Moving Medicine
Mentorship in medicine with Ved Gossain, MD
Jul 18, 2024
Featured topic and speakers
Featured topic and speakers
Ved Gossain, MD, endocrinologist and former chair of the Senior Physicians Section Governing Council at the AMA talks about his career path and the importance of mentoring the next generation of physicians. This episode was created in collaboration with the PermanenteDocs Chat podcast and is hosted by family physician Alex McDonald, MD.
Speaker
- Ved Gossain, MD, endocrinologist and immediate past chair, Senior Physicians Section Governing Council, AMA
Host
- Alex McDonald, MD, family medicine physician and host of PermanenteDocs Chat, Kaiser Permanente
Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.
Unger: Welcome to Moving Medicine—a podcast by the American Medical Association. This episode was produced in collaboration with the PermanenteDocs Chat podcast. Dr. Alex McDonald, the host of PermanenteDocs Chat, talks with Dr. Ved Gossain, a renowned endocrinologist and immediate past chair of the Senior Physicians Section Governing Council at the AMA. They discuss the power of mentorship in your medical career. Here’s Dr. McDonald.
Dr. McDonald: Hello, everyone. How are you? I'm Dr. McDonald. Welcome to today's PermanenteDocs Chat. They just finished mowing the lawn outside my window here, so hopefully there won't be too much background noise. So, thank you all for joining wherever you may be listening or watching from. Shout out to those joining our LinkedIn Live. Today, we are very excited for this conversation.
It's another podcast co-presented with the American Medical Association, and we will be talking about career development and mentorship in medicine. And our guest today is Dr. Ved Gossain. He has many titles. Welcome Dr. Gossain, to the conversation. I'm excited to have you.
Dr. Gossain: Thank you, Dr. McDonald. It's a pleasure to be with you. I'm looking forward to this conversation.
Dr. McDonald: Excellent. So again, those of you joining live, drop your questions in the Q&A box. Make sure you get those questions in early and often. These chats are pretty short. So, we're going to just jump right in. So, Dr. Gossain, tell us a little about who you are and what you do.
Dr. Gossain: Well, I was born in the Undivided India in a small village, which now happens to be in Pakistan. And so, I've had the misfortune, if you want to call it that, of being a refugee in my lifetime. So, I grew up in India, went to medical school in India, completed a residency in one of the most prestigious institutions of India, All India Institute of Medical Sciences, a three-year residency—including writing a thesis—and I completed that.
And soon after that, I came over to the U.S. to do an endocrinology fellowship and only to discover that my residency training was not considered valid. I went through it. So, I went through another residency at the Baystate Medical Center, three years of endocrinology fellowship, and after a small stint at the University of St. Louis in St. Louis, Missouri, I ended up at Michigan State University where I've spent almost all my professional life. I was the chief of the section for about 20 years, and then just recently retired.
Dr. McDonald: Wonderful. Well, congratulations on your retirement and the new stage of life. I think that's such an incredible story that you have, and I think all of us have these stories and that in some part motivates us for our career in medicine, but also helps to shape who we are and how we build relationships and connections to others and bring up the next generation, so to speak. So, tell us how has your experience really motivated you and shaped your career and your values, but also helped encourage you to mentor others and give back to the medical community?
Dr. Gossain: Well, as I said, once I finished my residency, during my residency, my thesis had to do with the dietetic analysis, blood liquids and vascular complications of Indian diabetics. And I was very lucky to get a supervisor who was a relatively new endocrinologist, but British trained and U.S. trained. And I just fell in love with endocrinology. And although he and my institution tried to keep me there very much, there were no formal endocrinology fellowships in those days.
So, I traveled here to the U.S., looking to do an endocrinology fellowship and go back to India in three to five years. Here I am 50 some years later and it's been a wonderful experience. And I've had many good experiences during this time period.
Dr. McDonald: Well, and I think your point really touches it or is an important point that many of our careers and our journeys, we have an idea or a plan that we set out and there's twists and turns, and there's people we meet and experiences we have, which really shape our career as we go without even really realizing it sometimes at the time.
Dr. Gossain: Oh, that's absolutely true. So, like I said, I had a brief stint at the University of St. Louis in St. Louis, Missouri, and I ran into my former partner. God bless his soul now. He passed a few years ago. Two of us just hit it together. And Michigan State University at that time was a relatively new medical school, but this partner of mine, Dr. David Rovner, he was a big, well-known name in the field of renin-angiotensin-aldosterone system.
As a matter of fact, he was very instrumental in describing the Conn's syndrome or primary aldosteronism. I got hooked with him. And even though my field of research and interest was mostly diabetes, but I learned a lot from him about the investigative techniques, what research methods to use or not to use, and so on.
Dr. McDonald: Yeah, that's very true. Well, and again, you touched on it, your clinical practice, your research, your teaching roles in medicine. So, what insights could you maybe share with younger physicians or even mid-career physicians looking to continue to build their career to make sure that it's sustainable, because that's ultimately, I think, what we're all looking for?
Dr. Gossain: Sure. We all went to medical school to take care of patients. It was a calling. I think almost everybody who goes to medical school feels that it's their calling. It's always mine. So, we spent a significant amount of time taking care of patients. And then I think there's no better role in medicine, and I may be biased because I've spent my lifetime in teaching, there's lot of pleasure in teaching the younger generation how to take care of these patients.
An interesting anecdote, one of my colleagues, he just published a book, second edition actually came out, patient-centered interviews. And when he was trying to collect this data, I would go to him and say, "Bob, it's been all about patients since I went to medical school," and he says, "You're absolutely right. But you see, we learned it informally from teachers." And in doing this patient-centered interview process, he defined the process and there are steps to it which we can now teach the younger generation. And just one little example, you meet with a patient and you use the acronym NURSE. If the patient says, "My chest hurts," you repeat it, "Okay, Mr. Jones, I understand your chest hurts. Tell me more about it." And then he says, "It makes me limited in my activity and I can't do things I used to do."
Okay, I understand it, and then you repeat it. "I understand it's making your life difficult." And then in the end say, "I understand your difficulty. I sympathize with it. Now let's see what we can do for it." In other words, you engage the patient. That's the most important thing. And I must say that in the recent times, when I was younger in residency, we had all the time in the world to talk to the patients.
And I know the younger generation doesn't have it. And especially with the corporate takeover of medicines, I'm sad to say it's becoming more of a business than the profession it used to be. And the third component of the academic career is the research. And people can do basic research or clinical research. And I'm basically a clinician and I think most people when they graduate from medical school have a tendency to do the clinical work and related work.
If you have a PhD or something and you want to do basic research, I'm not trying to knock the basic research down by any means. Basic research is very important. But the clinical research is you see the patients, the questions arise, and you say, "What can I do to study this?" So just a simple example, we knew insulin and glucagon are the two hormones in the field of diabetes.
Insulin we knew a lot about. Glucagon, there was much less known. So initially, we studied glucagon and patients with diabetes and obesity. What happens to glucagon when you exercise? And again, patients with diabetes have two to four times likelihood of getting kidney disease. And in those days, the hypertension was getting a lot of attention when I was younger, so we studied what's the role of renin-angiotensin system in diabetes.
And that gives you a lot of satisfaction. You ask a question. You study some patients. You get an answer. You get involved with some of the earlier drug trials. And when the drug trials succeed and you have a new medicine, then you can deal with it and use it efficiently.
Dr. McDonald: So, I guess I'm hearing a couple themes of what you're saying here is that diversity of practice and diversity of skill sets. You do some teaching. You do some clinical work. You do some research. I think it's really important to think about how we can help diversify our skills to maintain our own professional satisfaction, but also being open to new ideas and not necessarily limiting ourselves to some degree too.
It sounds like you've done lots of different things. If someone was a younger colleague who was interested in making sure that they had those skills, was there something specific you'd reach out to them or something specific that you'd recommend for those individuals to make sure that they can have that sustainable longevity?
Dr. Gossain: Well, again, for the clinical practice, there's a couple of sayings by Dr. William Osler—medicine is an art, it's not a trade. So, you learn the art from your teachers. Like the old saying in medicine—you see one, you learn one and you teach one. So, this is a matter of practice. And then if you want to reduce your focus, which particular disease entity or group of disease entities you want to do, then you can increase your focus there and pay more attention there.
And then you have to pick. And luckily, many medical schools are saying, the academic medicine has three stools: patient care, the teaching and research. And if you can do well in two out of those three, you could be promoted to whatever level you want to get to. So, you don't have to be excellent in all three, but two out of those three you have to be. And again, if you have an idea for research, you discuss it with your colleagues.
You study the literature. You write up a grant proposal, hopefully you get funded, and then you go from there. So those are the things you need to learn. And I think some of this comes from within, but a lot of it comes from you need to have a good coach or a good mentor. So, if you're lucky enough to have a good mentor, you're on a good road path.
Dr. McDonald: And that's a perfect segue to actually my next question. Talking about some of the benefits and the challenges of mentorship in medicine, particularly really, that intergenerational mentorship I think is just so critical from those who have past experiences and can draw on that. How would you recommend somebody go about finding a mentor? Or is it these things happen more organically?
Dr. Gossain: Well, there are a couple of ways. I think the question that you ask is very pertinent and medical schools are recognizing this. So now there is already a mentor-mentee program at the Michigan State University that I know of. A junior faculty member can be hooked up with a senior faculty member of the area that they're common with. You meet with them. You talk to them, and you figure out if there is a connection between.
And now if I can put a plug in for the Senior Physician Section, there's enormous amount of experience in that section. In any field of medicine you want, you want to set up a new private practice, there are people who have been practicing all their life. You have high class researchers, many people in other kinds of expertise in the field of medicine. There are some people who actually have served in the legislature in their state for 15, 20 years.
And so, you could learn legislative things from them. And they're more than happy to provide their expertise to the younger generation because now they also have time on their hands. So, it's a two-way traffic. You got to find the right mentor and the mentor has to find the right mentee. And I hate to say this, but sometimes it can be trial and error. Many times, because of the environment, you get to know people.
I'm sure if I go to your colleagues and ask, "How is Dr. McDonald?" they might tell me, "He's a great clinician or he's a great researcher," then I can say, "Yeah, that fits with my definition. I'm going to talk to Dr. McDonald."
Dr. McDonald: Yeah, no, I think it's interesting. There are all these formal mentorship programs out there, and I actually remember this very clearly. When I was a medical student, I was in a formal mentorship program, and I got paired with this person. But there was no spark there, so to speak. So, for me, that didn't really happen. And I organically found some mentors, which I think met my needs in various different ways.
I think the other thing too, which we don't necessarily always think about is we can have different mentors for different aspects. You can have a research mentor. You can have a professional development mentor. I mean, I practice family medicine and sports medicine, and so I have different mentors maybe for sports medicine versus for primary care. And I think it's okay to have a menu of mentors, if you will, and you go to those different mentors for different things. Has that been your experience as well?
Dr. Gossain: That's very true. That's very true. Actually, there was a program at MSU, which they've now stopped, and I am sorry that they stopped it. There were few medical students that were assigned to me. I was their mentor. I would meet with them once a month in my home, and it'll be an informal get together. And the students will ask, "Dr. Gossain, should I really go into surgery? I'm going to go practice in a small rural area. I need to be a family physician, or I need to be an internist. Or what are the problems if I want to go this route or that route?" And there we had the opportunity not only to talk about medicine, but we also had the opportunity to talk about their background, their needs, their family situation, and so on. So, I think that particular setting, personally my view, was much more helpful than simply saying, "Okay, let's work on this research project or that." And like you alluded to; you can certainly have multiple mentors to guide your path.
Dr. McDonald: All right. I think part of also you mentioned this earlier is having more experience and being at the end of your career. Looking back, would you give any advice to physicians who are entering the retirement stage or at the end of their careers, how they can either find new meaning and new fulfillment as they transition to retirement? Or is there any specific advice you'd give for folks entering that early retirement stage?
Dr. Gossain: Sure. That's a stage that you hope everybody will get to. So, there are a couple of decisions. One, of course, is you need to have some financial security, which I think for physicians is not a problem by and large. And the second thing is that you need to decide whether you need to abruptly retire or ease into it. And I think easing into it is much easier, or that's what I did also. I retired, and then during the five years, I said, "You need to remain engaged during that period."
And what I did is I wrote a book, and the book is this, I don't know if you can see it, but it says, “My Journey through the United States: 8 Dollars and No dream.” And that's because I had $8 in my pocket when I landed in this country and no dream because I had no idea what the American Dream is. So post-retirement, for about three years, I saw patients about once a week, supervising fellows. So, they did all the documentation, which is a no-no for me, if you will.
And that's also the cause of a lot of physicians’ burnout, as you well know. So then after the pandemic, I stopped seeing patients, but I was teaching secondary and third year medical students, and some of the teaching could even be done on Zoom. Now that I'm retired, I have found a volunteer organization called MAVEN, which stands for Medical Alumni Volunteer Expert Network. It was founded by a Harvard alumnus. And there you can communicate electronically.
So, you may have a patient with hyperthyroidism, and you have some issues. You might send me an email and say, "Dr. Gossain, I got this patient XYZ. This is what's happening. What should I do?" So, I can send you back an email, or if we need to, we can get together on Zoom and talk about it. And I think that's a very rewarding thing. And if any of your senior colleagues are interested, I can get them into the network if they would like.
And then there are people who have hobbies. If you have another hobby, certainly getting travel if your health allows. But the unfortunate part is a lot of us get old enough that the health doesn't allow to travel too much. So far, I'm in good health, so that's okay.
Dr. McDonald: Well, and it sounds like you're finding new ways to stay engaged in medicine, whether it be through formal mentoring or informal mentoring, or I love MAVEN, this consultation service, if you will. So, finding ways to stay connected and stay active without the demands of daily clinical practice sounds like some themes that you're sharing. Is that a good summation?
Dr. Gossain: I think medicine is part of us. Physicians and medicine cannot be separated, in my opinion. So, I think it's best to remain engaged, although some are limited, then you could do some engagement with medicine and then you can do some other things that you want to do. And so that's a good combination in the post-retirement and retirement years. You're not completely divorced from medicine, and then you have the time and opportunity to enjoy other good things. So, I think that's a good combination. And again, eventually everybody will find their own niche.
Dr. McDonald: Yep, very true. It reminds me of the phrase, medicine is who we are, not what we do. And I think that so many of us are so passionate and have been spending so much time in our careers in medicine, it's hard just to remove that entirely.
Dr. Gossain: You said it better than I could have said it. That's wonderful.
Dr. McDonald: Wonderful. Well, and lastly, very quickly here, I do want to wrap up here so we're not going on too long because I think we like to keep these pretty short, just making sure that we are casting a broad net in terms of how we invite people into the field of medicine, and then how we mentor and sponsor individuals within medicine to make sure that we have a variety of perspectives and ages and cultures and ensuring that equity and inclusion and diversity are one of those forefront values.
Do you have any thoughts there or any ways that we can ensure that DEI stays at the forefront of our mentorship work we're doing in medicine?
Dr. Gossain: Sure, absolutely. I grew up in a multicultural society in India. And again, anecdotally, I visited a site in India when I went back, and it's now in Pakistan again, by the guru who established the Sikh religion. And it's a site where he was followed by Sikhs and Muslims, and it's the only site that I know of where a Sikh temple and a mosque are on the same premises.
Dr. McDonald: Oh wow.
Dr. Gossain: And on the mosque, there is an inscription that it was a miracle that human beings were created, and all men were created equal. So, I grew up with that kind of a background. And after having come here again into a multicultural society, I have no trouble, or I find it quite easy to accommodate and get acclimatized to people of various backgrounds.
And your point is well taken that we need to encourage people who are, I should say, not well represented in medicine and then counsel them, go back to high school, the middle school even, and say, "This is a career that you can pursue." And I think we're doing quite successful. Actually, at Michigan State, we're doing reasonably well, if I can say so. Although I can't take any credit for it, but I think as an institution, we're doing quite well.
Dr. McDonald: Yep, absolutely. Wonderful. This has been a great conversation. I appreciate your time. Last question, I always end with this question, what makes you most proud to be a physician?
Dr. Gossain: Oh, that's a great question. And I think the most proud thing is I think when a patient comes to you or a relative of the patient comes to you and say, "Dr. McDonald, Dr. Gossain, you saved my husband's life, or you saved my brother's life." Money cannot buy that. That's an extreme degree of satisfaction. So, I think that in the long run, if I look back over the years, I've probably saved a few lives. I've made a few people better than they were. And I think that's what you need to be proud of and say, "I've done something good. I've done something good for humanity and my fellow human beings."
Dr. McDonald: Wonderful. That's such a great note to end on. So, Dr. Gossain, thank you so much for joining us and sharing your insights and a little bit of your journey in medicine.
Dr. Gossain: My pleasure. Thank you. It's been really good chatting with you.
Unger: Subscribe to the PermanenteDocs Chat podcast to never miss an episode and register to take part in upcoming live chats. Visit permanente.org/amadocschat.
Disclaimer: The views expressed in this podcast are those of the speaker and are not meant to represent the views of The Permanente Federation, the Permanente Medical Groups or Kaiser Permanente, or the views and policies of the AMA.
