President’s Blog

Madhav Swaminathan, MD, FASE, ASE President

June 15, 2020

Resolve, resilience and recovery

As I write my final blog as ASE president, it’s hard to believe that it has almost been a year since I began my term in Portland last June. I’d like to take this opportunity to reflect upon my resolve to focus on three areas for ASE – diversity, caring and core values – along with the myriad of enriching experiences during this eventful year. Sometimes mentally exhausting and, at times, physically tiring, the subsequent months were extremely fulfilling as I went about travelling across continents and making connections throughout the world as ASE’s ambassador. I made new friends, reconnected with old ones, and rejuvenated relationships that more than compensated for any travel fatigue. At ASE, we also worked diligently on our plans to enhance diversity, create a caring community, and develop our core values.

Then COVID hit and the world as we knew it changed dramatically.

As we were coming to grips with the stress of the pandemic, passions of a sickness-weary public were fueled by an act of racial injustice that galvanized citizens around the globe to plead for change. Two events juxtaposed – one that sent people into isolation, and another that brought them out in huge numbers. Some changes, like COVID, are forced upon us. We respond because we don’t have a choice. Then there are those changes which force a response from us because we do have a choice. At ASE, with a focus on diversity, caring and core values, we were well placed to respond to both crises with the right approach. I’ll try and recapitulate the effort we put into our plans and how these concerted efforts helped us respond appropriately.

The first focus was on diversity and inclusion, and we attempted to make the Society more aware of its significance in all our activities. It is important to remember that not all aspects of diversity are obvious. While race, gender, and ethnicity may be the most visible, other less recognizable forms of diversity, including institutional, specialty, and international, also need due consideration. These take a more active approach to incorporate. It is vitally important to heal the wounds of racial injustice, and our efforts must be directed towards eliminating the systematic bias that threatens the diversity of our community. After firmly articulating a diversity policy late last year, we created a task force to examine all our activities and make recommendations to address any deficiencies. Later, and perhaps most importantly, we incorporated diversity as a core value. Although this kind of change is gradual, we can already see its positive impact on our efforts in several activities. From selecting speakers at our meetings to organizing committees and writing groups for our official statements, diversity has become an imperative driving principle. The eventual goal is to make us more effective as a society by including viewpoints from across the spectrum of our diverse community. This will also make us more resilient.

The second focus was on was building a more caring community. While originally targeted towards the omnipresent threat of burnout, the concept of a caring for each other centers around mutual respect, which helps promote equality and combats discrimination and bias. Consequently, we launched the #ASECares campaign. The GEM program was also created to recognize our hard-working colleagues, and other initiatives were introduced for our meeting attendees that included onsite childcare and lactation pods. We planned wellness activities and developed resources to enhance the sense of community among our members. ASE also participated with a consortium of societies that coalesced resources to deal with the scourge of work-related musculoskeletal disorders among our echocardiographers. The goal was for our providers to be better positioned to handle stresses – physical, mental, or emotional – of our healthcare system and the world outside it. Again, our efforts attempted to enhance our collective resilience.

The third focus was on developing our Society’s next strategic plan. In November last year, ASE leaders  gathered to create a vision and articulate a mission that would incorporate our core values and develop our strategic goals for the future. The retreat was an opportunity to reflect on our past successes, learn from our failures, and chart a path forward for ASE for the next several years, thereby reaffirming our commitment to excellence in every aspect of cardiovascular ultrasound. It turns out that the intense exercise of creating a vision, mission, and core values was necessary in making us more resilient by further strengthening our foundation to withstand future crises.

Like most of us, ASE’s past year too was clearly a story of two parts, surgically divided by a virus. After February, our world changed drastically. As this global health crisis continues, our ability to withstand its long-term impact will depend largely on our resilience. Thankfully, our resilience predates the pandemic. The statistics on burnout notwithstanding, healthcare providers are fundamentally resilient, driven by their ability to see positivity in the toughest of situations. The Society too deftly responded to the new needs of our community that emerged in this pandemic. ASE quickly released a detailed statement on March 18 to guide our practitioners on best practices during the outbreak, advocate for the protection of our patients and providers, and promote the value of cardiovascular ultrasound to legislators and regulators. Groups within ASE added support for practitioners in their areas, held webinars, and fielded questions to allay the anxiety of echocardiographers. Later during the pandemic, we developed a framework that would help echo labs around the world to safely resume services and restore some semblance of normalcy. Like other groups, we also took several blows, including the cancellation of our Scientific Sessions and other live courses. However, a nimble shift to virtual platforms enabled us ensure the continuity of our mission.

The pandemic tested our resilience, but we proved more than capable of withstanding its pressures. The moral crisis of racial inequality is once again challenging our resolve. Guided by our mission and commitment to our core values such as diversity and caring for each other, our community remains resilient and our Society strong. Together, we will emerge stronger from this crisis too. In the coming year, ASE will continue to explore novel ways to reach our strategic goals with innovative ideas. The Society is in great shape and thriving in the capable hands of our amazing volunteer leaders and outstanding staff.

It has been my honor and privilege to serve the world of cardiovascular ultrasound as the president of ASE. I have also enjoyed writing these blogs and sharing my thoughts with you. I deeply appreciate the feedback you have provided during my tenure at ASE.

Take care and let me know what you think on Twitter @mswami001.

Madhav Swaminathan

May 1, 2020

The pursuit of positivity in a pandemic

The COVID-19 pandemic has impacted almost every person on this planet in one way or another. With millions of people infected and thousands succumbing to this disease, the pandemic has decimated world economies, overwhelmed healthcare systems, devoured large and small businesses, and continues to mercilessly add people to a growing list of those furloughed, unemployed or bankrupt. Ominous signs point to a second wave of bleak repercussions. From complications of COVID-19 to the deferred treatments for existing conditions, the negative effect of this pandemic will continue to be felt for some time. Even further out, we can expect our healthcare heroes to increasingly report burnout and chronic consequences of COVID-related stress. When it feels like dark clouds are enveloping the entire globe, a silver lining is hard to imagine. But the human spirit is remarkably resilient and has always triumphed over adversity. It may seem hard. However, it is not impossible.

While this pandemic may have brought many things to a halt, it has also forced us to re-evaluate what we consider “essential”. I’ll provide personal examples that may resonate with some. I am acutely aware of how much time I have spent traveling, including waiting at airports and staying in hotels. Now I am spending that time at home with family. “Non-essential” activities, like airport waits, are no longer vying for or encroaching upon that time. I realize that I may not be able to travel to see my extended family and friends but, thanks to video conferencing, I have never felt more connected to them. Now we “meet” way more often virtually. The cacophonous excitement of this meeting is a welcome distraction from the depressing news cycle on television. Watching some baby boomers first hesitantly fumble and then get tech-savvy just to connect is a uniquely satisfying experience in itself! Even though conference rooms are shut, virtual meetings are buzzing with greater attendance and, in many instances, interactivity.

We don’t go out to eat at restaurants these days and the ‘foodie’ in me misses that experience. However, that’s been replaced by something better – the making of healthier home-cooked meals and consuming them with family. Even though gyms are closed, the vast outdoors remains open for business, and that too in spring. I’ve never walked or run outdoors this much ever before, and now I do so with my wife for company!

While we all have always considered those in healthcare as essential workers, new and worthy candidates for the ‘hero’ sobriquet have emerged during this time. Grocery store workers, janitors, package deliverers, convenience store employees, and many others, have joined the team of essential folks that are providing invaluable service to keep our world moving despite a shutdown.

Many in our echo community are working tirelessly to scan COVID patients in heavily-impacted hospitals during the pandemic. Some have been furloughed while others anxiously await the return of ‘normalcy’ in whatever muted or phasic form it arrives. Anxiety and stress are common, arising from personal or professional concerns in almost equal measure. This is especially true when grim news seems to come in a deluge while uplifting stories barely trickle in. The constant barrage of negativity on television and social media may make us oblivious to the several positive signs all around us. But they do exist. As echocardiographers though we should be skilled at distinguishing signal from noise!

Signs of caring are everywhere. Communities are honoring their neighbors who work in healthcare. Hospital workers are celebrating their frontline colleagues. Messages of gratitude are now often seen on faces of buildings, storefronts, neighborhood front yards and social media. Corporations are giving generous discounts to healthcare workers, be it for shoes, gasoline or meditation software. These signs are all around us; we just have to recognize them.

While challenges remain real, there are also several opportunities to make a difference. There are two sides to every coin. You just have to flip it to see the other side. At ASE, we have never ever had to cancel so many events, including our beloved Scientific Sessions. However, our teams have accepted this challenge as an opportunity to do something new and exciting – to host our first-ever scientific sessions virtually! We may not be able to congregate physically in one place yet, but we will still learn and teach together. We may not be able to travel to the conference venue, but we will still embark on a virtual journey for an exceptional educational experience. We may not be able to shake the hands of peers and experts, but we will still network from our homes and continue to forge and cement new connections. Our Society has also been working hard to ensure that our hardest-working community members have the resources they need in our wellness center to stay resilient and withstand the stress this pandemic continues to unleash.

Even though it may be difficult to look for something good in the midst of this global health crisis, it is not impossible. Moreover, the pursuit of positivity is probably a lot more worthwhile and will help you emerge stronger in the long run. And when the light at the end of the tunnel does become visible, the resilient will see this glimmer as hope. I choose to remain positive during this unfamiliar time. I hope you will too.

Take care and let me know what you think at, or on Twitter @mswami001.

Stay well. Stay positive.

Madhav Swaminathan

Read previous blog posts:

April 2020 – Connecting and caring in a challenging time

March 2020 – Paying it forward

February 2020 Snorkeling and the value of discomfort

January 2020 – Celebrating our similarities

December 2019 – What is your duty factor?

November 2019 – Gratitude, Reflections and Parachutes

October 2019 – Leadership lessons from a ladder

September 2019 – People helping people

August 2019 – Giants and their shoulders

July 2019My first blog as President of ASE

April 1, 2020

Connecting and caring in a challenging time

A pandemic that is impacting every aspect of our lives is also hurting us through fear and anxiety. The 2019 novel coronavirus, or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that results in coronavirus disease-2019 (COVID-19), continues to march across the globe with little regard to artificial boundaries of politics, religion, or ethnicity. But what’s marching even faster is fear. As healthcare providers, who are at the frontlines in the battle against disease, fear and anxiety can cripple our ability to care for those truly in need. However, as we fight this tiny yet formidable foe, a lot of us, including me, are torn between our professional duty of care and the risk we may pose to our loved ones as we do our job. During this difficult time, it is wise to take a pause, follow the recommendations of your institutional experts, and arm yourself with knowledge from trusted sources. And while you do that, indulge in some self-care, care for others and occasionally, some humor too.

The surrounding negativity can quickly devour any rationality within us. While we may be socially distant, we have virtually come together as a community more than ever before. From Madrid to Mumbai, the sounds of home-bound people standing at their balconies cheering healthcare workers as their newly minted heroes, and each other as they realize the strength in a collective response, is truly heartwarming. Handling the stress of a global pandemic that hits our homes, our friends, and our wallets, is hard, to say the least. It is at times like these that self-care can be the armor against this apparently invisible enemy. Working from home may bring several challenges, but it also brings some unique opportunities that may not seem obvious.

Technology has enabled us to make even more connections with people across the world, whether in virtual meetings, or online webinars across several time zones. The COVID-19 webinar from ASE on Wednesday, March 19, 2020, attracted over 4,000 registrants from a global audience, and the recording on the ASE YouTube channel has received over 16,000 views. People have shared their institutional protocols, ideas for protection of echocardiographers, best ways to shorten scan time, and of course, methods for ensuring high quality images. On social media, people are sharing how they are keeping themselves healthy through exercise and meditation. Some have come together for virtual yoga classes. The company Headspace, now offers free meditation modules for healthcare workers to help ease anxiety and stress. Even the CDC coronavirus site has a section on management of stress during this difficult time. Social distancing has also promoted “distant socializing” (courtesy ASE past president, Michael Picard, MD, FASE) through Zoom and Webex, as more and more people turn to innovative solutions to remain connected to one another. Maintaining connections is a critical factor in ensuring our emotional survival during this difficult time.

If you’re working from home, check in with a colleague on the frontlines. If you’re working on the frontlines, check in with a co-worker. But take a moment to take care of yourself as well. There’s a reason behind that safety announcement that flight attendants make at the beginning of a flight, “Ensure your own mask is on before helping others.” If you run out of oxygen, you can’t help anyone else. So, take a moment to ensure you take care of your own health and well-being.

As we continue to adjust our lives to a new reality that changes every day, the one constant is our need to remain connected to our communities. We have realized that socializing may not necessarily require physical proximity. The pandemic has forced us to be physically distant from each other, but has made us all connect in many other virtual ways that could turn out to be an unexpected benefit.

Take care and let me know what you think at, or on Twitter @mswami001.

Madhav Swaminathan

March 16, 2020

COVID-19 Update

As we all grapple with the unexpected impact of the coronavirus pandemic on every aspect of our lives, I wanted to provide you with some information on how ASE is responding.

The 2019 novel coronavirus, or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that results in coronavirus disease-2019 (COVID-19), continues to impact every aspect of our lives. Healthcare providers, who are at the frontlines in the battle against disease, are at high risk when we participate in the care of patients who are suspected or confirmed to have COVID-19. ASE is committed to the health, safety and wellbeing of our members.

At this time, we encourage you to follow your institution’s guidelines, and trusted sources, such as the CDC, and federal guidance on COVID-19 preparedness. We understand that many of you have questions regarding performance of elective procedures, triage, personal protective equipment and cleaning of equipment. ASE has organized a live webinar on COVID-19 preparedness for echo labs, which will feature experts who are at the frontlines in this battle. You may register online for free here. Please spread the word among your colleagues and have your questions answered and share your own experiences. A social media thread on Twitter has been organized using the hashtag #EchoFirstSafety.

In addition, we have created a discussion thread for members on Connect@ASE which may be accessed here. I urge you to share your lab’s protocols and ask questions to enhance our knowledge base. A COVID-19 resource page has been created on the following ASE site, which may be accessed here.

A small group of experts are preparing an ASE statement with pooled information that will help guide echo labs on recommendations for dealing with the pandemic and protecting our patients and healthcare providers. The statement will be released soon.

As of today, March 16th, the ASE headquarters has instituted a work from home policy for all staff members. More details are available here.

We are all in unfamiliar territory. While we struggle with uncertainty and stress, it is important to remember that we are all in this together and we will all get through this together as a community that cares for each other. Take a moment amidst this crisis to check in with your colleagues and your family members, especially the elderly and vulnerable among us. ASE remains strong with our committed member volunteers, dedicated staff, and engaged leadership.

Please do not hesitate to send any questions or concerns by email at

Madhav Swaminathan, MD, FASE
ASE President

March 1, 2020

Paying it forward

A few decades ago, I was offered a training position in another country. I was delighted to accept this offer, but there was one small problem. I couldn’t afford the cost of travel and accommodation for my family and I didn’t want to go alone. On learning about my predicament, an elderly gentleman, whom I vaguely knew, offered to help out. He provided me with the funds that enabled my family to travel with me. I was obviously concerned about the terms of this ‘loan’. While he didn’t ask for it to be returned, it did come with one condition – that one day when I am able to do so, I should pay it forward to another deserving trainee. In his words, he was making a worthwhile investment in the education of a deserving candidate, and hoped that its dividend would to be realized by a future trainee. He had no way of ensuring or guaranteeing that his transaction would reach its desired outcome, but relied on the goodwill and positive impact his act of kindness had created.

The concept of paying an act of humanity forward is perhaps as old as parenting itself, in which there is a generational transfer of kindness. However, in our busy professional and personal lives, its practice is not perfect. We often assign little time to engage in acts of kindness or humanity unless an opportunity presents itself. There is also the situational context. Research suggests that our attitude towards helping strangers is greatly modified by the setting and the company we keep. When we observe a few people help, we tend to help more. However, when we see several people help others, the ‘bystander effect’ kicks in and we feel our time need not be sacrificed, a phenomenon termed ‘diffusion of responsibility’. In contrast to the observation of kindness, when we receive an act of generosity from a stranger, we are far more likely to pay it forward to another stranger. Hence, that act of kindness towards someone you don’t know may potentially have a positive impact in perpetuity.

Unfortunately, behavioral science suggests that the reverse is also true and may even be asymmetric. We tend to pay forward negative treatment towards us more than generosity, since negativity tends to hit us harder and generates a stronger emotional reaction compared to positivity. These natural human reactions to acts towards us have profound implications. We can choose to reciprocate the act back to the giver, do nothing, or pay it forward. The impact of each action can either be limited or be exponentially propagated. In every situation, though, we have a choice. And perhaps the most optimal one is to pay positivity forward, and even potentially cleanse the reaction to negative behavior with an act of humanity.

The important point here is that when we receive an act of generosity, paying it forward has great benefit in promoting happiness and resilience. Our act may be observed by someone else, thereby setting up a cascade of generosity in many directions. One result of this propagating positivity is altruism and an increase in overall giving. In a professional society like ours, which relies on its volunteers and donors to be the voice of echocardiography, giving is what drives us. So, the next time you observe or receive an act of generosity, pay it forward. And if that involves ASE and its Foundation, you may help a trainee travel to an educational event, or conduct valuable research, or diagnose congenital heart disease in an underserved community. The positive impact could be exponential.

Many years after my interaction with the benevolent gentleman who helped me with my international training, I had the opportunity to support a bright young college student who was struggling to complete her courses as she couldn’t afford the associated expenses. My benefactor was in my mind when I offered the student some financial aid. It did, however, have one condition attached – that she pay it forward to a deserving candidate one day….

Let me know what you think at, or on Twitter @mswami001.

Madhav Swaminathan

February 2020 

Snorkeling and the value of discomfort
“A ship is safe in harbor. But that is not what ships are built for.”  – John Shedd (1928)

Lessons in leadership can come from very unexpected sources and often in the most unexpected of places. On a family vacation many years ago, I watched as my young kids tried out snorkeling in the shallow sea for the first time. Uncomfortable with the concept of breathing underwater, my son put on his mask and snorkel and proceeded to enter the warm water with some (more likely, a lot of) trepidation. He struggled to breathe through the snorkel and I struggled with his discomfort. After several unsuccessful attempts to keep his face under water, I asked him to get back to the safety of the boat and not struggle in frustration with the snorkeling gear. I gave up for him. To my surprise, he refused to get back to safety, saying, “No, I need to get this right.” After a few coughs and sputters, thanks to the unwelcome contact between salt water and his vocal cords, he learned how to breathe under water with a snorkel and emerged from the water with a sense of “I did it” pride. He had actually done way more than just learn how to snorkel. He had conquered his fear by not only declining safety, but by embracing discomfort. And by doing so, he also taught me a valuable lesson. Discomfort is something most of us are unwilling to experience, thereby placing limits on our curiosity. Most successful people and organizations have taken risks at some critical point in their evolution, when others preferred safer options. By conquering his fear, my son got to see the beauty of the coral reef and also whetted his curiosity about the experience of being able to breathe underwater. Curious people are naturally willing to step outside their comfort zone and risk discomfort for the opportunity to grow. While discomfort may be a possibility, growth is a guarantee!

But are curiosity and growth related? Is risk necessary for innovation? Could either be a solution to the healthcare burnout epidemic?

In her best-selling book, The Beauty of Discomfort, author Amanda Lang argues that curiosity is key to innovation, and as we grow into adulthood, we progressively lose that element that helps us grow. The tendency to curb our natural instincts to take risk increases as we grow older. A retreat into a comfort zone consequently leads to a lack of growth. Sixty-five percent of us just show up to work, she claims. Indeed, a 2017 Gallup poll of U.S. workers found that about 51% of workers are disengaged, and about 16% are “actively” disengaged. The most glaring differentiator between kids and adults happens to be curiosity. As I indicated in my January message in JASE this year, the avoidance of discomfort drives our resistance to change. We somehow stop asking the question “Why?”, and perhaps, even more importantly, don’t ask “Why not?” But to be sure, the world will continue to change driven by the few who see value in discomfort, the significance of curiosity and the benefit of growth. Our Society has always had amazing members and leaders who have taken bold decisions, however uncomfortable, that benefit the world of echocardiography. A great example was during the 2007-2008 recession, when, despite the tumbling stock market, we remained steadfast in our commitment to education and invested accordingly. It resulted in a positive trajectory of growth that is still visible.

Now to the second question of risk and innovation. Larger and established organizations are quick to realize that innovation is critical for survival. They know that if they don’t shed their ‘safety’ mindset, they will trade innovation and growth for stagnation.  In 2018, then ASE President Jonathan Lindner, MD, FASE, took a risk when he envisioned and created the E21 grants to stimulate innovation through novel, yet natural partnerships between engineers and clinicians to further discovery in echocardiography. What remained unknown at the time was how we would fund these ideas. However, he was undeterred by the risk of an unfunded initiative and proceeded to raise money for the idea. The results of this bold action were quite spectacular. We had about $600,000 in funds contributed by several entities who saw great value in the entrepreneurial spirit of innovation in echocardiography. Had he or the leadership preferred the safer option at the time, the E21 grants would not have been created and resulted in amazing projects that have the promise to improve lives with innovative ideas.

Finally, could curiosity be cultivated to fuel resilience and combat our burnout epidemic? In 1960, Berlyne proposed that while perceptual curiosity leads to the increased awareness of stimuli, epistemic curiosity drives the behavior to acquire new knowledge. It is probably the latter that represents the positive trait that combats depression and anxiety by fueling the exploratory mindset. Research suggests that curiosity is indeed linked with mood and physical activity and is positively associated with well-being. And it can be cultivated by focusing attention on activities that promote learning and a sense of purpose. The development of an exploratory mindset and the ability to seek out discomfort is more likely to promote engagement and prevent stagnation, and has been proposed as one way to battle burnout. The ASE Cares campaign, which was launched in May 2019, aims to enhance member engagement to build resilience and reduce the burden of burnout. Perhaps providing our community with practical tips and strategies to stimulate curiosity and promote inquisitiveness will help with this effort.

That summer vacation was marked by a snorkeling adventure and lessons in curiosity, discomfort, growth, and accomplishment. I too have learned the value of stepping outside my comfort zone periodically and question safe choices. I guess it’s okay to be uncomfortable sometimes.

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001.

Madhav Swaminathan

January 2020

Celebrating our similarities
“But I don’t want to be different…”

For the last few years, I was focused on supporting diversity and inclusion in just about everything I’ve participated in. “Celebrating our differences” became my mantra. However, a recent conversation with a young man about why it was okay and even valuable to be different got me thinking differently when after a few thoughtful minutes, he said, “But I don’t want to be different, because I am like everyone else, right?” His words gave me pause as I pondered similarity in the face of diversity. Global travel has driven that point home.

In the last six months as ASE president, I have had the honor of representing our Society and its members at numerous international events. A mere transit through an international airport can give us an idea of how diverse we all are. Humans come in all shapes, sizes, and colors. Yes, we are all different. And yet, we are also similar. Each progressive mile of travel has increased my appreciation of our similarities in terms of our values and beliefs, in spite of obvious diversity. Wherever my travel took me last year, the same theme emerged. Echocardiographers all over the world share remarkably similar values – but manifest them in different ways.

Let’s start locally. I represented ASE at a legislative conference organized by the ACC in Washington, D.C. in November, 2019. Members of various cardiovascular subspecialty societies came together to brainstorm ways in which we could collectively leverage our strengths to both improve access to cardiovascular care and advocate to preserve valuation of our services by payers. Attendees came from all corners of the country and represented a diverse range of practitioners of cardiovascular medicine. A consistent theme throughout this gathering was the value of diversity and inclusion. We all reaffirmed our commitment to this important issue.

I also attended the Indian Academy of Echocardiography (IAE) annual meeting in Kolkata in November along with echo enthusiasts from several regions including South Asia, the Middle East, Africa, and Europe. The science presented at this meeting was of the highest caliber and relevant to local audiences. Presentations were brief, targeted towards specific topics and largely case-based to allow greater engagement with audiences. The underlying themes I felt that emerged at this meeting were education and growth. All IAE members and leaders were committed to the value of self-improvement through high-quality education and growth of the next generation of echocardiographers.

In a meeting with the British Society of Echocardiography leadership, also in November, I discussed opportunities for working together to benefit echo enthusiasts in both countries. The value we implicitly endorsed here was collaboration. We were determined to explore novel ways to engage echocardiographers on both sides of the Atlantic that would be valuable to both groups.

Our Society had a strong representation at the Euro Echo meeting in Austria in December. Once again, the scientific content of the meeting, format, posters, discussions, were of the highest quality and we all learned a great deal from each other. In the midst of focused education and cutting-edge science was a free supervised creche for children. This very visible effort to include all attendees was aimed at facilitating those with young children to attend the meeting by providing them with an on-site childcare option. It became obvious to me that the values of community and caring were pervasive.

Throughout my travels and at each of these meetings, it became evident that our similarities were so much more pronounced than our differences.

As we ring in 2020, I can’t help but think that this joyous celebration of a new year is truly global. Across the planet, we will welcome the new decade with a spectrum of resolutions to change ourselves and the world we live in for the better. Perhaps one way to ensure a better world is to recognize that despite our diverse origins, no more than six degrees of separation connect us all. It’s our common values that probably keep us together, diversity notwithstanding. Hence, while we continue to celebrate our differences and our uniqueness, let us resolve not to forget what makes us feel like everyone else. I am grateful to the young man who got me thinking about diversity and similarity as two sides of the same coin. Realizing that he wanted to feel included like everyone else despite his uniqueness, my answer to his question was an unambiguous “Yes, you are.”

Happy New Year everyone!

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001.

Madhav Swaminathan

December 2019

What is your duty factor?

“When you talk, you are only repeating what you already know. But if you listen, you may learn something new.” Dalai Lama

Listening, it is said, is perhaps the most important skill a leader should have. Having two ears compared to a lone tongue should make this an easy choice. However, only if it were as easy as it is logical.

We are primordially primed to listen for threats; the purpose is survival. Listening in a non-threatening environment, however, is a nuanced skill that few have mastered. Perhaps we should take some lessons from our ultrasound machines. What is the connection? some may ask. Well, let me briefly take you back to that lesson on ultrasound physics. Ultrasound transducers spend about 0.1-1% of their time sending ultrasound signals, listening for returning signals in the remaining time between pulses; a phenomenon known as the duty factor. The result of this duty factor is quite spectacular. We get to see great images because our machines are such good listeners. And we learn something new about the person we are imaging. Let’s circle back to human communication. Oftentimes we listen with a focus on our subsequent response. That’s probably a bad idea. Natural, but nevertheless a bad idea. Active listening, or being present and engaged, is a necessary skill that can have a profound impact on all our relationships.

In an interesting study published a few years ago, researchers tested a framework of leadership skills stratified by organizational level (junior, mid, senior) and segmented by skill (cognitive, interpersonal, business and strategic), among more than 1,000 career managers in an organization. They found that cognitive skills, including active listening, were the most important among all segments regardless of organizational level, and were required to succeed throughout the hierarchy. Business and strategic skills emerged as more important requirements at senior levels, but still not as vital as cognitive and interpersonal skills. They proposed that leadership development programs required for career progression focus more on vital skills, which include enhancing the ability to listen effectively. It turns out that listening is an essential leadership skill, without which it is impossible to make progress. Regardless of the setting, active listening is perhaps indispensable for establishing trust, building solutions, and managing conflict. All three outcomes are centered on being quiet, yet quite active.

At ASE, we are actively listening to achieve the best outcomes for our members and attendees at our scientific meetings. Almost all of our educational content – whether at physical meetings, like the Scientific Sessions, or virtual offerings, like our webinars – is based on feedback from our users. The products are constantly updated and modified based on what we hear from you. Rest assured, we are listening!

Recently, we sent a survey to our members soliciting their thoughts about the Society. We listened to their concerns, suggestions, and thoughts on our performance so far and challenges that may lie ahead. ASE’s Board of Directors convened last month in Durham, North Carolina, to brainstorm our vision and strategic plan for the coming decade. It was an intense but thoughtful exercise in which we discussed, debated, and deliberated a diverse set of perspectives on the future of our Society. The entire exercise was based on feedback from our members and leaders. We were listening!

While we spend a lot of our time as ultrasound professionals guiding the development of echocardiography, we seldom pause to reflect on what leadership lessons ultrasound can teach us. The quality of an ultrasound transducer can be judged more by what it does while it listens rather than ‘speaks’. As leaders, we would do well to follow the example set by that transducer we so often hold in out hand, and ask ourselves, “What is my duty factor?

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001. I am listening!


Madhav Swaminathan, MD, FASE


November 2019

Gratitude, Reflections and Parachutes

“You cannot do a kindness too soon because you never know how soon it will be too late.” – Ralph Waldo Emerson

Charles Plumb, a fighter pilot in the United States Navy, was captured and spent six years in a Vietnamese prison after his plane was shot down. He had ejected and parachuted into enemy territory, and he survived. Many years later, at a restaurant, a man walked up to him and said: “You’re Plumb! You flew jet fighters in Vietnam from the aircraft carrier Kitty Hawk. You were shot down! I packed your parachute. I guess it worked!” Plumb replied, “It sure did. If your chute hadn’t worked, I wouldn’t be here today.” Plumb realized that we often fail to recognize those who play an important part in providing us what we need to get through our day. Gratitude is often an underused social emotion.

At some point later this month, many of us will gather and express gratitude for what we have. Either the fourth Thursday of November, as in the U.S., or the last Wednesday of November, as in Australia, or the second Monday in October, which has since passed, as in Canada, many countries and cultures have a way of recognizing a day when their communities can gather to give thanks. And for good reason. The benefits of gratitude are numerous and resilient. Gratitude seems to be a primordial construct, perhaps even rooted in our genes. And there’s research that shows its value.

Scientific literature is replete with the benefits of gratitude. No wonder the attitudes towards showing gratitude are changing. All around us, we see how organizations and societies are creating more ways to recognize any behavior or conduct that elevates a community. At ASE, you can recognize a sonographer colleague through the sonography council as ‘sonographer of the month’. Recently, ASE announced a new initiative – the GEM program – that encourages members to recognize colleagues who ‘go the extra mile’. This initiative advances our efforts at creating a caring Society to combat the crisis of burnout our healthcare systems are facing today. A recent report from the National Academies of Sciences, Engineering and Medicine highlights this burden.

But why reserve only Thanksgiving Day to give thanks? Thanking those who help make your day better is easy when their effort is visible. Much harder when it isn’t. Do you know the name of the custodial staff who takes away your office trash every day? Or those who keep your clinic clean? Or your boss, who probably constantly hears complaints more than compliments? Spare a moment sometime, to make a deliberate effort and thank those who work behind the scenes. It’s easy to get trapped in the whirlpool of the screaming negativity. Winston Churchill once famously said, “You will never reach your destination if you stop and throw stones at every dog that barks.” It’s the distraction of negativity that can halt your progress. Instead, take a moment to pause and listen to the whispering positivity around you. There are so many opportunities to recognize the wonderful people who knowingly or unknowingly make your life better.

While the pressures of the daily grind can feel restrictive, positive social interactions can relieve what may seem like the ever-tightening grip of reality. As the ASE Cares campaign matures, our

Society is creating more ways to recognize our fellow echo enthusiasts for the admirable work they do, while simultaneously tackling the pressures of our healthcare systems and our personal lives.

While you pause this Thanksgiving Day to express appreciation for what you have, make gratitude a part of your daily plan. Think about Charles Plumb and reflect on who’s packing your parachute.

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001.

Madhav Swaminathan

October 2019

Leadership lessons from a ladder

Several years ago, a senior colleague asked me whether I had thought about who would be next in line to take my position as section head. All sorts of thoughts instantly materialized. Was my job in danger? Was I already being replaced? After all, I had been in my current position for only about four years. Surely this wasn’t the turnover timeline. Was I doing a bad job at work? I was bewildered, baffled, worried and perplexed. Yeah, all of them! Guidance though, came from an unexpected source – a ladder.

I was on a stepladder trying to change a ceiling lightbulb at home. When trying to get closer to the object, my bottom foot got caught on something on the step it was on. As a result, I couldn’t take the next step to get to the lightbulb. There was some old adhesive on that step from a previous project to which my shoe was stuck. Obscured by the annoyance of the adhesive was a positive leadership message. You cannot get to the next step on the career (or any) ladder without letting go of the step you’re on. As I was contemplating advancing my career, I needed to introspect whether there was something keeping me ‘glued’ to the step I was on and preventing me from moving up. Applying it to my most recent career dilemma, two messages emerged: the value of letting go, and the need for succession planning.

The wisdom of letting go

A great deal has been written about the value of detachment, mostly from Zen philosophy. Letting go is difficult, especially when you feel you’ve worked so hard to get to a particular position. You’ve earned it, haven’t you? How can the thought of giving it up cross your mind? Strange as it may seem, that actually may be the most important strategy for advancing your career. Academics are notorious for hanging on to their possessions. Whether authorship on a document, management of a project, leadership of a group, or guidance of a mentee, we can be quite passionate in our pursuit of perfection. I realized somewhat early on that there was only one outcome if I didn’t let go. I would either drown in everything I said yes to, or nothing new would come my way. Could it be that what I thought was ‘mine’ was actually what I needed to be detached from and was the ‘glue’ holding me back? Like a wise one once told me, your hand cannot accept something with a closed fist. Letting go may seem scary at first, but can be quite liberating.

Whether a manuscript authorship, a project leadership, or a governance position in a society, think about the next place you’d like to be, and think of what’s holding you back. And what’s best for that manuscript, project, or governance. Staying in the same role also perpetuates the ‘old boys club’ phenomenon where the same people are seen in the same or similar positions year after year, project after project. Lack of humility is easily diagnosed in others and often under recognized in ourselves. But humility can be an invaluable asset. Part of being a leader is committing to the development of other leaders. That can’t happen without letting go of that step you’re on. It’s a control thing…

One reason we simply cannot let go is the lack of control we perceive (“What will happen?”) if we relinquish stewardship to someone else. That’s where the value of succession planning comes in.

The leadership pipeline

‘Succession management’ is gaining traction in corporate circles as a strategy to ensure continuation of a positive trajectory in an otherwise unpredictable environment. In fact, a Pricewaterhouse Cooper study found that lack of a succession plan may have cost shareholders in large companies, on average, an estimated $112 billion in the year before and the year after their CEO turnover. But even when thinking about your own, rather than a CEO position, succession planning has its advantages. Fresh ideas and different perspectives can add more value. You place a greater significance on the project than yourself. When considering succession, there’s a tendency to pick a ‘safe’ choice, or a ‘likeable’ person. That’s when we are most at risk of succumbing to our implicit biases. Regardless of the methods we use to hand off the step we left to the next climber, the ‘letting go’ part is helpful to both. The step will continue to offer support, agnostic of the stepper.

What it means to us

Ladders are all around us. Even at ASE, there are abundant opportunities to contribute as volunteers and excel as leaders. There are also opportunities to mentor, help, and encourage fellow echo enthusiasts. It is important to recognize that these are steps on that ladder of success, whether at ASE or in your own career. Staying put on that step may seem like a safe choice, but it does two damaging things. First, it stops you from taking your next step, and second, it stops someone else from taking their next one. Think about that for a while. Letting go can be hard. But it is the right move to make.

Ten years after my senior colleague asked me about my succession plan, I can see why it was a wise question. I’ve moved on to bigger and better things. My successor has too. But more importantly, the section I once led is thriving. Just as I had always wanted it to.

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001.

Madhav Swaminathan

September 2019

People helping people

“Time is money!” You may have often heard that expression. It is true in the sense that time is of immense value to all of us. It is its own master, irreverent to our presence, agnostic of hierarchy, and unforgiving if poorly managed. Efficient time management seems to be this seemingly insurmountable challenge that often plagues early career professionals. Indeed, committing the appropriate amount of time to meaningful and productive activities can be challenging – starting with trying to figure out what is meaningful and productive. In a professional society like ours, commitment of time to society activities may seem like a burden, especially when considered in context of our day jobs that generate income.

Let’s consider this a little more closely. We spend most of our time with our work colleagues (if you discount the hours spent sleeping). Then there’s time needed for necessary household chores. The remaining time to rejuvenate is distributed variably between community and family in activities that aren’t necessarily revenue-generating. Community could take the form of a place of worship or a community of like-minded people, while family time includes vacation and time spent in self-care. All of these focus on wellness and enhancing resilience. These, essentially, are our coping strategies for the stresses we face.

Committing volunteer time for service to a professional society can have multiple benefits. First, you get to spend time with people who share your passion for your profession. That, in itself, is personally rewarding and intellectually stimulating. Second, you get to advocate for your profession, thereby improving its visibility to the world and making your own job more meaningful. Third, your career gets a boost with the networking and collaborating opportunities. You also get a chance to shape the future of the profession, and every small step is meaningful in that effort. Finally, you learn from others by sharing experiences, and help others move ahead in their careers. The overall reward is one of meaningful engagement with your profession, with simultaneous benefits to your own career. Service to your professional society is similar to service in any other community setting. It’s a volunteer effort that drives a community forward. Reminds me of the phrase, “A rising tide lifts all boats”.

In the almost 20 years I have spent as an ASE member, I have come to realize the value of service to a professional community. While it may not have been clear at first, it certainly became obvious as I worked in many ASE committees, councils and task forces over time. The most visible value is in the more nuanced understanding of the difference between individual excellence and collective effort. You can see how an entire specialty benefits from the simple concept of community. Whether in advocacy, guidelines, education, or membership, I have learned much from my colleagues – both from giants in the field, as well as rising stars and legends in the making.

Making a difference can seem like a daunting task. It does, though, begin with a simple construct – people helping people. And over time, professional colleagues become a community and an extended family, and become another source of personal strength, resilience and wellness.

So, when the time comes to decide what activities are deserving of your time, think about what is meaningful to you. That’s when service to a community can be a part of your strategy for personal and professional growth. For me, it’s always been ASE! So, the next time the opportunity to volunteer for ASE presents itself, don’t ask “Why?” but rather, “Why not?”. It will be well worth your time.

You may reach me at any time with questions, suggestions and concerns, at, or follow me on Twitter @mswami001.


Madhav Swaminathan

August 2019

Giants and their shoulders

I have often said that it is easy to stand on the shoulders of giants. It is adapted from Sir Issac Newton’s 1675 expression, “If I have seen further, it is by standing on the shoulders of giants.”[1]

I have had the extraordinary fortune to have had many giants, on whose broad shoulders I humbly stand. Many great leaders at the ASE supported and encouraged a plan to not just endorse, but live a core value of diversity by choosing an anesthesiologist lead the Society. I am, but the result of that effort. Foremost among them is Pamela Douglas, MD, FASE, who became ASE’s first woman president in 2001. Her commitment to diversity in leadership is unparalleled. She has been a fantastic mentor to me as I traveled this path towards the presidency. Neil Weissman, MD, FASE, another ASE past president, truly believed that this was the right move for the ASE to make. Susan Wiegers, MD, FASE, and Joseph Kisslo, MD, FASE, added their support behind this effort. But none of their efforts would have been possible without those who paved the way for anesthesiologists to be visible and respected contributors in the team sport of echocardiography. Joseph Mathew, MD, FASE, Sol Aronson, MD, FASE, and Jonathan Mark, MD, FASE, were pioneers in the field and made perioperative echocardiography prominent enough to be recognized by the ASE as a valuable addition to the team. Robin Wiegerink, ASE’s CEO, who is the most tireless champion for excellence in the field, has been a pillar of strength for the ASE and its leaders, and the glue that binds the organization.

People often ask me what it is like to be ‘the first’ at something. I assume they are referring to my reaction to being the first anesthesiologist to become the ASE president. There are several emotions that emerge – excitement, hope, gratitude, and of course, anxiety!  Excitement from imagining the possibilities for the Society and its members, and for new opportunities for growth, education, and global impact in cardiovascular ultrasound. Hope from a confident optimism of positive outcomes for all our initiatives. Gratitude towards the sheer number of mentors and supporters who encouraged me to take this unique path to serve the ASE. Finally, anxiety about the unknown that lies ahead, but confidence in the vibrancy and resilience of this organization that will lead to an exciting year ahead.

There are several initiatives that are ongoing and planned at the ASE in the coming year that I hope our members will experience. The ASE Cares initiative is one that is central to my vision for the coming year. As we move forward, this campaign will help us create a more caring Society for years to come. This month, we have also been busy planning the 2020 Scientific Sessions in Denver, CO. Don’t forget to register early for this unique gathering of echo professionals. #SeeYouInDenver for more #EchoFirst education at #ASE2020.

If you aren’t on social media, and if these hashtags don’t mean much to you, you probably aren’t, I encourage you to join in and engage with the global echo community. Twitter is a fun yet immersive platform to learn, educate, grow, and communicate with fellow echo professionals. So, join and follow @ASE360. You’ll be pleasantly surprised at how much there is to learn and network, especially with our Twitter Journal Club (#ASEchoJC).

The ASE continues to go from strength to strength. Our current strategic plan is in its final year. In November, the ASE leadership gathers to develop our Society’s next five-year strategic plan. It is imperative that we hear from our members and ensure that you help shape our collective future. This is critically important, especially to our advocacy efforts as we battle to promote the value of echocardiography and preserve its valuation by payers. In addition, we will set our strategic sights on promoting growth in membership, innovation and research in technology, and setting standards in the practice of cardiovascular ultrasound. While we get busy with these tasks, we will also commit to developing our next generation of leaders. The ASE Leadership Academy enters its second year in existence. As it continues, we will see the emergence of young echo professionals with leadership skills that will be important not only to their own careers, but also to the future of the ASE.

Mentorship continues to be the cornerstone of our professional development and career advancement. If you’ve been mentored well, recognize your mentors. If your mentees have done well, recognize their accomplishments. But above all, become a mentor to someone else. We have all been successful by standing on the shoulders of giants.

Now, we must be those shoulders on which others find it easy to stand.

You may reach me at any time with questions, suggestions and concerns, by email at, or follow me on Twitter @mswami001.

Madhav Swaminathan


July 2019

Writing my first blog as the ASE president, I am excited, enthusiastic and humbled by the role and the possibilities. The ASE is an extraordinary organization. The world’s largest society of cardiovascular ultrasound professionals is fortunate to have an abundance of talent, skill and passion among its members, staff and leaders. Each of these characteristics were on full display at the scientific sessions in Portland, OR last month. As we joyously celebrated innovation and science at our 30th annual meeting, we also recognized that we must face a new challenge to our professional and personal well-being – burnout. This pervasive problem in healthcare is now a recognized diagnosis under the International Classification of Diseases 11th edition (ICD-11) by the World Health Organization.[1] Many organizations are responding to this crisis with programs to increase awareness and develop strategies to address this phenomenon. As a society of over 17,000 professionals, the ASE is committed to creating a community that works together to combat this burden.

This year, on May 20th, we launched the ASE Cares campaign. This initiative is designed to address challenges to our collective resilience. A task force, headed by Erin Michos, MD, FASE, will spend most of the coming year developing strategies to provide resources for our members through position statements, website resources, physical resources at our educational meetings, and foster closer connections with each other – creating a caring society. This year, for the first time, we made childcare available to young parents who were attending the Portland meeting. In addition, there were special secure pods available for nursing mothers. Networking events and career advancement opportunities added to the manner in which our members felt welcome within the professional community they love. While we develop these initiatives and increase engagement to erase burnout, we must recognize that the road will be long, and the journey arduous. Outcomes are hard to measure. Interventions are known to have mixed results that undermine the enthusiasm with which they were adopted. Nevertheless, any effort aimed at improving civility, enhancing professionalism, and promoting self-care should lead to a positive experience in the community.

We hope that ASE Cares increases awareness of burnout, promotes a conversation on resilience, and creates pathways to help people find joy in the important work they do.

As we progress through the coming year, I will seek your counsel in helping me understand how the ASE and its leadership can serve you better. The ASE promises to focus on all echo enthusiasts, demonstrate our commitment to making burnout a thing of the past, and help us become happier and more effective practitioners for the benefit of patients with cardiovascular disease.

You may reach me at any time with questions, suggestions and concerns, at