The Game-Changing Women of Healthcare | Dr. Luna Gargani: Point-of-Care in Pisa

Today, on Episode 6 of the podcast, Meg speaks with Dr. Luna Gargani, Cardiologist and Senior researcher at the Institute of Clinical Physiology of the National Research Council in Pisa, Italy. As an advocate for, an expert on, and a pioneer of point-of-care lung ultrasound, Luna has had the opportunity to see this technology come full-circle.

Show Notes

Meg speaks with Dr. Luna Gargani, Cardiologist and Researcher at the University of Pisa in Pisa, Italy.

As an advocate and pioneer of point-of-care lung ultrasound, Luna has played a key role in bringing this technology full-circle. Meg and Luna talk about the dramatic impact one key mentor made in her career, why, despite much resistance, Luna was confident a novel technology she was researching would one day become widely accepted, and the value of carefully choosing what to focus one’s research on especially if, like Luna, you are naturally curious and passionate about making an impact in a wide variety of challenges in healthcare.

Sostenitrice e pioniera dell’ecografia polmonare point-of-care, la dott.ssa Gargani ha avuto l’opportunità di vedere questa tecnologia svilupparsi dagli esordi più incerti fino a prosperare. Meg e Luna parlano non solo del ruolo cruciale che un mentore ha avuto nello sviluppo personale e professionale della dottoressa, ma anche del motivo per cui, nonostante le molte resistenze, Luna era sicura che quella nuova tecnologia che stava investigando sarebbe stata un giorno ampiamente accettata. Infine, si confrontano sull’importanza di scegliere scrupolosamente l’oggetto della propria ricerca soprattutto se, come Luna, si e’ curiosi di natura ed intenzionati ad avere un impatto concreto nel vasto spettro di sfide che si profilano nel settore sanitario.

Luna Gargani, MD is a Cardiologist and Researcher at the University of Pisa in Pisa, Italy. At the time of this recording, she had been Senior Researcher for the Institute of Clinical Physiology of the National Research Council for 18 years.

Dr. Gargani’s research focuses on cardiovascular imaging and point-of-care echocardiography. She is a pioneer in lung ultrasound, a recognized expert on the topic and was a member of the committee that wrote the first set of international, evidence-based recommendations for point-of-care lung ultrasound.

Further Reading:

University of Pisa

Clinical Physiology Institute CNR - Pisa

Handsonecho

First International Consensus Conference Expert Committee on Pleural and Lung Ultrasound

American Heart Association Study by Dr. Sarah Zaman, Elizabeth Shaw and Sonya Burgess,in Australia Originally published 19 Feb 2019

Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study Epub 2021 Mar
Eugenio Picano

Episode Credits

The Game-Changing Women of Healthcare is a production of The Krinsky Company.

Hosted by Meg Escobosa.

Produced, edited, engineered, and mixed by Calvin Marty.

Theme music composed and performed by Calvin Marty.

Intro and outro voiced by John Parsons.

Creators & Guests

Host

Meg Escobosa

Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.

Producer

Calvin Marty

A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.

What is The Game-Changing Women of Healthcare?

The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.

Luna Gargani: There is a sincere need from everybody to share our experiences and to be naked in our gains, but also our failures and we all need advice. We all need so much support and it is useful to see how other people who have a similar situation to yours are struggling and trying to handle that. I think mentoring is everywhere you want to find it.   

ANNCR: You're listening to The Game-Changing Women of Healthcare, a podcast, celebrating courage, perseverance, creativity, and vision in the pursuit of healthcare innovation. Join host Meg Escobosa in conversation with some of the most inspiring and forward-thinking women working in healthcare today. Meg goes behind the scenes to uncover previously untold stories of struggle and success in a notoriously complex and highly-regulated industry.  As the worlds of healthcare and technology continue to converge, and as women take on increasingly more important roles in both, these are timely tales that deserve to be told. And now, here's your host, Meg Escobosa. 

Meg Escobosa: Welcome back to The Game-Changing Women of Healthcare. I'm your host Meg Escobosa. This month on the podcast, we’re celebrating International Women’s Day, which lands on March 8th. We’re featuring four inspiring healthcare innovators who live and work outside the U.S. Which means we’re releasing four episodes this month! Come and hang out with me, weekly! Today, we are very fortunate to be speaking with Dr. Luna Gargani, a cardiologist and senior researcher at the Institute of Clinical Physiology of the National Research Council in Pisa, Italy. Dr. Gargani’s research focuses on cardiovascular imaging and point of care echocardiography, which is when doctors use small portable echocardiography machines at the patient's bedside.  

She is a pioneer in lung ultrasound. Having served as the youngest member of the first International Consensus Conference Expert Committee on pleural and lung ultrasound, she is a recognized expert on the topic and was a member of the committee that wrote the first set of international evidence-based recommendations for point-of-care, lung ultrasound. Benvenuto, Dr.  Gargani. I'm so excited to be speaking with you today.  

Luna Gargani: Thank you, Meg. Thank you so much. Your Italian is very promising. I'm really happy to be here. Very excited and honored to be part of this group of women in healthcare. Thank you.  

Meg Escobosa: We're so lucky to be talking to you. So thank you very much. Are you in Pisa today?  

Luna Gargani: Yes, I am in the beautiful town of Pisa. I feel very lucky because actually one of the best regions of the world, but I, of course I'm not so much objective about that.  

Meg Escobosa: So I really like asking our guests how you got interested in healthcare. What were you most passionate about?  Were you particularly skilled in an area, in science or math, or what drew you into the field?  

Luna Gargani: Okay. So I have to say that medicine was not my real first slot. When I was young. When I was in high school, I wanted to be a conductor. I wanted to be a music conductor, but then as I grew up, I thought that when you're ill, when you don't feel well, everything else becomes kind of secondary.  I wanted to get knowledge in what I thought was the ultimate knowledge. I wanted to know how the human body works and functions and how to mandate. So that's why I started to think about becoming a doctor. Of course. In the beginning, I never thought about research. I just wanted to be a doctor.  
But then, I mean, in Pisa, we are really lucky because we have a, in this small town, a very ancient university, a lot of excellent centers and hospitals. And so I started to work at the Institute of Clinical Physiology, which was absolutely a leading place for clinical research. And so a bit of lag and a bit of that, I chose it because I really liked what people were doing there.  
I also started to be interested in research and that's the story, but I never regret it. So I like to see conductors on the video and I enjoy that, but I'm happy that I've become a doctor and a researcher.  

Meg Escobosa: That's great. Fascinating to think that you could have been a conductor, but ultimately we're very blessed that you are doing the work you're currently doing.  
How did you decide to focus on cardiology specifically?  

Luna Gargani: Well, again, that was not my first choice in the beginning. I wanted to be an oncologist when I started medicine because I was very fascinated by the cancer issue and all the word around cancer, but
then I realized that when you are an oncologist, actually you start seeing patients after they receive a diagnosis.  
So you skip the diagnostic part, which to me was the most interesting. So you cure the patient, but you apply a kind of standard therapy. And I really, really enjoy that part of our job when a patient comes to you with a symptom and you have to guess what it is. So it's a bit like pass me the similarity, your Sherlock Holmes, to trying to understand what's going on.  That part in cardiology is huge, and indeed then I became to be interested in imaging and diagnostics and that's to me the most interesting part and the other issue about cardiology and the reason why I chose it is about prevention. So probably the cardiovascular disease is the disease that can be most prevented by a healthy lifestyle and by your choices.  So the ability of changing your life with your choices, with a good and healthy lifestyle, to me was so fascinating. So I decided to go for cardiology and again, never regret it and I will do the same choices again and again.  

Meg Escobosa: Wonderful. We read a study recently from 2019 by Dr. Sarah Zaman,
Elizabeth Shaw and Sonia Burgess, in Australia, and the study demonstrated that women comprise 14% of practicing cardiologists at a percentage that was pretty much similar across these countries studied in the US, Australia and the UK. What difficulties did you face? And if any, entering a, not only a profession in which women are the minority gender, but also a specialty made up of mostly men.  

Luna Gargani: It is true that cardiology is why men-oriented, especially, when we think about interventional cardiology and electrophysiology, I think that probably in Italy, these percentages are different, at least now, I would say that probably about 40% of people doing cardiology are women. And I didn't really face any, or at least I didn't perceive any real barriers in the very early parts of my career, everything was small and I never felt I was discriminated to be a woman, but then growing up it becomes a bit different, and you realize that you have to demonstrate much more. I mean, if you are a talented and especially enthusiastic man doing cardiology or other specialties, especially in the academic world, it is kind of expected that you have, that you want to have a career that you want to get promoted, that you want opportunities in your work.  If you are a woman, it’s kind of like, “oh, why you're not fine with what you have, especially if you have a family and kids are, so why are you looking for more? Why do you want more?” So I face this conversation sometimes and it was a bit odd. There are a lot of cultural changes that we have to face. Also with ourselves, we have to start to cut out to feel guilty and understand that we deserve the same opportunities and the same pathways as men, but you always have to give your best, you know, to be top, which on one side can also be nice, but it is quite, I mean, tiring sometimes.  

Meg Escobosa: Absolutely. I'm sure many women have felt similarly, you have to sort of out-do everybody around you to get the attention and get the opportunities.  Do you have any advice for women looking to enter the field of medicine?  

Luna Gargani: Well, I have many, I don't know if they're valid advice, but my first thought at the moment is about maternity because I have two small kids. And so of course, this fills my life in every second of it. And I would say don't, if you want to have kids, don't wait for the right timing, according to your career.  So I think that our professional lives in the end can be more flexible than our biological lives. This is sad. This is unjust, but this is so true. So if you want to become a mother. You just have to adjust your career to your maternity desire and not vice-versa because the rest somehow can come, and while I have a lot of colleagues that have waited too long, and then they struggle so much that there are a lot of studies about that. That women in medicine struggle a lot about fertility issues, basically because they wait a lot to have kids. So this, this would be my first advice.
The second one is linked to what you were saying before.  So don't be afraid of asking for opportunities. Don't be afraid of asking for a promotion for things. Men ask for that all the time, and that's good. I mean, it's not them to do wrong. It's us, that we feel that we are not able to do things. Of course, we all have this imposter syndrome, as we always say.  So don't feel ever afraid of asking what you want to do. And another thing that, I think we should learn from men is to keep their playful approach. So sometimes we complain that men always play. And also sometimes with our partners we say, “oh, well you men, you always play with everything.” And I think we should learn about that.  And stop thinking that we have to carry the burden of the world on our shoulders all the time. We need some lightness sometimes in the work-life and also in the private life. So this is something I would like that someone told me when I was a bit younger, so there's no need to be so heavy-headed all the time. 

Meg Escobosa: Really appreciate that. Play so important in life. It just adds so much to us. It's fulfilling. It makes us be able to take on the big challenges. When you have joy and lightness in some parts of your life, you can sort of prepare yourself for the big, big work ahead. That's great advice. What has it been like for you this last year with young children?  Managing through those last couple of years. I mean, especially with the huge surges of COVID in Italy, has that affected your work and how about managing your life as a mom?

Luna Gargani: It has been really hard. I mean, I cannot say anything different and although, I mean, I was very lucky because we didn't have any real health issues.  
No one in my family died. And so it could have been much worse than that. But for balancing family and work was really, really challenging because even if you don't have, COVID all the people who worked with you may have it. And so it means that you don't have childcare anymore. You don't have someone who helps you with the chores in the house.  And this happens to you, happens to your partner and in the workplace. So it has been really, really, really difficult. And we are all very tired now. I mean, the first year of COVID, it was hard, but I think we were all feeling this strong sense of responsibility and that we had to do so much to help the world go on.  And this is still the same now, but we are kind of feeling this COVID fatigue. And then of course, there was all the lung ultrasound search during the COVID. And this was another big issue because in the very first month, 2020 - March, April, May with the first wave that in Italy hit so hard that, I mean, everybody wanted to learn lung ultrasound.  And so I received so many emails and calls from people that want to be trained quickly. So I really felt this huge responsibility to work day and night to be able to give a little bit of help as everybody has done and I was pregnant. So I remember those weeks as a kind of crazy moment of our life that I think we will never forget, but this teaches you so much. I’m happy that, I mean, in a few months, actually the whole healthcare system was able to employ lung ultrasound in emergency departments in hospitals. So the boards actually not need so much anymore to train people, to record podcasts, to record videos on that. But it has been really, really unexpected and an astonishing time for all of us.

Meg Escobosa: I didn't realize that you were pregnant during all of that. So you both were managing your own health and expecting a newborn and navigating this difficult time of all this demand and understanding ultrasound. Can you maybe share a little bit about point of care ultrasound and point-of-care echo, what is so special about that technology?  Why is it so valuable today? What does it do? What are all the benefits?  

Luna Gargani: Yeah, this technology is great, especially thanks to its versatility. So actually point-of-care, the first to the ability of doing things at the bedside. So it means that you don't send your patient to another doctor, for example, to a radiologist to do a chest x-ray or a CT, but you do the examination, the diagnostic examination yourself at the bedside. And it is very powerful because you have all the clinical information. So these allow for a very strong clinical integration, which is the key for a successful point-of-care approach. And then you can do it directly at the bedside, and indeed, one of the main gain of point of care is actually time-saving. When things are fine and everything is easy and is smooth, maybe you don't need that so much, although it really helps you even in these circumstances. But when you're really struggling as in a pandemic-situation time and any single gain you can have in the management of a patient becomes crucial.  And so that's why the community soon understood that lung ultrasound could really be helpful in the management of patients, because actually it can speed up the decision and easily let you understand that the patient has a pulmonary involvement due to COVID pneumonia. And so it was sad that we needed that, but this has helped so much to make point-of-care echo, in general, and lung ultrasound day-by-day routine clinical work because it has been like that all the time. I mean, when we started to do lung ultrasound, like 15 years ago, there was a huge skepticism about that and it has been really interesting to see the journey of how a tool can become, something that the other doctors almost laughed at and think it's science, rocket science, to something that everybody acknowledges that it's completely useful and can be done everywhere - at home, in the hospital, outside the hospital, in a space, shuffled everywhere. But anyway, about COVID. I mean, I didn't do anything different from all the doctors in the world. I mean, all of us just try to give their best and I could do this and I did that, and everybody did their best and it was a big community help from everybody.  

Meg Escobosa: Amazing to think that you guys were struggling or being maybe even laughed at with the idea of point-of-care ultrasound. It's fascinating. You probably would never have imagined that a global pandemic would have come along that affects the lungs, where having that technology would make the difference in terms of getting attention around the world. You published a paper on lung ultrasound-based diagnostic technique.  How does it feel to have gotten that paper out? Can you talk a little bit more about your research and the work you're doing?  

Luna Gargani: That paper was very important because I think it justifies how people from all over the world in a special situation can gather together publish great results, which have a big impact on the clinical management and actually all these patients,  I mean, in that paper, we described the results of almost 1500 patients were gathered from 22 centers in Europe and in the US. And when we started to propose this study together with Giovanni, who was my co-chair, I mean, all our colleagues sat, them responded so positively and although they were working day and night and we were all struggling, the response was so high and everybody was so helpful and it has been really beautiful to see this kind of support.
It has been a bit hard again. I mean, I remember these Zoom calls with the colleagues and myself with this big belly. But I didn't feel the tiredness because I thought we were doing a good thing. We actually try to collect all these data because there were a lot of small studies on lung ultrasound, but we felt that we really needed to put something big; I mean, with a large population to really understand what was the added value and we had all the connections to do that. So with Giovanni, we felt again the responsibility to try to gather all our colleagues in this journey and they were fantastic. Absolutely fantastic. I hope that that paper could be just published and not be useful anymore, but unfortunately this is not what happened.  

Meg Escobosa: Yeah. We continue to need that information and those learnings, because we are not out of this problem yet. Fingers crossed that we get to a new place. What was that like to bring something, some new approach to medicine into the world. I know we sort of talked about the fact that today's pandemic has actually enabled acceptance of the approach of using the point-of-care, but can you describe some of the early days when you were thinking about it and trying to explore the idea and help people to accept a new approach?  I know medicine, certainly in the US, it's an evidence-based approach to care. So you have to make a good case for doing something differently, right, for them to accept it because obviously there's risks involved. So I'm curious what the early days were like and what kept you at it? What allowed you to keep working and stay the course, as opposed to give up?  

Luna Gargani: Yeah, again, this was really interesting. I feel so lucky that I had the chance to start to be interested in something that was completely out of knowledge in the beginning. And I think that in the very first days, the skepticism was high, especially because the main sign of lung ultrasound that we use, which are these beelines, these are artifacts.  So it is reasonable that people say, you are speaking about artifacts. This is what we have tried to avoid for all our lives in ultrasound, and now you use it for diagnostics. And I think that one of the good assets that we put into it was a good balance because when you have to propose something that in the beginning that is so not accepted, you have to be very balanced. You cannot just come and say, “oh, I'm right. You're wrong. This is so good and you don't understand anything.” I mean, you have to understand doubts. You have to understand why your colleagues want to have more data and want to better understand. They are right. Absolutely right. So first of all, balance and not being too much assertive with them. But I think that I had the strength to go on for sure because, I mean, I started to study these things in a fantastic echo lab. And actually I did that because my first mentor at Eugenio Picano was the one who brought lung ultrasound into the cardiology field for the first time.  And since it was a very easy thing to do, and I was the youngest in the lab, he just gave this topic to me. And I said, okay, you're going to study lung ultrasound because you're too young to do echocardiography. So it was on his advice and his big shoulders that I did all the first steps. And then I think that I had this strength to go on because I knew with my clinical practice, how much that was useful. And I think this is the real thing in clinical research, because if you're speaking about something that you don't do yourself, that you just read in books, or you have a file with numbers, your colleagues are going to feel that you are just proposing something, but you don’t really live it. I knew day-by-day with my patients, how useful it was, how much game-changing it was. And so this made my life so easy because I had no doubt. I knew that it was just a matter of time. And when I started to hear colleagues calling me back and saying, “oh, Luna, you know, You taught me how to do lung ultrasound. This has changed my practice so much, and I was able to do this and that, that patient, that other patient was much better.” And I mean, it was so rewarding from a personal point of view, but really showed me that that was the right path. It was, again, only a matter of time and people would have understood that this is really useful and cheap and easy to done, easy to be taught, easy to be interpreted.  So it's a good thing.  

Meg Escobosa: That's great. What would you say has been the biggest challenge that you faced in your career?

Luna Gargani: I got many challenges and I'm still kind of early career. So I think I'm going to have much more in the future, but I think that time has been one of the main challenges. So time constraint and in general, organization of your activity because when you're very enthusiastic about your work and you're very young, there are all your chiefs and mentors that of course want to make you work in a positive way.  
And you see all these topics that are so interesting. I mean, when you like clinical research, everything is super interesting. You want to know everything you want the answer to all the questions. So you start doing and being interested in too many things, and that can be detrimental because of course you cannot do everything.  
And especially if you want to focus very deeply on one topic, you have to be very dedicated on that. So I think one of my big challenges was to not to be tempted, to follow any research line. And sometimes I've been good at doing that, sometimes have been very bad. And so probably coming back, I would have prioritized better a few choices than I have done. And this is something I always try to transmit to my younger colleagues. So don't get distracted by too many things because we don't have so much time. And the risk is that you get burnout and you feel that you have wasted a lot of time without anything concrete, because you do too many things.  

Meg Escobosa: Do you have a rubric or some methodology to help yourself recognize a good research area to focus on and that you could pass on to the next generation as a guideline or a way to think about it?

Luna Gargani: Yes. So my red line about clinical research is how much that can impact the clinical management. So this is also one of the reasons that I chose cardiology.  
I like diseases that are highly prevalent. Not because rare disease are not important, they are absolutely important, but of course you cannot study everything. And so to me, I usually ask myself how much can this impact the life of my patients and how many patients I can impact with that. And usually I always try to go with things that can have a huge and quick clinical translation, but of course, we also need all the rest. We need to take care of the rare disease we need also to face some pathways that may have a longer clinical implication. I mean in a longer duration. Since I had this ability to see how lung ultrasound could affect the clinical management so early in my life, that was a my mentor used to tell me - heavy drugs, when you're too young, then you get used to that kind of results and you don't want anything less. And it can be also dangerous because not everything you do in your life in research can have such a huge clinical translation.  

Meg Escobosa: Can you bring us down into your world in terms of what are the steps that you take when you've decided to focus on a particular area? Like just help us understand the actual practical, real-world effort to do research. Can you just describe a little bit about the day-to-day of clinical?  

Luna Gargani: Yeah. Okay.  So again, when you start with a question, which is a clinical question, and usually this question just comes out when you are in the ambulatory office or in the world. So you're seeing a patient, there is an issue and you want to give a good answer to that issue, which is not just empirical, but it is based on data.  This is the first step.
The second step is to check if someone has already found an answer to that because many times someone has thought about that before you, and if not, you can start designing a trial. You have to start thinking how to try to answer to this clinical question with a robust methodology, because this is the key.  You can do clinical research in many different ways, but the methodology makes a difference and also gives credibility to your results from the scientific community, but also for yourself. So this is how to start with that. Then of course you need the resources because you need some money to get some fundings, we are quite lucky because if you, the research with the ultrasound. Once you have a machine, you don't really need so much money for that, but of course you need time, people, effort, and this is crucial to go on. But if you are an investigative mind, I mean, every day you can have 10 research questions for you, and this is why medicine is so interesting. It's a source of research everyday, all the time. You just have to choose the appropriate one. Again, you can not do everything and you have to do something that can have an impact, something that nobody has already done and something that it is reasonable to follow.

Meg Escobosa:  And what about funding when you, when you talk about resources, is there a unique approach that you take to finding resources? Is it something about the university or the organization you're associated with? How do people in Italy usually get funding for these kinds of things?  

Luna Gargani: Yeah, we apply for the rest of the world today's grants.  And usually we have both more regional trends or Italian-based. I mean, from the Italian Ministry of Health or from the European community. It's a very hard process because it takes so much time to apply. And the percentage of proposals that are accepted is very, very low so it is really frustrating.  It is of course, a system that has been debated a lot that is being debated a lot, but I mean, in the end, usually you're able to win some of these competitions. So you have a certain amount of money at your disposition for your research. And it is a big responsibility of course, because it is the money coming from our taxes so it's the community money that you have to spend in the right way and to find good results that can then be useful for the entire population.  

Meg Escobosa: No, that reminds me. We wanted to ask you about kind of your perspective working in Italy, the national health service in Italy - Servicio Sanitario Nacionale, or SSN, provides free universal coverage throughout the country.  
Something that we currently don't have in the US. How would you say practicing medicine in a country with free universal healthcare has shaped your career and the services you provide?

Luna Gargani: Yeah, this is a very important point and a beautiful question because we sometimes don't even realize how lucky we are to have this kind of healthcare system.  
We just take it for granted, but it is great. I mean, here. Don't ever have to think about if your patient has insurance or not, who is the patient? Where is she or he coming from? I mean, you have a sick person and you just cure that person, and the possibility to offer to everybody the highest quality of care.  So you have this disease, what is the best thing I can offer you, it is this, and you can have it. And there is no limit. About that, this is really fantastic and we don't even realize how important it is. And of course it shapes your way of working. I mean, I think we feel very proud to work in this kind of system.  
And although of course, doctors are always unhappy about the situation and they say,
[yeah, I would like to work in another place. This is so bad,” but in the end, I'm sure that the vast majority of Italian doctors are really proud to work in the sistema nazionale and this is why they continue working there although the salaries are not so good, but the overall system is a beautiful place to work in.  
And not only for the patients, but also for the healthcare personnel, because in the end, it is very protective also with us. I mean, if you are ill, but you get paid and you can stay home. If you're pregnant, you have five months of maternity leave and many other days and it is more frequent that we don't use all the facilities that are offered to us.  
The contrary because in the very end we are all a workaholic group. We want to give the best service. And so usually we have even more than what we use and what we know we can do with our work facilities.  

Meg Escobosa: Wonderful. What can you share as far as mentors that you've, you already mentioned one mentor, can you remind us their name and just share a little bit more about some of the people that have influenced you in your life?

Luna Gargani: Yeah, mentoring is, I mean, one of the most crucial issues in a research career. Yeah. Again, I was really lacking, but also I think it was good from my side to choose. My first mentor was Eugenio Picano. He's a cardiologist who has always had a visionary approach to medicine, and it was the one who started lung ultrasound in the cardiology world. And of course, that has shaped my research so much and it will forever. But I think that mentoring is a very dynamic thing. So you don't have to feel that there is one mentor in your life and also, sometimes you can get some fantastic mentoring just by one sentence or one situation that happens once in the life. And I also believe a lot in peer mentoring because we always think of mentors or as seniors compared to ourselves. And of course this is the most common situation, but I also get a lot of inspiration, a lot of support from my peers and colleagues.  
And sometimes you can give advice on something. Sometimes you get advice on something else. So I really like a lot about, especially other female colleagues in my field. And I have to say that in this, Twitter and social media are great. The Twitter community is a great community. And there is a sincere need from everybody to share our experiences and to be naked in our gains.  
And of course we all do some self promoting, but also our failures and we all need advice. We all need so much support and it is useful to see how other people who are, have a similar situation to yours are struggling and trying to handle that. So I think mentoring is everywhere you want to find it.  

Meg Escobosa: That's a beautiful idea. I love that. You know, I was actually curious, I meant to ask you early on, what was it like growing up in Pisa? Did you grow up in Pisa? What about your family? Can you share a little bit about your family and childhood?

Luna Gargani: Yes, actually, I didn't grow up in Pisa. I grew up in a town close to Florence, but it's actually one hour away from Pisa.  I think it's a kind of fun because compared to the US where distances are so huge and people are used to changing states many times in their life, we are so deeply-rooted to a place. So I was born when our. Driving from here and I'm working in Pisa. But I really chose Pisa as my place.  
And I love this town because it is small. So quality of life is very high, but there is this a good big university. So the cultural life is really interesting. There are a lot of bright people around. It is a touristic place. So you always also have the chance to have a lot of tourists around you. You have an airport which is so close to downtown.  
You can go there in 10 minutes, driving. The trains are so well-connected, the seaside is 10 minutes from downtown. So I think I could be employed at the local office, but I really love this town. And I had to turn down a couple of very flattering work proposals because I wanted to stay here, but I mean, at the moment, I'm happy to be here because it is so important to me that I can walk to go to work and that I can go and pick up my kids in 10 minutes and I can get a flight just by driving 10 minutes.  Sometimes we go there by Vespa to the airport. These are things that really can change your day.  

Meg Escobosa: I was just going to say, if you're going by Vespa, you must pack very light.  

Luna Gargani: Exactly. You can put the suitcase just in front of the Vespa, a few clothes, and you're done.

Meg Escobosa: My husband would be really appreciative of that.  That's great. We have a couple of questions that we like to ask at the end that are focused on innovation. What does innovation mean to you?

Luna Gargani: Wow, this is a very good question. I think that at least in medicine, innovation is doing something that we used to do in an easier way, or in a brighter way, in a smarter way.  And in this sense, a point-of-care is a huge innovation. And I really think that in a few years, all doctors should learn and will learn the basics of point-of-care ultrasound during med school, and this will accompany them in any specialty. So sometimes we say that it is a new set of scope. So somehow, of course, this is not a set of scope, but the similarity is very appropriate because the concept is that this is something that everybody has to do.  
It must be part of the most basic approach to patients and thanks to the innovation. So thanks to the technology, allowing us to have echo machines that are portable. You can put it in your white coat. You can really be able to do that to all your patients. So I think this is going to be a big revolution in healthcare.  
It is already ongoing, but it will become even more in the future and will allow us to do a lot of diagnosis much, much quicker than we do now. And hopefully to manage patients in a lighter way, in a quicker way and avoid some mistakes that we still do.

Meg Escobosa: So exciting, really is. What do you think is one of the most exciting innovations in health?  
 
Luna Gargani: This is another very difficult one. I think just, I mean, there are so many, but something that comes into my mind. Very quickly is the possibility to use remote control with patients. And again, the COVID pandemic has taught us that we have these fantastic technologies and we really can rely on them.  
So I think that in the future, and I hope that in the future, patients will need less and less to come to the hospital, but we will be able to see them on a video and do a part of the visit. Of course you cannot do everything, but this can allow you to follow-up with your patient more regularly and more often, and in an easier way, because especially patients with chronic disease, they struggle a lot to come to the hospital. They need caregivers. So I mean all the remote telemonitoring that we are allowed to do now, I think is another big revolution and we have to use it in the right way and it will really help us in the future.

Meg Escobosa: And finally, what do you believe are the most essential ingredients to healthcare innovation?  

Luna Gargani: Well, I think one of the main things is the clinical link. So you cannot do a real innovation if this is, in the end, not so useful to your patients. So you must start with clinical needs. And if it works, that is innovation because there are also a lot of innovations that are very fancy and very nice, but then when you really in the end go to see. Where they help and the added value can be quite small. So that kind of innovation is nice. Maybe it can be the basis for something in the future, but the ingredients for a great innovation are something that must be translated into the clinical practice in an easy way, and not only in third level hospitals. Something that all the doctors can do and can be for the benefit of everybody in the world. Not only for a minority of lucky patients in super beautiful hospitals.  

Meg Escobosa: Thank you so much, Luna. This has been just a really interesting and exciting conversation. And I'm so thrilled we got to speak with you. Thank you so much for making the time, especially on an evening with your kids around.

Luna Gargani: It was a great opportunity for me and I really enjoyed talking to you. So my kids are downstairs with my husband. Because this is an essential part of all this life work balance. You need a lot of support from your partner.  Of course, this is essential, but it's really hard, but we can do that. We must make it possible for the next generation.  

Meg Escobosa: Super. I hope we get to speak with you again, and I wish you all the best in your work. And of course, in this difficult time, best wishes to all of you.  

Luna Gargani: Thank you Meg. And thank you everybody.  Bye bye bye. 

Meg Escobosa: And thank you to our listeners for joining us today. If you enjoy our show, please consider leaving a rating and review wherever you like. It helps us reach new listeners. And if you know other folks who might enjoy it, please spread the word to find out more about The Krinsky Company. Check out our website. See you next time.  

ANNCR: Thank you for listening to The Game-Changing Women of Healthcare. This podcast was produced, engineered, edited, and scored by Calvin Marty. Please take a moment to subscribe via your favorite streaming service. The Game-Changing Women of Healthcare is a production of The Krinsky Company. A growth strategy and healthcare innovation consultancy.  Visit us on the www.thekrinskyco.com.