AMA Presidential Installation Speech
"Passion, perseverance and professionalism: A prescription for renewing medicine for the 21st century"

2002 AMA Annual Meeting  -
Hyatt Regency Chicago, June 19, 2002

Yank D. Coble Jr., M.D., President, American Medical Association

In the past few years, I have traveled all fifty states, visiting medical schools, and state, county and specialty societies. I have testified in Washington, DC, briefed Congressional leaders and aides, and responded to media questions from reporters around the nation.

In every case, I have witnessed the incredible influence our AMA wields and the high regard it inspires, especially among our patients and the public. I am energized by the prospect of serving the AMA and its mission, even in these difficult times for our nation and its health.

Health care in America is facing unprecedented challenges. Yet tonight I want to remind us that adversity can be more than just an inventory of problems. Adversity can be a force for positive change. Or, to paraphrase the great entrepreneur, Henry J. Kaiser, adversity is really opportunity dressed in work clothes.

With hard work and enthusiasm and hope, we can take the challenges we face in medicine and turn them into opportunities for better health. If we remain responsible for our traditions of ethics, caring and science. If we work with our patients and others to bring down the barriers to quality medical care. If we strive to be active, united members of our profession.

I learned the value of hope and hard work from my grandmother, back in Burlington, North Carolina, the little town where I grew up. She had only a sixth-grade education. She lost her husband when my mother was just a baby, and she supported herself by sewing the toes on socks.

My grandmother was a remarkable woman. I've often wished Reader's Digest had continued its feature, "My Most Unforgettable Character," because I have a submission ready to go. I still remember climbing the stairs to her tiny, third floor apartment. Even now, I picture her working that foot-pedal sewing machine. Putting ten cents of every dollar she made into a Mason jar for church.

Looking back, I know my Nana's life must have been difficult. Yet I never thought of it that way, because she didn't. She was always optimistic, always enthusiastic. Whether she was singing a song or throwing a baseball to me or telling me how I could and should become a physician.

You see, no one in my family had ever gone to college, let alone medical school. Yet my grandmother believed I could become a physician, despite the barriers. And so I believed it, too. Thanks to scholarships, guidance from physicians in my hometown and, of course, hard work, I made her hope my reality.

As your president, I promise to work even harder to create opportunities and to overcome the barriers that we, and our patients, face. Especially those barriers that undermine our ability to provide quality medical care. I also promise to remain enthusiastic and optimistic. Just as my grandmother taught me.

It's easy to be enthusiastic and optimistic about our profession. Because we, the family of medicine, have such enduring traditions to guide and strengthen us, even in difficult times.

Our tradition of ethics is fundamental. It means putting the patient first, above all else, including self. It creates the trust essential to the patient-physician relationship.

Our tradition of caring inspires hope, so necessary to the conquering of disease, disability and despair. As Dr. William Osler once said, "caring is the most important thing to do so do it first."

And finally science, a tradition that endures, paradoxically, through constant innovation. We embrace science and the change it represents, because without science, ethics and caring are simply well intentioned kindness. It is science that makes American medicine the icon for medical care, medical education and medical research throughout the world.

I learned this back in the 1960's and 70's. At the time, I was doing research and studying around the world, thanks to the National Institutes of Health. And I discovered that my family back in little Burlington, North Carolina, was receiving the best medical care available anywhere.

Today, our ethical standards guide not only our practice of medicine, but also the practice of international physicians and physician organizations. Our caring is evident not only in our everyday work, but also in the millions of hours of charity care we provide, and in the work of physician volunteers, here and abroad. Our medical science is so renowned that international students come by the thousands to study in our country, every single year, along with the tens of thousands of patients from other lands who come to receive our medical care.

We set the standards for the world. We do it well, and we intend to do it even better despite the obstacles we face.

No one better understands these obstacles than physicians and their patients. That's why, as AMA president, I will take my cue from the people on the frontlines and make your agenda and your patients' agenda my agenda. Our agenda.

That's a lesson I learned the summer after my first year at Duke Medical School, when I went to work at Tyler Place, a resort in Vermont. The first week I was there, the owner called me over and said, "Yank, you're our new entertainment director."

At first I thought, that's great. Because I knew the entertainment director could eat as much of the guest food as he or she liked. But then I had to say. "You must have the wrong guy. I can't sing. I can't dance. I don't play anything."

He said, "Don't worry. I don't expect you to be the show. You just have to make sure we have a good show."

So that's what I did. And that's what I plan to do as your president. We'll set the stage. We'll get the acts together. But you, the leaders of medicine and your patients, you are the show, and your concerns get top billing.

Our Chairman of the Board, Ed Hill, our EVP, Mike Maves, and I will be in constant communication on your behalf. Teamwork, discussion, and well-considered direction will be our goal. We pledge our sincere and unified commitment to you. Together, the family of medicine will bring its agenda to the national stage. We will encourage patients and other partners to stand beside us. We will help put American health care back on the right track.

So what issues are at the top of the agenda for American medicine?

Some might say liability reform or the uninsured. Others might say managed care abuses or regulatory hassles. Still others would focus on Medicare issues and health system reform. Many would say, all of the above.

And they would be right. Because all of these issues are undermining medicine.

But let's step back a moment, to see the big picture. What are these issues really about for us, for our patients and for all stakeholders in human health? The answer is simple: All of these issues create barriers to quality medical care. You know this firsthand.

Soaring liability premiums that compel physicians to stop delivering babies, to drop high-risk procedures or even to retire prematurely form a barrier to quality medical care and to good health.

A costly, inefficient health insurance system that leaves millions uninsured or underinsured is a barrier to quality medical care.

A regulatory system that forces us to spend more time with paper work than with our patients is a barrier to quality medical care.

An insurance company more interested in making medical decisions than in covering an appropriate service creates a barrier to quality medical care.

And an unfair payment system that requires us to increase our patient load, shorten visits or limit charity care creates a barrier to quality medical care.

The issues we care about aren't just physician issues. They are patient issues. Patients don't want their medical care interrupted or distorted. They value the quality medical care we give. I say this as a physician. I also say it as a patient.

Today, I stand two inches taller than I did in 1997 and not just because I am proud to be the President of our AMA.

That year, I had hip replacement surgery, and it changed more than my height. For the first time in years, I was able to sleep through the night, to pick up a grandchild and to run to catch a flight. That single surgery, unimaginable in my grandmother's lifetime, will help me lead the AMA with vigor in the coming year.

I can't put a price tag on what this means to me. At this year's National Leadership Conference, however, a professor from the University of Chicago discussed economic studies (supported by funds from Research! America and Funding First) that did place a monetary value on some of the work physicians and physician scientists do.

According to one study, Americans in the 1970s and 80s valued increases in life expectancy at 57 trillion dollars. 57 trillion dollars. This number is simply astounding, and it does not even attempt to capture the value placed on improved quality of life or productivity. Nor does it put a complete value on the 60 percent increase in life expectancy we saw in the last century.

American patients value medical research and innovation. They value medical care. They don't want to see that care undermined.

American patients want access and affordability. They want competence, compassion, and continuity. And they want choice. In short, they want quality medical care.

We must make sure our patients understand: the problems we face as physicians undermine our ability to deliver quality medical care. How the public perceives us is critical. As the saying goes, perception is reality. We must ensure our patients are accurately and adequately informed.

Informed patients don't want to see us driven out of state or into retirement because of liability costs. They don't want our nation spending 50 billion dollars a year on defensive medicine or 200 billion dollars a year on medical liability in general.

Informed patients would rather see that money used for endeavors that strengthen patient care and safety, such as biomedical and clinical research and electronic medical systems.

Informed patients don't want physicians to choose between shutting down their practices or limiting Medicare or capitated patients. They don't want us wasting time arguing with bureaucrats or deciphering documentation guidelines. They want us to spend time on medicine.

Informed patients know just how rigorous American medical education, training, certification, and accreditation are, and they appreciate how much effort it takes to keep learning and changing as medical evidence changes.

Informed patients also understand the significance of language. For example, they know it's not medical malpractice but liability. Because the problem isn't bad doctors; it's a civil justice system that's neither civil nor just.

Likewise, informed patients know we are not health care providers, but care-giving physicians. They know they are not mass consumers of health care, but flesh-and-blood patients. Complex human beings.

Informed patients understand that the terms "provider" and "consumer" reduce the patient-physician relationship to a commercial exchange, a commodity for sale, demeaning us both.

Informed patients know that we, as physicians, have entered with them into a sacred trust. A trust that requires us to put their needs first, to care for the whole patient, and to uphold the highest standards of clinical practice.

Informed patients understand as well as we do that this trust must be protected.

We must reach out to our patients with messages like these. Because patients can help us bring common sense to government edicts and managed care mandates. Patients can help us fix our so-called civil justice system. Patients can help us expand health care coverage and choice through our superb health system reform proposals, and without shaking the foundations of what is best about American medicine.

What's more, our patients aren't the only partners we have in this work. Employers care about health insurance how to get it, how they can pay for it. Yet they also understand they are not the experts when it comes to making decisions about medical coverage and medical care.

Likewise, liability is not just a physician issue; it's a business issue. Indeed, the American Tort Reform Association, an organization we helped found, includes more than 300 businesses, corporations, municipalities, and professional firms that support civil justice reform.

Organized medicine must engage all stakeholders in human health.

We must also remain united and leverage our wonderful diversity. Because all our strength is in unity, and all our danger is in discord.

Today, physicians come from every ethnic, racial and socioeconomic group. We are men and women. We are young and old. We are primary care physicians and sub specialists. We live in small towns and big cities.

Our diversity enables us to see the profession from many perspectives. This diversity, and the collective wisdom it represents, can help us find solutions to the problems we face. Solutions that work not just for one physician group or organization, but for the entire family of medicine.

For even in our diversity, we are all still physicians dedicated to the science and art of medicine, and to the betterment of the public health. This unity of purpose has been our strength since the AMA was founded 155 years ago.

At that time, we were facing incredible adversity. Medical standards were nonexistent. True medical science was just a glimmer on the horizon. Public esteem of our profession was as low as the frequency of quackery was high.

The AMA and our partners in the Federation changed all that. We did it by bringing together physicians from across the nation and by working, united, on behalf of our patients, our profession and our society.

We have been reminded of the importance of such unity in the days and months since September 11. That tragic day brought us together as Americans and as physicians. It reminded us how much we can do, even under the most difficult circumstances.

In response to September 11, the AMA and many other physician organizations are renewing the essential partnership between medicine and the public health and ensuring that our public health response systems are strengthened at the federal, state and local levels. Because of this work, we will all be better prepared for acts of terror, as well as for naturally occurring outbreaks of disease or other threats to the public health.

This is the opportunity we have created as a nation and as a profession. Even in the midst of a national tragedy.

As stewards of human health we are called to do much. We are participants in a sacred covenant with our patients, with one another and with society. This is a serious responsibility. It is also an honor and a joy. For we have the opportunity to be useful every day of our professional lives, in so many ways.

I hope my words tonight convey the optimism and enthusiasm I feel about our profession, and especially my unwavering belief that we will prevail.

I mentioned earlier how my grandmother believed in me. What I didn't say was that she told me I would grow up to be President, not of the United States, but of the American Medical Association.

For a long time I never told anyone this story. Because I thought if I talked about it, it might not come true.

But tonight her dream has become my reality. And her legacy of hope and hard work has blessed me yet again.

How can I not believe that so much more is possible for us, our profession and our patients? I do believe. Medicine is not a job; it's a passion.

And though I am wearing a tuxedo this evening, I have metaphorically speaking put on my working clothes for the patients and physicians of America.

Tonight I ask you to join me.

Find the opportunity in adversity. Stay optimistic and enthusiastic. Hold fast to our three traditions of ethics, caring and medical science. Help renew our sense of pride and professionalism.

Communicate the value of what we do, especially to patients and the public. Make them our partners in bringing down the barriers to quality medical care.

Most importantly, work together, in unity. For our AMA and for our family of medicine.

John Gardner once said that resilient, relevant, responsive, and self-renewing organizations and people share three common characteristics: Tough minded optimism, staying power and belief in a mission above self.

155 years ago, these characteristics defined our AMA, and they helped us change the world of medicine forever, for the better. Today, these characteristics continue to define us, our Federation, and our entire family of medicine. Together, we will change the world. Again.

Jacksonville Medicine / June/July, 2002

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