Five Questions with Giora Weisz, MD, Interventional Cardiologist
We spoke with Giora Weisz, MD, about his experience as a faculty member at Columbia—including his role in helping establish a new catheterization lab in Hudson Valley.
What was your path to Columbia?
I was born, grew up, went to medical school, completed my residency, and did my cardiology fellowship in Israel. When I decided to be a “plumber,” I knew I wanted to have the opportunity to learn from the best people. And I was really lucky and blessed that Dr. Martin Leon accepted me as his fellow. That was back a zillion years ago; it was actually at Lenox Hill, before our group moved to Columbia. So I came to New York, and I did two years of fellowship followed by one year that was a combination of additional fellowship training and attending.
When it was done, I was on my way back to Israel, but Dr. Leon made it clear that I was not going back. He told me about the move to Columbia, and he wanted me to move there, too. And when the boss says to do something, I do it. So I joined them and stayed with them for another 10 years. Those were fantastic years.
After those 10 years, I was tempted back to Israel; I was offered the position of chief of cardiology in a big hospital in Jerusalem. I was there for four years, but I didn't like the administrative part. So I came back to New York, running the cath lab at Montefiore. And then I was called to come back home to Columbia.
Can you tell us about your roles here?
I was the director of the clinical research group and was able to develop a robust research program. We were very busy; we had over 50 active studies enrolling patients at each point of times. I had 26 research coordinators working for me.
It was a really good experience, first from the organizational and managerial aspects that I learned a lot about. But even more than that, I gained insight into how medical devices are developed. Interventional cardiology is a very technical and technological profession, so there’s a long history of innovation. I just had lunch with the nurses here in the cath lab, and I told them about how every device that I'm using now, every stent, I actually used in an early research, and how at the time, we still didn't know how good it was.
And that's the way of our profession: progress all the time. How they progress from early feasibility, first-in-human studies, all the way to FDA approval and post-marketing studies… all from an idea. Starting from a PowerPoint presentation, that idea makes it all the way to better patient care.
As a researcher, I became increasingly involved in developing new devices in our field. I was the Columbia champion for innovative technologies. If I'm allowed to show off, I helped pioneer robotic intervention. I was blessed to perform a series of firsts in robotic interventional procedures; the first in a human, then the first in America, and the first commercial patient. It was a robotic system for placing stents, performing the entire procedure sitting, shielded from radiation, simply with joysticks. I was the national principal investigator for the study that got FDA approval. It was a very satisfying time.
And now, I'm spending most of my time in the Hudson Valley NYP campus, helping to develop their new cath lab.
You've been working with the cutting edge of technology your entire career, from TAVR to robotics. What technologies are you most excited about now?
Do you know what the beauty of our profession is? That we don't stop. We don't stop after we achieve something; no one says, “Now we can rest, right?” We are always moving, striding forward. Now it's the mitral and tricuspid valves, but we didn't forget the coronary arteries. For example, we always had difficulty taking care of very calcified arteries; those are hard enough that even strong balloons don't always expand them enough. Now we have miniaturized lithotripsy, acoustic shock waves to break up these severe, deep calcium deposits. This is a new field that's emerging.
With the growth of intravascular imaging, we don't have to make decisions by just looking at blockages and eyeballing things. (When we want to be a little sarcastic about ourselves, we just say, ‘Oh, this is just an eyeballing.”) <laugh> Now we have intravascular imaging, so we don't just assume, we don't just believe… we know! It's a big difference.
Beyond that, I'd refer back to where I started my career, with robotics. When we talk about robotics, everybody understands something different. Many people think about Isaac Asimov's three rules for robots acting on their own in ways that keep people safe. We are not there yet in medicine. But I actually believe that we will get there.
The robots I was using mainly acted as an extension of my hands, my fingers. It's able to do things in a more relaxed way, in a more precise way, some smaller fraction of a millimeter movement that I cannot really do with my fingers.
I think the next stage is to add the brain to the hands; to really incorporate everything we have, taking the mechanics of delivering things, the imaging, and the physiology, and bringing them together and giving it to the computer brain.
Everybody has to mention AI nowadays; I don't think anybody can escape those letters. But in this case, I'm serious. I recently wrote an editorial about robotics titled “The Robot Will Cath You Now.”
The idea is to add the brain to the mechanics. Over time, as this field evolves, that brain can make better decisions than us humans. That's where I see the field heading.
You called Columbia home. Why is it special to you?
It really is home for me. Columbia is an amazing institution; it's top-of-the-line in many areas, and definitely so in interventional cardiology. It has this multilayered, multidimensional approach to things. I think it's a perfect combination of everything modern medicine has to offer. It has deep academic roots, spanning from basic to translational science. And by connecting basic science all the way to medical clinical trials, we make a difference for patient care.
And there is no profession, specialty, or subspecialty that is not covered at Columbia. And it's not about one exceptional person; if somebody is on vacation or at a conference, there are two or three others covering for them who are also internationally renowned in their field.
There is always a combination of elements that make up medical practice, which are part of taking care of patients. I have seen, during my lifetime, the business side of caring for enough patients to make the institution viable. But we also must never forget the human part, never forget the compassionate attitude towards the patient. That goes for our physicians, the nurses, and even the administration.
Of course, some people are just academics, some people just take care of patients, and some people do both; over my career, I've certainly served both worlds here. Columbia is really a full cosmos of modern medicine.
Can you tell us about the new Cath Lab?
NewYork-Presbyterian decided to open a cath-lab in Hudson Valley Hospital, and that's obviously very expensive. It takes big capital and commitment to bring Columbia’s New York City quality of care to Hudson Valley and Peekskill. The area lies at the border between suburbs and more rural areas, and people here don't want to go to the city. It's less than an hour's drive from Columbia, but if, for whatever reason, people need advanced care, they ask, “Are you sure we cannot do it here?” So that’s what we brought. My team and I brought the Columbia-treatment style and connection to advanced therapies here to their neighborhood.
They gave me half a floor, and we turned it into a modern cath-lab. It's more than just selecting the equipment; that was easy. The part I'm even prouder of is the team we’re building. In a somewhat remote area, finding a top-notch team of nurses, technicians, physician assistants, and nurse practitioners is an enormous challenge. We have a team that I'm very proud of, and I feel very comfortable treating patients with them.
We did a great thing for the community here. And I want to keep going. I want to increase our interaction with the community, to expand the services that our cath lab provides, along with the cardiology services being offered. Interventional procedures have become much safer and more routine. In the past, we needed a surgical backup for everything. Now, we don't need nonsurgical backup for most procedures. Most of our patients come in the morning, and they go home the same day. If, god forbid, something happens, it takes just an hour to get into Columbia.
So we’ll keep going: expanding the services and procedures, and working towards being able to do almost everything that is done in the city right here. To give the same level of service.
Bonus Question: What do you do when you're not being a doctor?
I'm always a doctor. <laugh> That's part of my identity. But more important than that, I'm married and have three daughters and one granddaughter, and they're the most important part of my life.
I have to tell you that, at every step of my career, I was always the youngest: the youngest intern, the youngest fellow, the youngest attending, the youngest faculty member of the group. Then I was the youngest chief of cardiology. Then I said, “I want to be the youngest retiree.” <laugh> I'm getting there.
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