Family man: Incoming AMA executive looks ahead
■ John C. Nelson, MD, MPH, outlines his goals for his year as AMA president with the idea that physicians must balance big issues with their own lives.
By Bonnie Booth — Posted May 24, 2004
On the day that the oldest daughter of John C. Nelson, MD, MPH, was to be baptized, one of his favorite patients went into labor. As his family left the house, Dr. Nelson uttered his signature phrase at the time, "I'll be there soon," and sent his family to the church. He went to the hospital, the delivery went swimmingly and he headed over to the baptism.
That night his 8-year-old daughter made this entry in her journal: "I was baptized today. The water was warm. My dad was late. My dad's always late."
The following week, he received a note from the patient, thanking him for coming in on his day off to deliver her baby. But the note went on to say that she didn't feel she had had his full attention during the delivery, and she needed more from her doctor. It was a life-defining moment, said Dr. Nelson, the president-elect of the American Medical Association.
"I decided at that moment that family was most important," said Dr. Nelson, a Salt Lake City obstetrician-gynecologist. "That's when I started making better decisions."
Dr. Nelson also credits his wife, Linda, with teaching him that family comes first -- a philosophy that earlier generations of physicians, including Dr Nelson's ob-gyn father, might not have subscribed to.
"He was very devoted to his patients, perhaps too devoted," Dr. Nelson said of his father. "Linda taught me that family was the first concern. It has been my goal in my heart to place family first."
Linda is frank about the struggles she and Dr. Nelson had early in his solo practice as he tried to balance his professional life with his role as a husband and as a father of eight.
"I think the kids always thought their father worked too much," she said, noting that when their oldest son was 4, he wanted his father to be a barber like the neighbor so he could stay home on Mondays and play. "It's a hard transition to make. Physicians feel such pulls from their patients, it's a struggle for them to learn that someone else can handle the job when they aren't there."
Looking back, Dr Nelson agrees.
"Most of the challenges we faced were John Nelson not being wise enough, smart enough or too egotistical to keep the balance," he said.
An above-average love affair
The couple will celebrate their 36th wedding anniversary in June. Dr. Nelson said they are very average people with a much-above-average love affair. The hardest part of his president-elect year, he said, has been being away from Linda. Before this, the most they were apart was the year he served in Vietnam, shortly after they were married.
"By loving each other and trying to share that love with the children, there has been a lot of love in the family," he said.
Indeed, the Nelson family ties are strong. Their home is warm and cozy. It's easy to picture their eight kids as teenagers hanging out in its family rooms and kitchen with their friends. The two finish each others sentences and laugh contagiously as they reminisce about special wedding anniversaries, holiday traditions and why they haven't played each other in Monopoly for 35 years. (Either someone is cheating or someone else doesn't play by the rules).
Dr. Nelson also credits Linda with teaching him how women think and for making him the successful physician he is today. He notes that in The Quotable Osler, William Osler refers to the correct practice of medicine as an exercise of the heart as well as the mind.
"He says in one passage to practice medicine as it should be practiced, a physician has to learn to love the patient," Dr. Nelson said. "And I think that having the feelings that Linda has been able to make happen in my heart, I've been able to feel close to [my patients] and ... was able to go to the mat for [them]. I think the patients feel that they have been cared about as well as cared for."
That's true, according to patient and friend Katharine Garff, who said that Dr. Nelson is empathetic, humorous and caring. She did not become his patient until after giving birth to her five daughters, but he has delivered all of her daughters' children.
"The greatest compliment I can give him is for the care he has given my girls," said Garff, whose oldest daughter was diagnosed with breast cancer at age 29.
"He went totally beyond what was necessary," she said. "He went to their home, he counseled them and taught them how to work with other doctors. He was the doctor that pulled it all together when she had all these different doctors."
Garff also had the opportunity to work with Dr. Nelson when the Utah State Board of Education rewrote its sex education curriculum. Dr. Nelson provided the medical expertise.
"He gave great service, and his leadership abilities came forth," she said. "He stated the facts and didn't waiver with public opinion. He calmed a lot of people down."
Garff said she was very supportive of Dr. Nelson's bid for the AMA presidency, even though it meant he wouldn't be offering obstetric care any longer.
"We all went into mourning when he became president-elect," she said, only half joking.
A full agenda
Dr. Nelson was first elected to the AMA Board of Trustees in 1994 after stints as president of the Utah Medical Assn. and the Salt Lake County Medical Society. He also served on the AMA Council on Legislation and was its chair. He takes the helm at a time when medical liability reform remains a top priority for the AMA.
"It is terribly important, essential that we fix the liability problem," Dr. Nelson said. "There won't be doctors to practice if we don't fix it. That which makes us need to fix it is our professionalism, and we want to fix it like professionals would. We want to use a science base, we want to use a proven method. We want our patients to know that we care about them. We are concerned about their ability to have access to care.
"But I want to go further," Dr. Nelson said. "I want doctors again to feel good about being doctors."
Dr Nelson likens the issues facing medicine to waves and tides. "The waves facing our profession are amazing -- liability reform, Medicare reimbursement, quality of care, the uninsured, tobacco, binge drinking, managed care. All of these are waves that can swamp the boat. We don't have the luxury of choosing which wave we will deal with, we have to choose to deal with every single wave.
"But there is something deeper than the waves, and that's the tide," he said. "If we don't control the tide, we can't control the waves."
He sees the tide as three interlocking circles. The first circle is the evidence base of medical science, the second is a base of caring for and about patients and the third is the ethical framework for practicing medicine.
"Where the three circles come together is where we have the quality experience between patient and physician," he said. "If we don't control that tide, somebody else might. They may not use a science base, they may not care about our patients. They might not use the same kind of ethics that we know as professionals.
"In my heart of hearts, I believe that the coin of the realm for the future of health care in America is quality improvement," he said. "The only ones to identify and measure and make that improvement [are] physicians. It can't be done by someone holding the purse strings or by the threat of litigation. It's got to be done for reasons of professionalism. In some fashion, I want that to be the message of the future."
Dr. Nelson also hopes to focus attention on racial and ethnic disparities in health care and on the 44 million people who don't have health insurance. "We have got, as leaders in American medicine, to find a way to close that gap and close it dramatically," he said.
Richard Hebertson, MD, was chair of the ob-gyn department at LDS Hospital in Salt Lake City when Dr. Nelson was a student at the University of Utah School of Medicine, and the two are still close. The Dr. Nelson he knows is well suited to take the helm of the AMA.
"John is focused and dedicated," Dr. Hebertson said. "After several years of practice, he felt he wanted to do something else, so he went back to school and got a master's in public health and at the same time became quite involved in organized medicine. When he set his course, he launched into it with dedication and purpose. He has great stick-to-itiveness."
That stick-to-itiveness will come in handy as Dr. Nelson works to accomplish his goals.
"The perfect year would be for the AMA to be seen in a better light by everybody," he said. "We'd work to have more members of the AMA who are more significantly engaged. We'd have a significant win, that win could be a legislation win, a health care win, a health policy win -- something that is good for our patients for which the AMA gets credit. We'd be able to pass liability reform. What if we drew attention better to the epidemic of obesity, what if we were able to eliminate some racial and ethnic disparities in health care, what if we were able to decrease the number of kids smoking every day?
"And at the end of the year, to have more attention brought to the American Medical Association than to John Nelson, because this is not about me," Dr. Nelson said. "It's about our profession, mostly about our patients and about our revered and venerated organization."