Dr. Harvey: It’s interesting because when you're in training, you're taught “this is how it's done.” And you're taught that by really smart people, and it's almost kind of like it went from God to them to you. But something started to change for me. When I came to WellSpan, I was lucky that I was doing a lot of procedures, getting more at bats than most people. And I started saying, “this makes no sense.”

So I picked up the phone and called a guy I trained with, Hemal Gada, MD. By then, technically we were “competitors,” but we had been bloodied and battled together as fellows so we're friends. And I told him, “I'm having trouble with this.” He said, “I think you’re looking at it wrong. I like this view.” I said, “That view makes sense. What wire are you using?” He said, “I use this wire.” I responded and said, “That’s stupid. That’s not enough stability. I’d use this wire.”

It was this very organic conversation. We weren’t thinking we were going to change the world. It simply started from not being satisfied. The more we talked and compared notes, the more we realized we should think about how we’d approach the procedure from the ground up.

Dr. Harvey: Yes, I was doing some research on intravascular ultrasound and stents and there was an animal lab, and we were able to get some time in there. When we started thinking about it from a fresh perspective, it changed the conversation.

One of us would say, “I’d probably avoid this area – that’s where the conduction system is, so let’s use this view.” And the other would respond, “Let’s try this wire.” It became an iterative process once we got started, and we kept at it. We’d share about something we tried and how it worked, and we’d ask each other’s opinions.

Because of our idea, we got a call from a guy I trained with at Cleveland Clinic, Rishi Puri, MD, PhD, and he said, “I’ve got an idea about this new 3-D probing with MRI catheter and I think we need to use your technique – the cusp-overlap technique.” So I flew to Cleveland and we got to work in an animal lab there. It was an ovine model, and we joked that we were doing TAAAVRs.

I remember I was so excited because this was real research. We were able to take our idea of what we thought would work and prove in the animal lab that it was working. The outcomes were good so it almost didn’t matter, but we actually proved that the view lined up the way we thought.

And we kept at it until one day, we realized that the national pacemaker rate for this procedure was around 25% and Hemal and I were both at 5% or less. Hemal told the chief medical officer at the valve company and I’ll never forget that phone call. The CMO of the company at the time asked us, “Could you guys teach this?” And everything changed. The next day the phone started ringing.

“Would you go to Missoula, Montana and proctor?”
“Can you go to conferences at Cleveland Clinic and Harvard?”
“We’re having a session in France, could you go?”

Then the FDA got involved and said to Medtronic, you have to prove you can teach this, so we joined the teaching and education committee for the Optimized Pro trial and helped them develop the procedural technique. At first, Hemal and I were the North American proctors, and then a third proctor joined us. I was flying somewhere every single week.

Dr. Harvey: The really cool thing about all the traveling and teaching was that I learned two big things. One, I learned that people were smart. Yes, I was going there to teach them something, but I was going to learn just by being there. It gave me a very different view of what's going on in the world, because it's not the same as my lab. And that was great.

And then the other thing I learned was that I could teach and pass on what I knew. Hemal and I had figured something out because we were pretty good at doing this but now we had to teach it. It’s a different skill set. I had to be able to explain what I was doing to someone else. If they started to go off course, I had to be able to talk them back without even touching the catheter.

The best thing about it was it afforded an opportunity for real talking between real operators. And while I did teach a lot of people, I also learned a ton that I got to bring back.

Dr. Harvey: First and most important, surround yourself with smart people. Hemal saw the opportunity way more than I did, and he was the one who thought it would be of value. Rishi had another idea that helped take us further. These guys I met during my training were instrumental in this happening.

The second thing would be to find what you’re good at and what you are passionate about and pursue that. I had good training but I never envisioned myself as a researcher. Before this, I had written one trial in my life. The beauty was I found what I was good at - I was good at doing procedures and I did a lot of them – at the time, I had done 300 TAVRS myself. That gave me insight that a very smart academic wouldn’t have, because that’s so many at-bats that I started seeing things I wouldn’t have if I was solely focused on research.

The bottom line is I capitalized on what I was good at and what I enjoyed and that actually led to something good. And there's no coincidence there, that's just how it happens. And so I'd say you don't have to try to be everything; be good at what you're good at and then if you're listening and you're watching, when the opportunity comes, you'll see it.

Dr. Harvey: I can't say most; I’ll give you a couple of things in this process that I am very proud of.

When I was in medical school, I just wanted to be a good doctor. I didn’t have aspirations of all this – I wanted to take care of patients because that’s what I love to do. And I'm proud of the fact that we did enough of these procedures so that when that little voice tugged and said “this can be better,” we listened and we had the nerve to try something different and make it better for our patients. I'm proud of that – it’s harder than you think to challenge what's been taught to you.

I was proud to discover that I am a good teacher, and that at the highest-level conference, I could still add value.

I'm probably most proud of the fact that I recognized that while I was doing something good, it was completely unsustainable to my wife and my children. We sat down and said, “This is what really matters and that means making hard decisions and saying no to good things.” So I set boundaries – limiting travel and week night events so I can put my family first. I am probably more proud of that than anything else.

Dr. Harvey: How few people are doing it – challenging the status quo or trying to change things. I suspect from this experience that there's a lot of wonderful ideas that are never suggested or never proposed because of insecurity or whatever reason. There's probably a lot of great, novel ideas that are never pursued.

It doesn't take quite as much as you think to change the world.