EP that extends beyond his patina. He challenges basic tenets and assumptions and frequently debates and comments upon some of the more contentious topics with which we are faced. He is outspoken about the role of the doctor in healthcare and the problems related to trying to put the patient and the doctor into a box. Instead, he promulgates out-of-the-box thinking on a multitude of topics. He has an eclectic, and diverse set of interests ranging from complimentary and alternative medicine and the placebo effect to basic understanding of arrhythmia mechanism with many things in between.

Dr. Olshansky is recognized globally for expertise in evaluation and management of syncope, the assessment of arrhythmia mechanisms, autonomic control of arrhythmias and cardiovascular function, multi-center randomized clinical arrhythmia trials, management of atrial and ventricular arrhythmias using device, ablation and pharmacological strategies and approaches towards anticoagulation. He has served key roles in managing the athlete with suspected arrhythmia-related problems. Dr. Olshansky was the principal investigator of one of the largest randomized controlled clinical trials of implantable defibrillators. As part of his diverse interests, Dr. Olshansky is an editor of the creative medical writing journal, The Examined Life, published through the University of Iowa Humanities program.

He is a self-starter who likes new projects and is most comfortable when involved with a wide scope of activities. He functions best in an environment that is high pressure and is variety-oriented.

In a career that spans over 3 decades, Dr. Olshansky has received numerous awards, honors and distinctions, published hundreds of articles in leading peer-reviewed medical journals, served on numerous editorial boards, lectured internationally, and been a visiting professor at institutions throughout the world. He enjoys making the obscure and abstract down to earth and palatable to the practicing clinician.

We are honored that Dr. Olshansky has taken the time to participate in our latest interview series.

Question: Please tell us what led you to the field of EP?

You know, I hardly remember since I have been involved in the field of EP for so long and I feel I was born to be in this field (even though I really never wanted to be a doctor until after I left college). In college, I did not think I would be good enough to make it a rock star (I tried) or a mathematician, so I went to medical school after a stint as a pulmonary function technician at the Tucson VA Hospital where I got involved with research. Getting into medical school was a challenge for me. I remember a half hour intense and heated conversation with the Dean at the time who considered my application rather weak. I argued that he was taking the wrong people into medical school with no interest in excellent patient care; they considered themselves above their patients. Based on my assessment as a pulmonary function technician, the medical students traipsing through the lab had little intellectual interest or drive. He thought my ideas were unrealistic, juvenile and misguided but from the start I was hoping to make major changes in the way medicine was practiced. Perhaps I was overly idealistic and forceful but ultimately got an interview, was admitted to medical school and surpassed my very competitive colleagues in the long-run. My goal was to improve patient care and enhance the practice of medicine. The abrupt demise of the Dean reinforced my conviction.

After medical school in Arizona, I got hooked on EP, sometime as a resident at Bellevue/NYU. Back in those days, I enjoyed the edginess of the rough and tumble ER work and used to wear cowboy boots and a corduroy vest being one of the only outsiders from East Coast medicine. I was called the “corduroy cowboy”. For a while, I lived out of the trunk of my car (to this day, Larry Chinitz, my intern, continues to marvel over this). I wandered from here to there. Still, I find this approach appealing and find travel fascinating.

As a resident, I never had any thoughts about focusing on anything besides the heart. As there was no EP at Bellevue in those days, I sought programs that offered the best opportunities for basic and clinical research, as well as clinical medicine. University of Iowa seemed to be a good choice and I was tremendously impressed with the research at that time. I worked with several people – most of whom had no interest in EP as my purported EP mentor had vanished into private practice in Indiana just when I arrived. So, I devised to work in autonomic research and echocardiography. I worked with Phil Schmid on muscarinic effects of cold-stress in guinea pigs and with David Skorton on echocardiographic texture analysis and 3 dimensional reconstructions. An opportunity came up to work on a project on syncope. This produced a manuscript on the use of EP testing for syncope patients in JACC. This was the start of my long-term interest in this topic.

In Iowa in the early 1980s, I observed some of the first Intec ICD implants and met Mirowski. The novelty, excitement and innovation in the field and its rapid advancement plus thinking on your feet made it unique and the only field that was for me. There were no opportunities to advance a career in EP in Iowa and thus I moved to Alabama to work under Al Waldo. Al's vision was that we could figure out the mechanism of atrial flutter and that the future of much of EP (not recognized at the time) was in atrial arrhythmias. Ken Okumura and I started a small project on point-by-point mapping of the atrium in atrial flutter and then performed entrainment to understand the reentry circuit. The intellectual environment in combination with the invasive nature was captivating. Also, the type of people who went into this field were just the kind of people I could talk to on a day-to-day basis.

Question: Can you tell us about your EP training experience at the University of Alabama Hospitals? What was the most important lesson or lessons that you learned which assisted you successfully transition into practice and prepare for the future?

Ask questions, look for answers and do it with conviction and put your heart into it. Work with colleagues, present your ideas, be open to critical analysis and advice, meet the leaders in the profession and learn from them, respect and listen to doctors in clinical practice, encourage younger colleagues and give them credit but develop your own approach and add your ideas. Most of all, be a leader by finding a niche that interests you the most. Be fearless. Have a vision of the future and go after it with passion.

Question: You have influenced many fellows both professionally and personally through your position as Director of Fellowship Training; please share with us what you find most gratifying about your experiences.

Watching fellows develop successful and rewarding careers is the best part of being a Fellowship Training Director. One of the most profound influences I have had in the field of EP is in educating others to practice medicine in a way that makes the field more than the daily grind. I train fellows to be the kind of people you would want to send your mother to if there were a serious problem. I am proud of every fellow I have trained and realize how much difference they have made to the practice of medicine.

Question: Could you share with us any pearls of wisdom for fellows who are transitioning into practice?

Stay connected with your past and carve out your future with sage advice from experienced clinicians and senior investigators. Find colleagues who are passionate about and committed to what they do. Put your heart into your work and enjoy every day no matter how cloudy it might appear to be. Try to find a balance in life but realize it does not exist. Enjoy life, and love your patients.

Question: You have served as a Principal Investigator and Co-Investigator for numerous clinical trials, Please describe the study that you feel has or will have the greatest impact?

I cannot say that anything I have ever done will be remembered or maybe all of it would be. I am totally surprised, regularly, about how tidbits from my past work resurface in the strangest of places, sometimes 10-20 years later. My reward is in the interactions with the investigators, young and old, inexperienced and experienced. Many go into the field thinking getting a research grant is valuable. I look at the end product as the most important aspect of the research, and in the process. Money is not the issue.

Question: What has been the biggest challenge and greatest reward of your EP career?

Over the years, I have had the to work with people who are not necessarily committed to excellence in patient care and who do not understand or care what this means. It is unfortunate. The challenge in working with people who are not focused on the right things has, in some instances, affected my career. I have had my failures. A lesson for those coming up in the field - it is not the end of the line. In fact, the failures are almost like a flower growing out of a junk heap. Sometime, new opportunities arise unexpectedly with stunning success. Fortunately, I have had the opportunity also to work with some of the best people in our field and even some great administrators. The collaborations have been intense and placed us at odds sometimes but these interactions have been among the best things I've had the opportunity to do in my life. The greatest reward is to see how to make a difference despite all the challenges.

Question: Please share with us your most complex and challenging case? How about your worst case?

Based on my areas of expertise, and perhaps for other reasons, I have seen some of the most challenging EP cases. It is hard to really say that there is one in particular that has been more complex than any other but I learn every day from patients and from my colleagues about how to manage complex and difficult clinical situations. I'm willing to take on some of the most difficult and challenging problems and not all patients have had excellent outcomes despite my wishes. One thing I learned is when to ask for help and when to count on colleagues who have specific expertise that I do not have. The value of collaboration and the community of electrophysiology makes our field unique, strong and valuable. I could not hope for better colleagues and I am proud for all we have accomplished over the years.

Question: Outside of your professional career, what are your hobbies? What gives you the greatest enjoyment?

I very much enjoy boating, music, travelling, philosophy, and creative writing as well as interacting with creative, innovative, intelligent and bold people who are willing to go over the edge.

Question: What does the future hold for electrophysiology?

One of my colleagues questioned years ago (1980s) if there was any future in EP and then look what happened. The future is so bright we need sunglasses. We need to stay focused on our goals and wend our way around changes and challenges in medicine. Although I'm concerned about where medicine may be going at this point, I think we will be very surprised and happy to see how much ourfield will progress in the next 10-20 years since we have very highly talented and enthusiastic young colleagues who will carry the torch to the next generation of electrophysiologists and then the next.