Jada Bussey-Jones, MD (Host): Hello, I'm Jada Bussy-Jones, the current President of the Society of General Internal Medicine and the host of SGIM's President's podcast. We engage SGIM's former Presidents who are leaders across healthcare, public health, policy and academia. As we lead up to the organization's 50th anniversary, we aim to capture insights from our national thought leaders so that our organization, our members, and healthcare and society broadly, are in a stronger position to grow, innovate, and meet the challenges of our time.

To our listeners, thanks so much for joining us. Today I am incredibly excited to talk to Dr. Lee Goldman, who is the Cournand and Richards professor of cardiology at the Vagelos College of Physicians and Surgeons, Professor of Epidemiology at the Mailman School of Public Health and Dean Emeritus of the Faculties of Health Sciences and Medicine at Columbia University Irving Medical Center.

He has had a variety of leadership roles, including as Chair of Medicine and Associate Dean for Clinical Affairs at UCSF. He was the Harold and Margaret Hatch Professor of the University and Dean of Facilities and Health Sciences of Medicine at Columbia University. Dr. Goldman has more than 500 publications that have focused on a variety of things, including cardiac risk and non-cardiac surgery, determining which patients with chest pain require hospitalization and establishing priorities for the prevention and treatment of coronary disease. In addition to leading SGIM, Dr. Goldman has led several organizations, including serving as Past President of the Association of American Physicians and the Association of Professors of Medicine.

He's received the highest awards of the Society of Journal Internal Medicine, the Glazer Award, the American College of Physicians, the John Phillips Award, and the Association of Professors of Medicine, the Williams Award. Dr. Goldman is the lead editor of the Goldman-Cecil Medicine; the longest, continuously published medical textbook in the United States.

Welcome, and thank you so much for joining us, Dr. Goldman, Lee. I'm very excited to have you and I'd love to hear when I've engaged in these sessions, I really love to hear a little bit about not just your professional story, but a little bit about your background and how you got started in your career, and your leadership journey.

So can you tell me a little bit about yourself?

Lee Goldman, MD, MPH: Sure. First of all, it's a pleasure to be with you, for society that I care deeply about. So I grew up in Southern New Jersey, right across the river from Philadelphia, in a small town that bordered on Camden. About 20% of my graduated high school class went to higher education, including trade school.

Neither of my parents had graduated from college. In fact, no one in my family had graduated from college even though my maternal grandfather was a dentist. He went to dental school so long ago, you didn't have to go to college first. Love baseball. Didn't make the baseball team in ninth grade, so I took up tennis and that turned out to be a good outcome in terms of future athletic interests, at least.

Applied to Yale because I was told a local bank had a scholarship, but it didn't. They gave me a scholarship anyway. Stayed there for medical school. They said I had to stay till I got it right. And while there in medical school, met my wife Jill, who's now a professor here at Columbia in Genetic Counseling.

I have three wonderful kids. Now they're old enough to be my doctor, except none of them are in medicine. Although, one of my daughters-in-law is. It's been a wonderful journey for me and not at all what I would've expected. I tell people that I was in my, uh, first months of medical school, actually first weeks even. I didn't know if I could make it.

Our courses at the time were embryology where things move around in three dimensions, and I have really no three dimensional sense, anatomy where the formaldehyde made me sick and histology where they turn off the lights and if you turn off the lights, I fall asleep.

So I was doing very poorly. Fortunately at the time you all had no exams or grades, you only had to pass part one of the national boards. So I went on a course of independent study, figured out how to get a master's degree in School of Public Health during the same four years, and thought I would go off and maybe run a group practice somewhere.

I spent a summer during medical school at a mine workers clinic in New Kensington, Pennsylvania. Actually, one of the leading physicians was Michael Fine's father, you know Michael Fine from University of Pittsburgh. But at Yale there was a requirement to do a thesis, and I went to Yale Medical School because there were no exams and no grades. And despite the fact that there was a thesis. I started with a thesis and I loved it. So I realized that doing research, finding new information, which is a lot of fun, and that fundamentally changed my life and my career.

Host: That is so amazing, including the fact that only 20% of your high school went to college and, and not having -

Lee Goldman, MD, MPH: Not even college. I'm talking about mechanical drawing school and hairdresser

Host: Wow.

Lee Goldman, MD, MPH: school and you know, trade schools. Yeah.

Host: Gotcha. Gotcha. And your family did not have that background and for you to go on to sort of this professional career in academia and writing, I think that's fascinating. Thank you so much for sharing that story. I'm also wondering about leadership. So you talked about how, being pass fail or sort of not having to do, get grades led you to sort of writing a thesis. Maybe I can understand how you, how that led to sort of academia and science broadly. But maybe talk a little bit about how you got into to leadership or how did you recognize yourself as a leader or, how did you, because you've led lots of organizations.

Lee Goldman, MD, MPH: I was one of these people who never, almost never ran for, and certainly never got elected to anything. You know, people who were high school presidents, I never did any of that. It was during my early years at the Brigham and it really came about because of the work I was doing on chest pain and we identified well, it's the time, it seems like the prehistoric now, but at the time, if you had a suspected, even a posible myocardial infarction with chest pain, the standard of care was three days in a CCU where they watched you, checked your SGOT, CPK and LDH each day and after three days you either had one or you didn't have one. But it was thought that took that long to figure out what was going on. It was very expensive and it took up a lot of intensive care beds to save the occasional person who would have a cardiac arrest. Some of the other things that our work showed was that there were people who were probably too high risk to send home, but nowhere near enough high risk enough to go to an intensive care unit.

And, adjacent to the emergency department at the Brigham was a small holding unit, which was for people to stay overnight with for two nights with urinary tract infections or asthma, or to be watched after a kidney biopsy. And we in general internal medicine, covered that unit. My background, as you know, is I'm a cardiologist as well.

And so I got the idea that that unit could be a place to put some monitors and to watch people who were really low risk. And we showed that if you're pretty low risk to begin with, you don't need three days to get to be really low risk. One or two days is enough. And so I set that up to try to show our research which was there some potential clinical value.

And I think once we did that, people started to ask me to do other things. So if I thought I could do them, I would say yes. And so I would say that a career in leadership or administration was never the goal. The goal was to discover new knowledge. For the people I trained, we always said that the North Star was write a paper that someone will quote on rounds, that will make a difference in the way patients receive care. That's still what I love to do. And the other was an unintended byproduct.

Host: Well, yeah, I mean, I think as I've been talking to so many of our leaders, that seems to be the trend. People didn't necessarily aspire to leadership per se, but as a way to, number one, have an impact or in your case, to sort of operationalize the science essentially to lead a program, to make a change or to demonstrate effectiveness.

So I think that that's, it's a really interesting story and I, I appreciate you sharing that. I'm curious about, so I've heard a little bit about your background, how you got into medicine and academia and even leadership almost, inadvertently, in some cases. But how about SGIM? How did you find your way to the Society of General internal medicine?

Lee Goldman, MD, MPH: When I got started, SGIM was in its infancy and its meeting was held, in association with or contemporaneously with what were then called the tri societies. Long since gone, which included the American Federation for Clinical Research, American Society for Clinical Investigation, which still exists, and the Association of American Physicians.

And they held a several day meeting, almost always in Washington, DC at that point. It used to be Atlantic City, believe it or not, where aspiring young academic physicians would present abstracts in sort of the academic equivalent of a meat market, trying to prove their wares and get invited for job interviews.

And SGIM held its meeting at the same time. And I was new to the faculty and I had fairly early on responsibilities in our fellowship program and we wanted our fellows to present. So they would either present at the tri societies meetings or the general internists, more commonly at SGIM. So I got involved really through the research end of the organization, because it was a great way for our young fellows to show their metal, if you will, and begin to start and forge their academic careers.

Host: Gotcha. That's great and I'd love to hear if you have any thoughts about, because you have been so active in a number of organizations in leadership and as a member, how you see SGIM as different or similar from other professional organizations and societies. Yeah, if you can share a little bit of your thoughts about that.

Lee Goldman, MD, MPH: So again, for whatever it's worth, these organizations go through lifecycle events just like people. When we started off, the tri societies were by far the dominant academic meeting in internal medicine. But as the subspecialty started to grow, many of the abstracts that had been presented there began to shift to the Subspecialist Society meetings. Those old Tri Society meetings began to involute.

Back when I was starting, essentially every chair of a Department of Medicine was at those meetings every spring. But as the research began to distribute to the Subspecialty Society meetings, the tri societies began to wither. So much so, that early on we felt sort of privileged to be an appendage to that meeting. As things grew, we became a section, if you will, within the meeting.

Lee Goldman, MD, MPH: We had a joint session with them on Saturday mornings, but ultimately, we declined to become a full fledged member because that society was sunsetting. In fact, there is no tri society, hasn't been tri size meetings, probably for almost all of your academic career. So that's what happened there. SGIM had, early on a very, very heavy research emphasis. One of the major reasons was that we were trying to establish a, a foothold in departments of medicine, in which having some sort of academic foundation was critically important. So again, this seems like ancient history and maybe some of the other speakers have gone through this. But division of general medicine really started when the ABIM changed the requirements for residency education and required that residents spend time in the outpatient setting.

Usually it was one half day a week back then, but you actually had to go, whereas before then if you didn't show up, nah, you're too busy in the wards, blah. But now that the residents actually had to go there, someone had to teach 'em. So departments of Medicine defined faculty to teach them. Early on, many of these people were former epidemiologic intelligence officers from the CDC and the like, but as I was coming through, they're just beginning to hire people de novo, and the division of general medicine trying to get established; began to realize they had to have some kind of academic footing beyond just teaching.

And so the research part was really beginning to grow, and I was very, very fortunate to be there at that really inflection point. So I'm in a cardiology fellowship looking for jobs and realize that no self-respecting division of cardiology will hire me because cardiology division circa 1978 are full of senior cardiologists who see general cardiology patients, but can't do electrophysiology, can't cath, can't read echoes, can't do nuclear medicine. If you can do any of those things as a fellow back then, you're being snapped up by divisions of cardiology. You want to do clinical epidemiology research and be a general cardiologist. No one was looking for people like that. So I actually looked for and got my first job in the division of General Internal Medicine because they were looking for people who wanted to do research, and I had a strong sort of generalist interest that went beyond typical cardiology.

Host: I love that. And you know, we are better for it in general medicine and I dare say in cardiology as well for your experience, in both of those worlds. So thank you for sharing that. I was wondering, as we think about our organization, the history of our organization that you've just shared a bit about, we plan for our 50th anniversary.

Are there any memories or reflections or thoughts that you want to share about your time? I mean, you've already shared some, but if there's anything else that you would want to share there.

Lee Goldman, MD, MPH: So the things I remember the most, I was the Treasurer, Tom Delbanco was the President, and that's when we began the separation from the American College of Physicians. Up till then, we'd been under their wing. We were not an official independent organization, and we came an official organization, I think during the latter part of my Presidency, just around the time that Bob Fletcher took over.

That change, I think was really important. During my Presidency, we focused a lot on criteria for promotion. We had two task forces, one for clinician educators, one for clinical investigators to try to come up with criteria. Because now that people were beginning to be on faculties for more than a couple of years, and there seems like there was a real job here, they shouldn't all remain assistant professors forever.

We tried to come up with general guidelines and principles of how do these people get promoted who are not quite like the people that the subspecialist divisions are accustomed to. Back then, division of general internal medicine pretty much had a monopoly on clinical epidemiologic methods, decision sciences, health services research.

Those were not at all common in the subspecialty divisions. So there's a, a lot of emphasis on research. Most of the members of the organization presented their best work at the SGIM meetings because the subspecialty meetings didn't have stuff like that. So I think what's happened over time, my impression is, that all the research is still important. The meeting has morphed a bit, and that in many ways follows the, the interest of the membership, which is, I said before a lifecycle phenomenon that all organizations go through.

It would be nice if the members still felt that SGIM was the best place to present their work, but I understand why so many people are now presenting their work at the meetings that focus on the diseases that they study. And that's a bit of a change from way back when. It's probably a good change overall for general internal medicine, but it certainly puts a bit of a stress, creates a bit of a challenge for SGIM. 

Host: Thank you for sharing that. And, and maybe to build on that question as we're thinking about that was kind of a backward or you know, in the past, but just moving forward as we're looking at our 50th anniversary, do you have any advice for the organization, future leaders? Anything that, you think is, you know, especially as things are evolving in general medicine, in academia, you know, I dare say in the country, but any general advice that you would offer to our organization and our members?

Lee Goldman, MD, MPH: Sure. Well, a couple reflections first maybe, and then I'll get to that. Obviously, I was very involved in the beginnings of hospitalists. We created the first hospitalist unit at UCSF. I brought Bob Wachter over from San Francisco General to do it. The rest is really history, he did a spectacular job. I think that's created some challenges for SGIM because back in my era, one of the major goals of the generalists was to sustain their one month a year inpatient attending to show they could still do that. And now the transition to hospitalists means that most general internists, SGIM members aren't attending on the inpatient service anymore. Unlike the subspecialists who still attend on their subspecialty service, even if they're not attending on the general medical service. For general internists, they become much more outpatient than we were back then.

Because again, it was a big point of pride. We can be in the outpatient arena four days a week, but we can still attend on the wards. That was a, a badge of honor. That's gone. I think the issue for SGIM, and again, I'm not in the leadership and don't tend to tell people what the best strategy would be, but I think when we split off from the American College of Physicians, they were very worried that SGIM would become a competitor. That we would strive to become the home for all the primary care doctors. Soback then we were called the Society of Research Education and Primary Care Internal Medicine, SREEPIM, almost unpronounceable acronym. But their fear was that just as the subspecialty societies had pulled some people away from the ACP, we would pull away all the primary care doctors.

 And we said back then, those of us who were involved in the organization, oh, contraire. We're not looking to be the home for all those primary care doctors, you know, all across the country. We're the home for academic general internists. And I think over time that's probably been a recurring issue or challenge. And as SGIM presumably wants to grow, you know, how do you grow?

You know, what's your constituency? And I don't have a good answer to that. Again, during my time, we certainly were involved in education, but there was a, a very big emphasis on the research side of things and creating sort of an academic home for people. I still think that's, I guess, should be considered as one of, if not the major goal of the organization.

But it's, again, the landscape has changed and many of the things that were critical to us back then are either unimportant or unattainable. And so that's, we talked about the lifestyle of an organization, but I would certainly like to see SGIM remain focused on the kind of research that matters to its members.

And I'm always a strong advocate of studying patients and diseases. So the kinds of patients, the kinds of diseases, the kinds of presenting signs and symptoms that generalists see. I think that's an enduring area of importance if you will.

Host: Absolutely. And I have to say, as somebody who still does, even though I have relatively a small amount of clinical effort, that I split that up between inpatient and ambulatory and I love it. Doing three maybe four weeks in some years of inpatient and, a half day of clinic, I love all of it. 

So tell me, you're clearly so busy, as a leader, as a clinician, as an investigator, tell me what you do. What are your sources of joy, and inspiration? What do you do for self-care? Maybe you can share that, with us after having this sort of incredible, career.

Lee Goldman, MD, MPH: You know, I stepped down as Dean now almost five years ago. It was the right time. I'd been Dean for 14 years, which if a dog year is worth seven human years, a Dean's year has to be worth at least that much. So it was a, it was a long run, hopefully a good run, but it was, it was time, and I'm still full-time, as you can tell.

I still do research. I still do teaching. I still do mentoring. Spend a lot of time on the book, now Goldman-Cecil, but the Cecil textbook of medicine is about to celebrate its hundredth anniversary. And what we've done with the book is to make it a much more useful electronic product.

It's a little bit different than up to date. And I realize up to date is still widely used, but our usage is increasing, surprisingly, perhaps. But that's where I spent a lot of my time in trying to have a book that's heavily evidence-based.

Host: That's amazing and see, you gave me more work that you're doing and maybe you don't consider this as work. I, so when I talk about self-care and joy is, are those the things that that bring you?

Lee Goldman, MD, MPH: No. Look, I, I have a wonderful family. I have, uh, three children with their spouses and five grandchildren.

Trying to spend as much time as we can with them.

Host: That's right.

Lee Goldman, MD, MPH: I can't play tennis anymore. My back just, uh, has gotten too old, but I can still play golf and that's a, a, nice escape.

Host: That's great.

Lee Goldman, MD, MPH: I read history books. Don't read novels. I read history books. So it's, it's a good mix. And it's, it's, I've been extraordinarily fortunate.

Host: Yeah.

Lee Goldman, MD, MPH: And lucky.

Host: Yeah. And you're, and you're still incredibly busy, but being able to find joy in, family and, reading and, maybe not tennis anymore, but, that's really great. So, as we wrap up, I just wanted to give you, a final opportunity to offer any additional last or final reflections or thoughts that you want to share with our listeners.

Lee Goldman, MD, MPH: Speaking to the younger members, if I may, a couple pieces of advice. One is try to figure out who you are as early as you can. Some combination of things you think you do well, enjoy doing, avoiding the things you don't do well or don't enjoy doing, and try to create in academics, some sort of a brand, what you do and do well. People have used different terminology for that, but academia's a great place.

But it's a little bit like being a member of an orchestra. Whoever's leading it tries to make good music, great music, but you don't make great music by having people who are pretty good at five different instruments. You do it by having lots of people who are really good at the instrument they play.

And so my message, young people, is figure out your instrument, figure out your position on the team, whatever it may be, and figure out how to do that well. That'll hopefully bring enjoyment because it's what you enjoy doing and what you do well. And hopefully it'll be something that's has some enduring importance to your institution, to American medicine, to the health of the public.

I think that the biggest mistake people do is fall into the trap of being so good at so many things, they try to continue to do so many things. One of my great fortunes, so I'm not good at that many things. And so, I told you I have no three-dimensional sense. I'm tone deaf. I can't draw.

So there's lots of things I just can't do. Sometimes that's more of a blessing than I thought it was back when I struggled to try to do those things at some not very good level. But I think for many people in medicine, they're good at lots of things and that makes it harder to choose.

And my suggestion to people is bite the bullet, figure out what makes you the most happy, what you do the best, and then go for it. Take those risks early on.

Host: I love that and I will acknowledge that as a generalist it can be hard, right? Because, but what I hear that message about finding your instrument, you know, what you love and what you're good at, and really availing yourself with that as, as your career. I think that has makes a lot of sense.

So, so thank you so much, Lee, for, for sharing your wisdom and your time with us today. I also want to, thank the SGIM staff and Roz Bogle, who is our executive producer and the entire production team. I also want to say thank you to our listeners. You have been listening to SGIM's President's podcast. If you like what you've heard, please rate us and leave a comment where you listen to podcasts as it helps others to find us. Also look for us on the SGIM website sgim.org and follow us on X.