President’s Blog

Madhav Swaminathan, MD, FASE, ASE President

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




ASE and the American Society of Nuclear Cardiology (ASNC) are pleased to announce that CMS has approved the ImageGuide Registry® as a Qualified Clinical Data Registry (QCDR) for 2020. The first national registry for non-invasive cardiac imaging, ImageGuide Registry is receiving this important designation for the sixth consecutive year.