Dr. Melvin Echols, Associate Professor of Medicine at Morehouse School of Medicine and Chief Diversity, Equity and Inclusion Officer for the American College of Cardiology (ACC), shares his remarkable journey from rural North Carolina to becoming a prominent cardiologist. Growing up in a community deeply affected by heart disease, Dr. Echols transformed personal experiences into professional purpose, focusing on heart failure in underserved populations and healthcare equity. After graduating from Morehouse School of Medicine in 2002 and completing his training at Duke University, he returned to Morehouse in 2019, bringing with him a wealth of knowledge and a powerful personal story of overcoming obstacles.
What inspired you to pursue a career in cardiology?
Growing up in Ivanhoe, North Carolina, we were able to actually experience the not so great side of cardiovascular disease, particularly things like sudden cardiac death and acute presentations for heart attacks. Unfortunately, I’ve seen quite a few family members with that, but I think more so than anything else, the science was really interesting to me as a kid, and my mom bought these encyclopedias. There were 26 volumes of books that were my, I guess today’s Google, and whereas my brothers were out joking around, I’m in the house in July, sweating, turning pages in an encyclopedia about science, because that was what was interesting to me.
What challenges did you face trying to become a Black physician in cardiology?
I think that there will always be challenges, especially when you’re trying to do something that is not the standard pathway that you are used to seeing everybody follow. I remember coming home on a school bus ride, again, rural North Carolina, hour and a half bus trip to and from school every day, and we were sitting there, and people were asking, “What do you want to do when you grow up?” And I was like, “Yeah, I want to be a cardiologist.”
People looked at me and laughed as if that was like the hilarious joke of the season. I didn’t really see anything funny, because I had already read about it. I knew it was going to be 12 plus years after high school. I think it’s about being resilient and realizing that no matter what happens, if you’re still here you always have another chance to try again.
Can you share a defining moment in your career?
I had multiple pseudo moments of that, I remember walking into the building at Morehouse as a 4th year, and chuckling to myself, “Oh, wow! I’m going to be a doctor in like 3 months.” But then my best friend in the world, my grandmother passed three days after I graduated from medical school, and it kind of took on a whole new meaning.
Just recently, 2023 had a just out of the blue random kind of outpatient procedure that I needed, and ended up having a complication, and ended up in the hospital for 4 months, on the ventilator for 3, dialysis for 3 months, lost 150 pounds. Had to learn how to walk, talk, eat, everything again. That was the defining point in my life where I realized I loved my patients before, but learning how to walk in a patient’s shoes, who happens to be critically ill is a whole nother game in terms of relating to what it really takes to be resilient as a patient.
What are the top 3 skills that make a great cardiologist beyond medical knowledge?
First thing is listening, you cannot be a good doctor if you do not know how to listen to patients. As a matter of fact, that’s the most important thing, we can always look up facts, we can always look up trials, but if you’re not hearing what a patient is telling you, you’re starting off on the wrong foot.
Being vulnerable, learning how to share parts of your story that can be inspiring. When I have patients in the ICU, and I’m telling them, “Hey, two years ago I was right here, looking exactly like you, probably worse, but God is good.”
Last but not least, we know what environment we’re in, and quality is quality, and as long as you are able to live your life, making sure that you’re doing the best that you can. Be proud of who you are because that is the standard, quality has always been the standard, not DEI, quality.
What networking opportunities and mentorship are available in cardiology?
I think it’s more so about the exposure and the inspiration. I don’t really think I ever saw a cardiologist growing up. I saw a doctor in the field, but never saw a cardiologist. I was fascinated by the science and what was going on with my family, but as the Chief DEI officer for ACC we are now sponsoring internal medicine exposure programs for certain groups that actually have not been exposed to medicine and to the world of cardiology.
For instance, the underrepresented groups in medicine that are actually a thing. We actually developed those groups to actually build out a psychological safety so that they could see people in that space that looked like them. So that means African American black cohort, women, we have a separate women cohort. We have a separate, indigenous people, native Americans cohort, small, but we’ve been running for the last 3 years. We also have a small LGBTQ cohort so that people can walk in and see cardiologists of all kinds that are doing what you want to do.
What are your thoughts on technology such as AI and telemedicine in cardiology?
I am also the co-director right now for an AI fellowship for full time clinicians of all kinds. It’s a part of the AIM-AHEAD NIH grant, and the fellowship is called CLINAQ. I think AI can be an amazing addition and supplement to medicine, but as anything, it’s a test, and it’s a tool and if you’re not quite sure how this tool is designed, then you run the risk of actually using the tool in not the most optimal way.
One thing I’m a little concerned about is because trainees see AI do wonderful things in terms of pulling up facts and putting together diagrams and pictures, in their minds, I’m wondering if they are considering that they’re learning that information. One of the problems is just because you see it doesn’t necessarily mean that you’re organizing it, or you’re storing that memory in the most correct way to actually apply it.
Are there areas of cardiovascular research that upcoming doctors should focus on?
There are always new trials and new therapies coming out, which actually has been a little bit of a double edged sword now. So now you have heart failure medicines that are FDA approved for the most part of guidelines evidence-based, 1a or, at the very least 2a evidence. And so you run a risk of actually having at least 5 to 6 heart failure medicines at one time, if you’re optimally treated. So precision medicine is a space that I think the AI will be incredible with.
For me, I do think that we need to pay more attention to heart failure and the stages of heart failure. People really, in terms of the community, only consider heart failure when you actually go to the hospital and you have that episode. But in actuality there are way more people who actually have what we call stage B heart failure, which are risk factors or structural changes already that they don’t even know about.
We do know that hypertension and diabetes and obesity which unfortunately challenge the African American population quite a bit, are also heavy risk factors for heart failure. So African American men and women are more likely than any other group in the US to die earlier from heart failure and usually have less access to therapies like transplants and mechanical circulation. So access prevention and much more community engagement. There’s an opportunity for cardiologists to actually do that.
