An ultra-marathoner and eight-time marathon runner, Raymond Rodriguez, M.D., serves as a role model for his cardiac patients, inspiring and empowering them to make fitness a part of their lifestyle. In an interview with The Source, Rodriguez talks about his practical ideas for improving population health, his passion for medical missions work in the Dominican Republic and his plans to assist members as a HealthTrust physician advisor.
In what ways are you improving healthcare on a micro level?
I operate a very patient-centered practice. When sick patients walk in unexpectedly, it doesn’t throw us a curveball. I’ve trained my staff to ask specific questions to help determine if we need to accommodate them immediately, or if they can wait.
Through this simple process we’re able to identify some very ill patients who need to be hospitalized. Recently, a 50-year-old man showed up at the office on a Friday morning and told my receptionist he wasn’t feeling well. After asking our preliminary screening questions, she realized he needed to be seen right away. I examined him and saw that he was having a heart attack. We rushed him to the hospital, where he underwent a heart catheterization and coronary stenting for two major blockages. Thankfully, he’s OK.
Whenever an incident like this happens, we convene a flash huddle to review what we did well and what, if anything, we could have done better.
How about improving healthcare on a macroscale? What would you like your role to be?
Fitness is a huge focus of mine, and I believe it can play a major role in improving a population’s health. However, I became acutely aware a few years ago that many people know they need to get into shape but they don’t know how to do it. If they have arthritis or other chronic conditions, it complicates the process further.
When I worked at the University of Pennsylvania, an exercise physiologist and I ran a popular “Walk in the Park With Your Cardiologist” beginner fitness program. We helped patients make walking one of their healthy habits. Each group was composed of 10 people, many in their 50s, 60s and 70s with heart problems.
The program included 30–40 minutes of education on cardiovascular fitness. I answered questions the average non-athletic person tends to ask, such as: What is aerobic exercise? Should I stretch before and after I exercise and, if so, how? What’s the best way to cool down? How long and intense should the workout be? We also talked about practical matters, such as what kind of shoes to buy and clothes to wear.
Each session ended with a two-mile walk in a beautiful park. Even though it was only a four-week course, individuals within the groups formed friendships and continued to meet after the formal program was over.
What does it mean to be a fitness role model for your patients?
I wasn’t very athletic until 12 years ago, when a patient inspired me to run a marathon. The training journey taught me a lot about fitness and exercise physiology, and the mechanics and psychology of running. The first marathon really was a life-changing event for me.
I’ve done eight marathons since. Four years ago, my wife, Michele, and I did the Two Oceans Ultra Marathon in Cape Town, South Africa. It’s a 36-mile route across the Cape of Good Hope from the Indian to the Atlantic oceans. It was extremely challenging, but I’m so proud to have done it.
Even after all the races, I still don’t like to run when my alarm goes off at 6 a.m., but I like how I feel when I’m done. My days always start off better. I often share this anecdote with my patients so they know it’s normal not to always love exercise.
How do you motivate your patients on their fitness journeys?
Instead of telling my patients to exercise, I tell them to focus on being FIT, an acronym for frequency, intensity and time devoted to an activity. I ask for 20 minutes of cardiovascular activity five days a week. Then I tell them they can organize the rest of their lives into the other 23 hours and 40 minutes of the day.
Another important part of the FIT equation is regularity. Even a trained Olympian athlete starts to decondition after four days of not participating in aerobic activity. Naturally, when we non-Olympians go on vacation for a week or stop exercising because we have a cold, it hurts to go back to working out. I tell my patients bluntly that they should avoid missing more than a week of their fitness program—that’s often when people fail.
The final piece of the puzzle is accountability. I encourage my patients to find an accountability partner to help give them the jumpstart they need and provide motivation when challenges come up.
What does medical mission work mean to you?
I’ve been on five trips with Somos Amigos Medical Missions, which serves a remote, mountainous village of 300–400 people in the Dominican Republic that lacks access to medical care.
The program is unique because it’s focused on medical volunteers going into the same community with the goal of long-term healthcare management. For a week, from sunup to sundown, our team sees all types of patients—from young children and pregnant women to 80-year-old men. We live with the community, eat local food and sleep in mountain houses, most of which don’t have indoor plumbing. It’s a powerful experience because we really get to know the patients by living among them.
We come back home exhausted, but it’s such a rewarding experience professionally and personally. In almost every trip, I diagnose some kind of congenital heart disease, even with basic cardiology tools. It definitely grounds me, as well as reminds me of how fortunate we are in this country.
Why were you interested in becoming a HealthTrust physician advisor? What are your initial impressions after a few months “on the job”?
A colleague of mine at the University of Pennsylvania was a member of HealthTrust, and he talked about the mission of the organization. I thought it was intriguing because of my interest in healthcare projects that change the paradigm and physician leadership education.
I have been incredibly impressed with HealthTrust’s clinical evidence reviews. They’re well researched, concise and practical, referencing documents and abstracts presented at the American College of Cardiology and American Heart Association meetings. I can complete my analysis in an hour, rather than spending 10 hours on my own to reach the same conclusions.
How have you contributed to HealthTrust’s work in the cardiovascular specialty area?
Most recently, I provided input on atherectomy catheters and devices used in the treatment of chronic total occlusion. For many of these devices, I was able to tap the opinions of my colleagues across the country. Even if I’m not familiar with a device being evaluated, I’m able to glean a variety of opinions within the field to gain a broader, more balanced perspective that helps me formulate my response to a HealthTrust inquiry. The process certainly keeps me on the cutting edge, which helps make me a better physician.
What’s your view on HealthTrust’s product review process?
I admire HealthTrust for recruiting a wide spectrum of physician advisors and promoting deep dives into products. I’ve been amazed by the almost universal response to questions about particular products or devices, even across different institutions and geographic locations. Having a consistent voice from physicians who are actually using the devices becomes very powerful. If other physicians want to ignore the consensus reached by these physician advisors, they must have a really good reason.
What do you see as one of the biggest healthcare challenges facing physicians today?
The push for electronic medical records has negatively impacted physicians, particularly senior physicians. I see so much physician burnout and discontent, and less clinical activity. But, they’re not alone—I recently polled 20 medical residents and asked, “In a 10-hour day, how much time are you spending on your computer versus spending with patients?” The near-universal response was “I spend eight hours a day on computer work and two hours a day interacting with patients.” That’s just wrong. For physicians to understand the nuances of their patients’ health, they need to maximize face-to-face interactions with patients. The move away from that is frightening.
Raymond Rodriguez, M.D. is a board-certified, non-invasive cardiologist and serves as medical director of Mount Sinai Cardiology of the Florida Keys in Marathon, Florida. He also serves as an assistant professor of medicine at the Columbia University Division of Cardiology at Miami Beach, Florida-based Mount Sinai Medical Center.
Previously, Rodriguez held a similar appointment with the University of Pennsylvania, where he practiced for more than 20 years. He was affiliated with multiple hospitals in the Philadelphia area, including Abington Hospital-Jefferson Health, Chestnut Hill Hospital and Penn Presbyterian Medical Center.
Rodriguez earned his medical degree at Georgetown University in Washington D.C., and completed his internship and residency in internal medicine and a cardiology fellowship at Thomas Jefferson University Hospital in Philadelphia. He is a fellow of the American College of Physicians and the American College of Cardiology, and a member of the American Medical Association, American College of Sports Medicine and Chest Pain Society.