The Zac Clark Show - What a Renowned Cardiologist Has Learned About Health and Life After 40 Years | Dr. Sheldon Goldberg

Episode Date: May 6, 2025

In this special episode on wisdom, Zac and Jay sit down with Dr. Sheldon Goldberg — known affectionately as Dr. G — a pioneering interventional cardiologist whose medical career spans over five decades. Dr. Goldberg serves as Clinical Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and Director of Cardiovascular Education and Research at Pennsylvania Hospital. With over 150 publications, 8,000 citations, and a central role in the groundbreaking STRESS trial that helped establish the use of coronary stents, Dr. Goldberg’s impact on the field is both deep and lasting.Together, they explore not just the evolution of cardiology — from the earliest days of interventional procedures to today’s cutting-edge treatments — but also the deeper lessons he’s learned about healing, resilience, and what keeps the human heart beating in more ways than one.The conversation moves from the hard truths about smoking, alcohol, and lifestyle choices to a candid critique of America’s broken medical system. Dr. Goldberg reflects on the emotional toll of medicine, the difficulty of balancing work and family, and why humility and human connection matter more than ever in an era increasingly dominated by AI and corporate healthcare.Zac and Jay also dig into the personal: What does a man who’s saved thousands of lives regret? What keeps him motivated? And what would he tell the next generation of doctors who are stepping into a vastly different world?This is a rich, revealing, and profoundly human conversation about medicine, mortality, and meaning.Connect with Zachttps://www.instagram.com/zwclark/https://www.linkedin.com/in/zac-c-746b96254/https://www.tiktok.com/@zacwclarkhttps://www.strava.com/athletes/55697553https://twitter.com/zacwclarkIf you or anyone you know is struggling, please do not hesitate to contact Release:[phone]releaserecovery.com@releaserecovery

Welcome back to the Zach Clark show. These next two episodes are going to be about wisdom. I'm so excited because I have someone with us today who is, I consider a friend. He's someone who's had a great impact on my life. I've known him my entire life. I'm very good friends with his son, who's also a cardiologist, and we're going to get into all that. Dr. Sheldon Goldberg, who I refer to as Dr. G is our guest today.

He's been practicing cardiology for over 40 years. Dr. G, what is up? Welcome to the show. Thank you very much, Zach. It's really pleasure to be here. And I'm honored that you asked me to appear. Yeah, no, I think, so my spoiler alert, my father is going to be the next episode. So we're going back to back here.

And I promise him, I wouldn't ask them how old they are. But there's a lot of wisdom coming in these next two episodes because as the world continues to spin these two guys have seen have seen a lot right yeah i i i just i hope that you know when i'm older and have kids and grandkids and they have you know that i'm running around and and still can wake up and want to do my life in a way that is productive and healthy and helpful and um so i think this is going to be good yeah so let's just start with a kind of an easy you grew up in brooklyn right is that give us like the how you got to medicine, the abbreviated version of why medicine, why cardiology, what was the

reason for that? I think it's always noble when someone wants to be a doctor. Well, when I went to college, I had a very brilliant roommate, and he was a great student. I wasn't that great a student, and his father was a GP in Brooklyn, and he would come up and take us out to dinner, and we were in our senior year, and he said, what are you boys going to do after graduation? And my roommate said, well, I'm really not sure that. And I said, I'm not sure either. Well, you should become doctors. Why? And he said, well, the first reason is you get to work with your mind. It's a scientific discipline. Second, and more important, you get to work with your heart because it's a very human discipline as well. And third and most important, don't forget

this boy, nobody can ever tell you what to do. And I always tell my roommate now, two out of three ain't bad, Gary. Your roommate now being your wife. No, my roommate, my former roommate is now a cardiologist. Oh, oh, your roommate now. I missed that. I thought that was a little joke on your wife who is also a friend and I love very much. Okay, I'm following now. My former roommate. Yeah. So that's how I got into medicine from a GP in Brooklyn who was a very inspirational character, you know, making house calls, the human touch. And I thought he really exemplified what he was telling us. So that was it. you make this decision to go into cardiology. I'm always curious, and maybe this is something

that I shouldn't ask, but there's always the first operation, right? Like, who is that patient? Right? Like, they don't know. Yeah. Like, I had a pilot the other day, like, this is our first flight on this plane. I'm like, what do you mean it's your first flight? It's our first flight flying this specific plane because they were waiting to gas it up or something. And I said, am I supposed to be nervous here? Like when do you finally, hey, put me in coach, you're ready to do a surgery? Well, you know, cardiology training is very long. First you've got four years of medical school.

Then you have medical residency that usually now is about three years. And then cardiology training, you do general fellowship for about three years. And then if you want to do interventional cardiology, that's another one to two years. Of course, when I trained, there was no such thing as interventional cardiology. That came about much later, but you get a lot of training using mentors, and once you finish your training and you're out there on your own, I always tell people, you learn more in your first year than you did in the prior seven years of training because you have to. You're the person. And I have to say, having practiced the interventional cardiology for 40 years, when I was doing procedures in my last year, I still felt I was learning. every time and we try to do something better, more efficient, and more elegant for the next patient. So it's a learning process. Very important to be around people and colleagues that

you can ask for help. It's not a sign of weakness to ask for help. It's a sign of strength and confidence to ask for help and other opinions. And my career, as I started, I had people working with me who were more experienced than I would always have them scrub in with me, help me out in terms of decision making, and also in terms of technique. So you continue to evolve. But certainly the first time you face that patient alone and you're in charge, it's a big step and one that I'll never forget. I also kept the biography of all my patients in terms of, you know, what I did. So when a patient asked me, how many of these have you done?

I could tell them. How successful have you been? And I think that's very important. And obviously, when I started out, I was not nearly as confident as I was in my later career. But it was still a learning process, even after 40 years. Amazing. What was different now or from back then, like in terms of going to med school? Yeah.

How did you, you know, was it just? I'm going to this school and you applied and you got in? Or how is it? Because I know it's like it's incredibly cutthroat and... Yeah, you know, I don't know if I could get in today if I had to apply today. I think it's really competitive. And again, my roommate and I decided, since he was such a good student, we'd go to the same school because then I could, he could help me out.

And it came down to a choice of a couple of really good places. And we chose the University of Pennsylvania because of it's, you know, reputation and it was a very laid back place at the time it's first medical school in the united states by the way really yeah first medical school north america penn yeah so our choice was between pen and johns hopkins and we decided we'd we'd pick the university of pennsylvania i want to go back a little bit just because there's a couple things that i really remember about you growing up and the first was you were always the joker I mean, like in my parents group of friends, Dr. Goldberg was the guy dressing up, you know, on Halloween and banging on your window to scare the shit out of the kids.

And like, I'm sure there are kids in Haddonfield, the town we grew up and to this day that still think of you in those moments. And then there's just another amazing story where my brother, Matt, had his driver, he was going to get his license. It was a driving test. and it was his birthdays in January, January 8th. So there was a huge snowstorm. The thing was scheduled. And Dr. Goldberg, there's no way of driving. I mean, we're talking three feet of snow, right?

Like, there's no way a driving test was happening. So he prank calls my brother. He calls our house and says, this is when there's landlines and says, can I talk to Matt Clark? And he puts on a voice and he tells my brother, he tells my brother, sir, we're looking at the schedule here, like you didn't show up for your driving test. and my brother says, what do you mean? And you're getting your driver's license. This is like the most important moment in your life to date. He says, oh, sir, we don't, we don't cancel driving tests for anything.

Rain, snow, sleep. And it looks like we're not going to be able to reschedule you until July. And so my brother hangs up the phone and my parents are in the other room and he goes into them white as a ghost, says, I missed my test and now I can't. And this was all you. And so like, I'm just curious, being a doctor, it's so. serious it's so heavy where where did you learn that playful side or was that always you or i think it just came naturally i think you know you are under um stress when you're doing

life-threatening procedures life-saving procedures and i think it was probably a that's a great reframe a great way to um let off steam and and have a good time and laugh and you know when you're doing medicine you're doing it for purpose you're doing it to make people's lives better So you need to have a side of your life that appreciates the human side. And I think, to me, it's very natural to tell you the truth. Right. I still do it, you know. Yeah, that's amazing.

And the second thing I remember is we summer down in a town called Avalon and Siahel, which is down on the Jersey Shore. And I remember, I mean, this was probably in 1992, 1993. You probably remember better than me. And our parents said put on the news, Dr. Goldberg, who I knew you as just my parents' friend, is going to be on television. And at that time, for someone to be on television that you knew as a little kid, you are amazed.

Like, oh, my God, my parents, friends is going to be on TV. And it was in relation to your work around the stent. So I need to know in the not so humble way your involvement in the stent, how you brought that to how you brought that to market and really the impact you've had on the medical community through that work. Well, I think it was the highlight of my medical career to be involved. And again, I was in the right place at the right time. The treatment for coronary artery disease and patients who needed to have their blood flow restored

years ago was coronary bypass surgery, which is a major operation involved splitting a sternum, taking veins out of the leg, and using a chest wall artery to bypass blocked arteries. And then in the 1970s, a Swiss cardiologist by the name of Grunzik was working with a whole different idea, a radical change. Why do we need to split the chest open to take care of a little, you know, three millimeter wide artery with a little blockage in it? And can't we thread a tube into the heart and use a little balloon to blow up the area and open up the artery and restore blood flow and relieve symptoms? And it was a breathtaking idea. And I had just finished my cardiology fellowship. And I went from Boston, Philadelphia, and I got a phone call saying, there's a guy in

Switzerland who's coming to Boston to demonstrate his new technique. If you have any patients that are suitable, well, we didn't know what was suitable. So I had a patient who I thought might be a candidate, and I flew her down to, flew her up to Boston from Philadelphia. You were working in Philly at the time. I was working in Philly and we went back up to Boston and I got to meet Dr. Grunzick. He flew over from Switzerland and I'll never forget what he said to me.

He looked at the films and he said my technique is not developed enough to using your patient. If something happens to this artery because of a prior history of a previous heart attack she could go into shock and it would be a disaster. And he thought we should pass over that case, step back. And he showed me all of the results that he had in Switzerland with his patients.

I think he had done about 20 patients at the time. Well, the group went ahead and did that procedure anyway, and it was a disaster. The artery tore, the patient had to be rushed to emergency bypass surgery. But then I had the opportunity to go over to Switzerland and meet Dr. Grunzik there and learn the technique from him of balloon angioplasty. And the balloon was a great new revolutionary therapy because it eliminated the need for bypass surgery in certain patients. But it had two very important drawbacks. One is you could tear the artery, cause it to close, and result in an acute heart attack requiring emergency surgery.

And the other is the natural scar tissue that formed after this procedure could re-block the artery some time later. So there was an acute problem and a more chronic problem. So we thought we'd need a better solution. And I was sitting at my office in Philadelphia, and I got a call from somebody at J&J who just started a new company. I hear you guys are having a lot of trouble with balloon angioplasty. I think I have a little solution that I'd like to show you. And he came to my office, and they took a little test tube out,

and he had a little metallic cage cylinder. The first time I had seen a stunt. And he said, you know, if we put this in, this will prop the artery open, it'll prevent it from closing. And if we get a nice big opening to the artery, maybe this is better than the balloon. I said, this is a great idea. Let's try it. So we flew down to San Antonio, Texas.

I met the guy who developed this idea, Julio Palmas, back of the envelope drawing that he developed. And we did some animal work putting in stents. And then we had to start clinical trials. So we did observational studies, and after a while, we did what's called a randomized trial, which is the highest form of evidence in medicine, where we had half the patients assigned to get a balloon angioplasty, and half the patients had a stent put in. And then we brought everybody back at six months and a year,

and we looked at our results, and it turns out the results with the stent were superior to those with balloon angioplasty. So now we had what we thought was a major step forward. We published that in 1994 in the New England Journal of Madison. It was a big to do. That's probably... Yeah, 94 was probably sitting on the... It was probably that time frame.

Philly's were probably stinking. Yeah, so that was a major advance, you know. This is in 94? 94 when we published it. And it was a great experience to me. took us seven years. I mean, we started working on stunts in the 1980s and took a lot of patients and a lot of time. And I got to meet the most outstanding cardiologists throughout the world. And it was a great experience for me to work with so many great people. And we organized the

trial and I was lucky enough to be the principal investigator on it. And that was it. So I was in the right place at the right time. I happened to be in my office. the guy from Jay made the phone call and away we went. Dr. Palmas, who invented this, by the way, has a great vineyard in Sonoma, California. You visit. And one of the great pioneers and one of the great inventions in clinical medicine. So it was great to be a small part of a large enterprise.

And how many those do you think you've put in people over the years? I mean. Thousands. Thousands. And of course. Are they still using it? I mean, I don't know. I mean, are they still?

Okay, well, let me tell you about the stent. So the stent was not a silver bullet because they had problems also. You could suddenly develop a clot. Just think about putting a piece of metal inside of a small coronary artery. You know, the body's going to react to that. So clotting of the stent was a problem. And tissue still grew inside the stent because the body heals. If you cut your hand with a little knife, you would form a slum.

And the same thing if you traumatize an artery, you still, the body wants to heal and form scar tissue inside. And if you form very thick scar tissue, it could re-block the coronary artery. So we weren't done with that. And later on, the stents are no longer made out of bare metal. They have a metallic framework. And they also have a drug coating that comes off of the stent that prevents this scar tissue from forming. And we also have better drugs that we give in addition to the stent to prevent

clotting of the stent as well. And so it took a lot of work on a lot of people's part. And I remember people asked me when we published that paper, you think you hit a home run. And I said, no, I think we hit a double and it needs a single to knock it in. Use a Brooklyn baseball analogy. And that was the development of better drugs and better stents. And I have to tell you that, Because of the results were mixed early on, there was a writer, an editorialist for the New England Journal who said the development of these techniques is probably futile, it'll never work.

Maybe it'll be applied to 5% of patients who need revascularization. Now it's the most common coronary procedure in the world. So you've gotta face the problems of your technique. You gotta realize nothing's a silver bullet. Face the problems. square on and try to solve it. We don't try to minimize it. And I think that happens throughout all of medicine. There are no silver bullets. Every technique has its drawbacks and you just got to keep

working at it until you make it better. Yeah, I mean, that's something we see in the behavioral health care field especially is that, you know, with drug addiction or substance abuse and mental health disorders, I mean, there more than anywhere else in the world. I mean, you know, you got to you got to hang in there. You got to keep trying and keep loving. And sometimes, you know, prescribed methods don't do anything. Yeah. The needle. And then one day it does. And you also have to realize that these stent techniques, these interventional techniques, surgical techniques only solve an acute problem that's been built up over years. And similar to the addiction world, you've got to realize the risk factors that cause it and address those.

as well, which is very important. Yeah. I always tell people in training, I can teach anybody how to put a stent in, but it's much more than that. It's patient selection. It's counseling patients beforehand and afterwards to prevent people from coming back to the cath lab. And I also think stents one day will be just one point in history that will be regarded as a

primitive technique as we develop better preventive therapies. So can you just describe plainly? what like the stent actually looks like when you're putting it in yeah so it's a little metallic cage and it's uh today it's mounted on a balloon catheter and it's crimped in the factory when the stents first came out we did it ourselves we it's kind of primitive but now it's crimped very tightly onto a balloon the balloon comes in various sizes so you could put it in different size arteries. And when you put the catheter in, you thread it into the lesion, you position it properly. There are markers at the tip of the balloon to tell you where you are, and you

inject a little bit dye, and you see that you're straddling the lesion appropriately. Then you have an inflation device. You increase the pressure in the balloon. The balloon expands. The stent is embedded in the vessel wall, and the drug comes off of the stent inside the vessel wall to prevent this exuberant healing response, the scar formation. But it's got to do it just the right amount. You want a little bit of scar tissue to cover the metal, but you don't want too much to block the artery. And that's taken years to develop. And I think we're pretty much there. The results are spectacular. And also the patients need to be on medication to prevent this clotting. Well, they're not, that's an interesting question, too. We used to give blood thinners.

drug called Warfarin, and we thought that was the most powerful thing to prevent this metal from clotting off. And it turns out it was the wrong drug to use because it wasn't the coagulation system that caused the clot. It's blood elements called platelets. So we switched over from these anticoagulation blood thinners to drugs, which we call anti-platelet agents. And they're much safer. They cause less bleeding, and they prevent this clotting of the stents. and that was first done by colleagues in Germany. They looked at people that they put stents in over 500 patients, and half the patients were assigned to Warfarin.

Half the patients were assigned to an anti-platelet drug, and the patients with the anti-platlet drug did much better in preventing clotting of the stent. It went from about 6% to 1%, which is a usual result. A very wonderful result, and if you clot your stent, you're having a heart attack. You can either die or have a major heart attack. So a reduction from six to one percent is a pretty major, major advance.

So it takes a lot of investigators, a worldwide effort, a lot of cooperation, communication, and pooling of results and understanding how to best treat patients. So you began in the 70s practicing officially or when? I finished my fellowship in 1977 and, of course, learned much more in my first year in practice than I did in all the previous years of training. Is there, would you say over the years, like, is there a general makeup or profile? Like, do you think people today are generally healthier or, you know, with the advent of, you know, technology and science and so much more information?

How has it changed from the 80s, 90s that, you know, throughout your career in terms of the kind of person that, you know, seeks help, when they seek how old they are? I mean, have you noticed that? it's random. No, it's not random. Definitely more elegant therapies and prevention have reduced the need for these procedures such as stent implantation or coronary bypass surgery. And I think that's a natural progression. And I think educating the population, getting to reduce their risk factors, your risk factors can be divided into modifiable versus non-modifiable. risk factors. The non-modifiable one is genetics. You can't pick your parents. But you can stop smoking. You can reduce your cholesterol. You can treat your blood pressure and you can prevent diabetes. Those are the major risk factors. And smoking is a terrible scourge. And, you know, just increases the risk for developing disease and also the outcome once you do develop disease is really negatively influenced by cigarette smoking.

The smoking. And what about the just, because a lot of what's happening now is there it's these almost nicotine lozinger. Is it the nicotine or it's the actual smoke and the? It's a combination of all of those things. And, you know, if you want to develop vascular disease, look in smokers. And, you know, when somebody comes in, came in for treatment with me, came to see me in the office, I could kind of smell the cigarette smoke. their breath. I knew they would have the worst disease. When I took pictures of what their

arteries look like, it was terrible. And they developed disease not only in their heart arteries. They develop it in their carotid arteries that feed the brain, the arteries that feed your leg, the abdominal aorta. And we call these people vascular paths. They developed this diffuse vascular disease that's very characteristic of smokers. And of course, the other big scourge is diabetes and pre-diabetes. And a lot of inroads being made today with medication. So I read about these people that just, you know, you'll read about 44 years old, drop dead.

And I think about my profile, right? I'm 41 years old. I'm someone who I think to the common eye believes, most people believe I'm pretty healthy. And I would say to the next person, I'm decently healthy. But I, you know, I'll smoke at the occasional cigarette. or cigar. I will use the nicotine from time to time just for whatever reason. The Zin pouches

or some of these other things that have come into the marketplace. My diet is not tremendous, but I run a lot of miles. I mean, I run eight miles today. I'll be running the London marathon this weekend. My sleep is so, so. In that profile, what is the most important thing for me to hone in at 41 years old. Totally stop smoking. I continue running. I think that's great. Sleep deprivation, that's a big deal.

We know now that, you know, good sleep is very important. What's the average hours? I've heard eight, seven. Yeah, I think, you know, the more the better. More the better. Eight hours, I think, is a pretty good number. And getting your, do I? What do you sleep every night?

Probably about six. Six? Yeah. And getting your LD. cholesterol your bad cholesterol down is critical and we have such great drugs now to do that and so would you say because like Zach brings up the nicotine I'm worried about dropping dead I mean like I think about that I that's why I brought up high cholesterol stay next to you know a renowned cardiologist you know like I I think about that all the time and and you know I I smoked in my 20s

I stopped didn't you know it was nicotine free then started smoking cigars like every day smoking cigars. I have been sober for 17 years. But I have this relationship to nicotine. And now there are these things, Zin, which is tobacco-free. So it's basically they pitch it as there's no carcinogens. It's just, you know, six or seven additives and nicotine. But nicotine is really the problem on your arteries, right? There are a lot of problems. I would break that happen. I would break that relationship as soon as you can. Okay. It's a good thing to bring up with them. mind right now to stop. I'm done.

I'm done. He's done. We got, we're counting days. I have one in my mouth. I'm not, oh, you're actively, he's actively got the nicotine. I have one in my mouth. Yeah. But I, but I know I do.

It's scary because I think about it, you know, uh, I, it's, I know that it's all bullshit. It's bad. Well, you know, one interesting thing, you talk about, uh, sudden cardiac death. Half the patients who have a heart attack never reached the hospital. They die at home of an arrhythm. me a big focus now is how do we identify those patients beforehand. And there are advancing technologies to do that as well. So one day we may want to take people who have multiple risk factors. We used to have to put a catheter inside of you to image your coronary arteries.

Now we can look at your coronary arteries non-invasively. Just a CT scanner. And just a little dye injection in a vein. You lie down on the scanner. You get a pretty good idea of what your coronaries look like. And we can actually characterize what plaques are that are vulnerable to suddenly rupture or erode and cause a heart attack. If I would insurance cover me, if I said I wanna just go do that

because I wanna be healthy or they, no way? No, no, not at this point. They wouldn't do it. I said I wanna go, you know, I've been, I have this relationship to nicotine and I'd like to see a cardiologist with my insurance covered and no. So there's nothing prevented it.

I mean, there's no, in an ideal world, is that part of a physical? I mean, is that part of, a yearly checkup? I think what's part of the physical is your lipid status, right? Your blood pressure, your blood sugar, a number called hemoglobin A1C, which is a reflection of what your sugar was like over the past month. So I think those are the starting points and really work on those things.

But how much is it like, you know, because I feel like for people who are not doctors, Don't, you know, and just play, you know, Mr. Google Doctor and start, you know, working themselves into it. My mom is WebMD. My mother will webmd me to death. I mean, she will. You can find anything you think to support the anxiety that you're creating. But how much of it do you think really is genetics? I mean, obviously smoking's bad, diet. But like at the end of the day, we do see people like, I've been watching this Celtics documentary. I mean, Red Arbac was smoking cigars all day, every day lived, you know, into his up. Brady's, Churchill smoking 10 cigars a day. I mean, how much of it is genetics? I think that's a component of it. And, you know, there are people on all ends of the spectrum. It's not that everybody's going to have this disease. Everybody's going to have this bad outcome. But if you average it out, you want to play the odds as safely as you can. Right. Yeah. Everybody can go to casino and have, you know, hit the jackpot. But more often than not, you keep playing and the house wins.

So I think the prudent thing is to, you know, modify your lifestyle and diet. And we're seeing it. I mean, I think there's a pretty big push, one of the benefits I've seen just in the social media world. I know that's probably not you're not spending near as much time as I do there, but there's a lot of people out there playing the longevity game, talking about ways to improve your health and your lifestyle. And a lot of that is around sleep and not drinking and really optimizing your life. life. So, I mean, maybe there's some things that are being done without us even. Yeah, I mean, I think definitely, like you're saying, modifying your life. What about, what about alcohol? You brought up alcohol. You know, the surgeon, last year, the surgeon general came out linked

alcohol to cancer, but from a cardiovascular standpoint. Tremendous effect, I'm glad to ask that question. Tremendous effects of alcohol on cardiovascular disease. One of the major effects is on the development of a very important rhythm disturbance called atrial fibrillation. So drinking is a risk factor for the development of atrial fibrillation. Atrial fibrillation is a leading cause of stroke because when the upper chamber of the heart doesn't contract, clots can form in a area called a left atrial appendage. And people may or may not know that they have a fib,

and the next thing that happens, they have a major stroke. Stroke is one of the worst things that can happen to you. It changes your quality of life completely. Not only can it kill you, but your quality of life is decreased. So, AFIB is a big contributor to stroke, and alcohol is a risk factor for stroke. We have some great treatments for atrial fibrillation in addition to drugs and blood thinners. We have techniques in the cath lab called ablation, where we can actually interrupt the pathways that cause the AFIB. if you stop drinking with AFIB, your chance of having the need for a repeat intervention

decreases by about 40%. So you don't want to go through multiple procedures, which carry risk. You know, people can have all kinds of things happen during cardiac procedures. And if you, it would be best to stay out of that situation. So alcohol, tremendous effect on the heart in terms of a-fib is just one thing. You can also develop a heart muscle disease called alcoholic cardiomyopathy, where your muscle doesn't contract well and you suffer heart failure. And it used to be thought.

People talked about the French paradox and drinking red wine and so forth. And actually, any alcohol at all is detrimental. There's absolutely no benefit to drinking. I'm not saying it on a moral. basis. I'm just telling you what the data is. The data right now shows that even one drink a day is not going to be too helpful to you. That's outside of addiction. I'm not talking about addiction. No, I know. Yeah. Yeah. Thank God. Just my zins over in the corner. I just, yeah, I mean, that's, that's where I keep going with some of this stuff because as a doctor and then I want to get

into some of the personal stuff around my journey. But as a doctor, you sit there and you do these surgeries and you tell people, hey, you have a chance to live a good life, don't smoke, don't drink, don't eat crappy food. And then they end up back in your office six months later or a year later and they've changed do you, when you, does the patient follow the direction or not follow the direction more often? I found the most frustrating is smoking. It's been very, it's been very hard for me to change people's habits. as far as cigarette smoking is concerned.

And some people would say to me, well, you keep doing procedures on this guy and he's still smoking, why don't you just not offer him the procedure? I never felt I could do that. I still try my best and encourage them as much as possible, but it's a real surge. He's been to rehab 25 times.

Why are you going to keep, well, because maybe on the 26 he gets it. That's one of the most incredible areas. The other is diet. You know, people get addicted. These food addictions are amazing. And, but I just keep trying, you know, keep emphasizing it, sending people to our dietitians. I'm very strict about cholesterol lowering, putting them on the right dose of medication,

getting their blood pressure under control, getting their weight under control, and just losing your belly fat is a very important thing because of the inflammation that's associated with, with belly fat. So people are using the, you know, GLP-1 inhibitors right now, injecting themselves. What do you think about those? I think they're important, you know. I think they can reduce cardiovascular events pretty significantly. I'd like to see you do it on your own, right? It's expensive. We don't know the long-term effects yet, but I think it's been a real advance in medicine. So if I'm a patient in America and I have, there's two profiles here. There's one that has all the money in the world and the best insurance and the other is, you know, state insurance and

not the greatest financial situation. How different is the care that profile A is going to get versus profile B? You know, I'm not an expert in that area. I can tell you that in the socialized medical systems, there's often delay in care and people get more immediate care in the United States. I think, but the medical system is broken. No question about it. Just getting an appointment is a big deal. We've got insurance companies overlooking you and telling you you need pre-certification for everything. That wastes an enormous amount of time of the doctor. And with the advances in medicine, these advances are expensive, right? The drugs, when they first come out, are expensive.

People always asked, when J&J got the approval for the stunt, people ask the president of J&J interventional systems, how can you charge $1,500 for a tiny little piece of stainless steel? He said, well, the first one cost $100 million, you know, because the development they have to put into it. So people are always knocking the drug companies. And I agree that maybe they could use their money a little bit more wisely. But drug development is a very important aspect of things.

And we don't have access. Let's face it, we don't have access. And I think our... We don't have access to the drugs or to the... While the insurance company, when you walk into a doctor's office, you're walking into the waiting room of an insurance company, basically. Right. That's what's happened.

And it wasn't like that when I started my... career, but it's certainly like that now. And people waste countless hours on the telephone, you know, telling some guy in far off state why you're doing a procedure. And they look it up in a guidebook and they say, well, it's not an indication. So it takes all of the personal touch out of medicine. And I think it's detrimental to patient care. So something has to change in the system. And I would really favor taking the insurance companies out of the picture. And you say that, you know, I see this too, that it's very hard to get an appointment and, you know, someone who's working a full-time job and doesn't make a lot of money and trying to prioritize,

and trying to prioritize their health seems very hard to do. Is there a lack, are there not enough doctors? I mean, what is it just, it's not too expensive? There's not enough doctors in areas of need, you know, in rural America. Doctors tend to congregate in the big cities. I'm guilty of that myself. You know, I want to be a specialist. I didn't want to do general practice. And I think that's the toughest job in the world doing, you know, primary care.

Yeah, very tough. So I'm going to ask you something about that because as a doctor, you get all kinds of calls. Some are in your wheelhouse and summer obviously not. So it's 2010, it's 2011. You're one of my father's closest confidants. And I, Zach, am struggling with a substitute disorder, and it's been gone on a couple years now, and the cat is out of the bag. And my dad calls you as a doctor probably at some point and says, look, Shell, I don't, you

know, I don't know what to do here. What was your response? What was your knowledge of addiction? What was your, as a doctor who's been prepared? practicing in this country for many years? My knowledge was paltry at best. I had very little knowledge of addiction. But I knew you needed serious help.

No question about that. But I didn't have the personal background or experience knowledge of what addiction is all about. I've since learned a lot about this devastating disease. And I know your organization release is really in the same business that I was in saving lives. And I think it turned out, you know, very well, obviously. Yeah, it turned, it turned out well. I just, I am always blown away, Dr. G. that doctors do not get more training at the entry level around this. I mean, like, the numbers don't lie. I mean, we're losing 100,000 people minimum of year just to opioid overdose. I mean, that's just a starting data point. And we just

fail to acknowledge this as a real Well, I'll be very honest, I had no training at all in this, in medical school. Zero. Look, Dr. Polt, we are the last guest. And I'm not saying that proudly. No, I mean, this is where I think impact can be made, right?

Because, look, I had a friend, I had a friend recently in the last month that had a surgery. And they were sent home from that surgery, which I am 1,000% convinced Tylenol and Advil would have been plenty. This was not a major

surgery with Tylenol 500 or 350 with 7 and a half milligrams of hydrocodone in it. So it's a per cassette 7 and a half or whatever. And it was just unnecessary. Yeah. And that they can start. The doctor

didn't warn about anything and this person, you know, like we were like kind of loosely in touch and then like you know they stopped taking it and they said two days later they didn't feel they felt kind of gray and I said well you're probably depressed you're probably feeling a little bit of withdrawal didn't the doctor explain to you that this would happen no yeah so that that's where I get all screwed up on this stuff well doctors don't do a good enough job in treating the whole patient there's no question about that it's true of addiction it's true

of many other things as well and I think patient education really should be one of our primary goals And first, we have to get educated ourselves. And I think the medical school curricular are much better today at addressing these issues than they were in my day. You know, it's like a totally different world. But is it fair to say that doctors don't have the time to actually develop those relationships with their patients because they are so busy?

I mean, that's... Well, we were talking a little bit about the work we do prior to coming on the show today. And, you know, I was explaining to you the way that we operate. And you said, I would love for to be able to have those, like if I had a caseload, if you had a caseload of 10 patients, you might be able to give the family a half hour to 45 minutes a week of education. The practice of the outpatient practice, I spent a lot of my time doing procedures.

That was on the inpatient side, but I would see patients one day a week. And if I saw 10 or 12 patients, that was a very busy day for me. My son is a cardiologist. and on his days in the office, he sees 20, 25 patients. The pressure for throughput is enormous. And, of course, the administrators are looking, you know, you're not being efficient enough. You only have 20 minutes to see a patient,

and people end up spending a lot of extra time eating into their home life. They spend extra time writing notes on their computer. Doctors hate their computers. And when I had to learn how to use a computer to see outpatients, they sent me to a class. I was like twice as old as anybody else in the class when we adopted Epic and took me a while to learn how to do it. And six months later, the lady who was the teacher in the course came to see me. And she said, you could increase your throughput even more.

Instead of taking notes while talking to the patient and facing them, just type it right in on the computer right in the room. and you'll increase your throughput, and I said to her, Carol, people don't come to see me to increase my throughput. They come to see me because they've got a life-threatening condition. And she said, you know, I agree with you. Keep doing what you're doing. But it's hard. If you've got a patient, you know, 20, 25 patients to see, the pressure is there. You stay later. Then you get pressure. Well, the staff has to stay later because you're taking time to explain things to patients. It's a real problem. The outcomes are better. Yeah. Is that what you meant, though, when you said before we started talking that you feel like medicine has become too mechanical?

Yeah, it's become corporatized. I feel like the doctors take the brunt of that because people think, oh, my doctor doesn't care. I'm just a number and I go in and out. And that's not true, I feel like. No, it's not true at all. And I tell people that people today have, doctors today, the young physicians today, have a much tougher time of it than we had. You know, I think there was more time to interact with patients, less time to be second-guessed by insurance companies, less time spent on the computer, and more time spent on that personal

contact. Do you think younger doctors are more because they're coming up in such a, you know, a world driven by technology that they're predisposed to being more, you know, crunch, you know, let's burn through and less bedside manner. And people miss things all. Also, just, you know, things that they should be picking up. Things like the physical examination, I always emphasize, how do we diagnose aortic valve disease? It's an echocardiography test.

Now you diagnose it by taking a history and doing a careful physical examination. The echo is to tell you how severe it is, but you should pick it up yourself. So people misdiagnoses. Just a simple thing, like taking the blood pressure in both arms, tells you if you have a blockage in one of the major vessels coming off your aorta and that can have devastating consequences and I always ask people did you take the blood pressure and both arms oh no I just took it in the right arm well you know could be very different well if you're rushed and you don't have time you can miss things no question about it same thing with the drug test I mean in our in our work right the the holy grail

of knowing if someone's getting high or not is they pee in a cup and then you know you dip the thing and it reads whether they're getting high or not. And I always say that should be the last line of defense. Is this human being acting like they typically act? Do you smell alcohol on their breath? Are their pupils dilated? Like there's real things that we can look at as behavioral health care professionals. And families, that's why it's so crazy to me because families will refuse all of these

behaviors until they have it in black and white on a piece of people. Oh, yeah. I'll ask somebody on rounds, did the patient have bypass surgery? I'm not sure. Did you examine the patient? Yeah. Was there a scar on their chest? Right, right.

And, you know, the last resort, talk to the patient, get that history, and the history is so revealing. And I think we're spending less and less time getting history, doing a careful physical examination, and relying on laboratory data, at least excessive testing that you don't need. a lot of anxiety and patients to go through extra unnecessary tests. And, you know, people talk about artificial intelligence all the time. And I always say, what about just regular intelligence that we use in our, you know, common sense and how we approach patients? And I think AI will be important in some areas, but I still think the personal touch,

the attention to detail is, you know, really, really important. And I always tell people, when I finish talking to a patient examining them, if I don't know what's happening to that patient, I don't know what the diagnosis is. I'll never know. The thing that's coming up for me is that you spend a lot of time on the heart, working on the heart, the medical heart.

What have you learned during your time as a doctor about the emotional heart? Like what allows people to pull through and stay alive in these moments where we think we're going to lose them? What have you learned being in that operating? room for so many years about the spirit of humans. I think it's very important to communicate with them afterwards and not take hope away from patients, you know, to give them something to

live for, to share your experience in a way that gives them hope for the future. And I think that emotional support is very, very important. And people get depressed. They have to have a cardiac procedure. I'm not in control anymore. This happened to me. How am I going to recover from this? So I think depression becomes a very serious issue, and depression, of course, can worsen the heart disease itself. So the mind, the brain, heart connection is a very important one to deal with. And I always tell people, I can teach most people how to do a procedure you're technically proficient. I can teach him how to put a stent in.

But I think much more important is being a complete physician and taking care of the emotional side of patient as well. And I think that helps with adherence to protocol. If you show that you really care, I might listen to you a little bit more, right? So I think medicine should be a very personal field. I mean, it's the most personal of all occupations. I can't think of another thing that I would rather do with my life.

And I know you feel the same way about, you know, we're in the same business, basically, you know. Yeah, and I think there's something that I struggle with from time to time is I am very much known as the person who, you know, is like this helper, right? And so your profession is in your name, the way that you are addressed, Dr. Goldberg. You know, that's how people know you. And the truth is you're much more than that. You're a father. I know you're a kid. And I'm just curious, you know, because there's a lot of young people that listen to this show. There's a lot of people that will tune in. And for the last 50 some odd minutes, I've heard you talk very brilliantly around, you know, your work. Cardiology and the heart and some of the amazing breakthroughs that we've seen. But I would want to shift gears and kind of ask you, like, at this point in your life, what do you tell? younger doc what do you regret what do you not regret i'm just curious if you have any thoughts sitting there in this chair today life thoughts yeah life just because because the world is crazy

right now and you've you've you've been through many iterations of this i assume is it crazier than you know 40 years ago is it is it is this normal to you do you have hope for us no i think it's I think it's very crazy, and I think part of it is the Pope used a great expression. I had a show about Pope Francis. He said the global epidemic of indifference, and I think we live in very isolated spaces right now. You know, when I was growing up, telephone rang. You didn't know who was on the other end of the phone. It was a sense of excitement.

You know, how am I going to respond? Bond. You took a picture with a camera. You went to have it developed and you got it back three days later. Now it's instantaneous. You don't have to think about it. Everybody's on their little computer screen, isolated in their own little world. And I think the sense of isolation breeds a lot of bad problems. And I think we see it in young men especially. I think that's a very vulnerable population, and I think the whole idea of a lot of screen time and little human interaction doing things virtually rather than in person. I don't think we could have this conversation if we did this on a Zoom meeting. I really don't. Right. I really don't.

The whole thing feels very different to me. And I think a lot of our medical education now is conducted virtually in a greater sense of isolation there as well. You know, when you're by yourself and your mind wanders and you start ruminating on problems and you can get to a very bad place very easily. But when you have a sense of commonality with other people, I think that's a whole different world. And I think it's important to have a little bit of a work-life balance with your family. I know for myself, I wasn't the best example I spent probably a lot of time on the work side. I should have spent more time on the family side. Do you regret that? Yeah, yeah. I watched my son. He's a much better father than I ever was. My daughter's a much better mother than I ever was a

parent. Fortunately, I was married to a great woman who, you know, made up for my, my shortcomings in that area. Yeah, I do regret it. But, you know, I... Do you think if you would have prioritized family, your career would have been different? Possibly, but when you really look at the big picture, not in any important way. You know, maybe I would have, Maybe a little stuff happened because of my dedication to my work, dedication or obsession with my work, I should say. Maybe some minor points were enhanced. But I think overall, I think it would be, you know,

I admire my son for the way he does it. He's really got the big picture. He's got four kids, four little kids. Oh, I know, Dave. I mean. But do you think you're a better doctor than he? No, definitely not. So like the sacrifice.

He is the new improved version, no question about it. No, no, he's... I'm not letting him hear that. No, I'm not letting him hear that. No, he, he really is. But, but, but, and I'm just talking here. And again, like, I just, what? Yeah.

I'm 41 and I sit here and I, I really think about how I want to spend my time on this planet. And I try to learn from people who have lived more life than me. So now, sitting in the seat that you're sitting and how do you want to spend the time that you have left? Like, what is important to you today?

Because I feel like at this point in your life, that's probably pretty clear to you. Well, a couple of things are important to me. On the professionals, I retired from clinical practice, so I do a lot of teaching right now of the residents, the fellows, and this cardiovascular institute is very important to me for continuing medical education through that nonprofit. That's all very important to me,

and I'm blessed having six terrific grandchildren, and I get the biggest kick out of that. I really, you know, look forward to being with them and getting inside their heads and see how they're thinking. It's very, very refreshing, and I have the time now to do things with them that I really look forward to. I think there are many,

nights when I didn't come home until very late and, you know, my wife and kids were without me. I think I could have handled that a little bit better, just very honest, you know, and I admire the way, you know, I watch my kids. They're better parents, and I don't think professionally there are anything less than I was. Were you thinking that, like when you were younger? No. No, it was just of the time. It's a different time, you know. It was a totally, different time. When I think about how life was back then, I can't even conceive of how it is right now. Those thoughts never entered my mind. That was so, I would say, driven professionally. So would you say that we could benefit maybe with taking the mentality of your son as a professional

and a father and transplant that back to a time when we all weren't isolated with these phones and technology and what could life be like that would be the best of all possible worlds i think yeah i think so um and i think it's important to be around you know the right role models too and having that extra extra time when i was a resident i just had great teachers and i remember one professor i had dr castle who uh straight out of essential casting in medicine. Tall, white hair, distinguished, did great research, discovered the reason for pernicious anemia, a real, you know, thinker and a great doctor. And we'd be on rounds with him and walk into a patient's room, and he would take out his

index cards, and he would ask the patient, may I sit down? I made it, you know, tremendous impression. You know, because he had, you know, respect. Now everybody's running around, you know, waiting to see the next patient. But he said, may I sit down? Then he would take out his index cards, write the patient's history, talk to us, take the time to explain things. Not very common right now.

We're checking the lab tests. We're looking at the computer screen. Not the best. You know, maybe we ought to get back to. a little bit more humility and taking the time to see our patients as human beings. I was saying, I respect you, you know. Yeah, I'm here to help you,

and I'm going to make eye contact with you and listen to what you have to tell me. But that doesn't provide the instant gratification that every human on this planet right now is searching for. You know, the phone, the computer, whatever it is that you're doing, that's sending something right back to you. And you might never know how that interaction

or that sense of, you know, seeing someone might affect them you might never know yeah well is there because you mentioned artificial intelligence and you know obviously it's like you can't go five minutes without hearing it or seeing it or reading it somewhere you know like what in medicine have you seen the impacts of it or what what are your thoughts on it and how it could be helpful or also harmful it's going to it's going to start to have an impact it hasn't had a major impact yet and in my practice but it will and I think it can be a very positive influence. But I hope it doesn't take people away from their intuitive skills

and developing the ability to talk to folks, to examine them, to look at data in a smart way than rather than just relying on the computer. I don't think that's going to be the answer. I think it can be a very important aid. You know, if you look at an electrocardiogram, I think, you know, hundreds of thousands of EKG, so certain patterns stick in my mind. Well, if a computer can do that better than I can, that's terrific.

But, you know, we have computers read EKGs right now. First thing I do is fold that piece of the paper over, so nobody gets confused by that and still want to do it myself, right? don't believe every lab test that comes back and still correlate it with my intuition and the results I know from talking to people and examining them right and do you believe though that like there are young physicians entering you know into the world that can retain that philosophy because my fear is that like eventually the old you know the transition happens and everyone is a walking computer you know and and forget

That's that human spirit to your point. I think there's a real risk to that happening. I hope it doesn't. But I think there is still a real risk to that happening. And we overlooks very obvious things in pursuit of the unusual, you know. But I think it'll be, you know, positive development, if used properly. If used properly. Yeah.

Well, I just, I mean, I can't even quantify the impact you've had. I mean, the number of lives that you've changed is amazing. We're running short on time, but I do want to hear just give us two minutes on what you're doing now with the nonprofit and kind of paying it forward and how you plan on riding out into the sunset with some of this cardiologist stuff. Yeah, well, I go into the hospital. I make rounds three times a week with the residents. They present cases to me. We go over the history, the physical examination. I always tell them I don't want to hear what the report says.

I want to look at the primary data myself. So we look at the images ourselves. We look at the heart catheterization, the ultrasound findings, the CT angiograms, the EKGs ourselves. We don't look at reports. We look at it, formulate our own thinking, and what do we do next? What's the evidence for what we do next? So that's been a really wonderful thing, you know, for me to do. I feel very happy about that.

And I've had doctors tell me after they graduate from our program, now they're in another program somewhere else. They say, you know, I just saw a patient in the ER. I remember what you told me. time and you know we made the right diagnosis and chose the right path and I remember it was based on that case that you that you reviewed with us so if we can this has a very practical impact you know it's not just talking for talking sake you're actually going over things in detail that can set people's way of thinking so that patients in the future can be helped so that's a real

positive for me. And we also use this as jumping off points to do research and writing articles on topics that need to be written based off of clinical experience. Then the cardiovascular Institute is a nonprofit, which has been around for about 25 years and some years ago in a moment of irrationality. They made me the president of the organization. And I mainly, dealt with practicing physicians with years of experience. And I changed it somewhat to look at the next generation of cardiologists. So we run an annual training course for residents and fellows. We have world authorities come to speak to them.

We have people present cases to them and use it as a jumping off point for the latest evidence in that field. We use medical simulation. You can come and put an aortic valve in, if you like. and encourage interactivity. And I like to select faculty. We're not just going to run in and give a 30-minute lecture

and be on the plane out. I want people who will sit down and have dinner with these guys and talk to them. We also talk about personal enrichment topics, how to act like a human being in your first year of practice. You're not a rock star, no matter what you think. You're still a servant.

And career development pathways, things like that. So it combines personal enrichment with the latest data on cardiovascular disease. We also do case demonstrations, patient presentations, and emphasize the latest treatment options that people are just learning about. So that's been pretty gratifying for me. I love it. Are you proud of your career? Yeah, very much so. I have no regrets as far as that's concerned.

Are you, do you feel, and I'll just have my last thought here, but it sounds like you are just as motivated and energized about the work that you're doing that you were 40 years ago. Oh, no question. Yeah. What do you, for you, like, how do you think, what has been like the key factors that have allowed you to maintain that or why do you think you still feel? So energized. Well, I think it's such an interesting field. You know, it's changing so much. You know, when I was in medical school, the mortality from having a heart attack in the first few months was about 30%. And then when coronary care units came in and cut the mortality to 15%. And then when we started opening up arteries, now it's about 2 or 3%. I mean, just in a span of 50 years, you had such major advances and they continue, you know, we're just, just looking at the surface right now.

I think, you know, people always say, doctors always say, well, don't send your kids to medical school, don't encourage it. I never encouraged or discouraged it. I let, you know, my son take his own path, and I think he feels the same way about it as I do. I mean, there's a lot of enthusiasm and excitement and making the right call, changing somebody's life, you know, there's nothing like it that can give you that much, that much gratification. And I think having finished clinical practice, that's one form of gratification. The other is teaching others to continue in the tradition of excellence. That's how I look at it. So I wouldn't trade places with anyone, you know. Well, this was awesome. I mean, really special for me. I mean,

you've been such a big part of my life and so I'm grateful that you're here yeah I was I knew Zach Clark went you certainly did I mean wiffleball in your backyard with David yeah like so that's going to be a wrap for this episode with that you over thank you very much thank you thank you very much thank you thank you very much thank you