Moral compass guides soul of medicine
■ A message to all physicians from the president of the American Medical Association, J. Edward Hill, MD.
By J. Edward Hill, MD — is a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06. Posted Dec. 19, 2005.
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In addressing the American Medical Association's Annual Meeting last June, I told of a time when my father, my brother and I spent a very cold, very wet, very sleepless night in the swampland near my home in central Mississippi. And how, seeking the higher ground, we found not only safety and comfort, but also found a renewed confidence in the leadership, integrity and love of my father and his trusty compass.
I said that we, the American Medical Association, with a trusty moral compass, could solve our many daunting problems. We can find the higher ground, the moral high ground, not only in advocating on behalf of our patients but in literally all that we do.
From that strong position, we can lead America in the right direction, restoring a balance to the AMA in all that it does, renewing and enhancing the very soul of medicine.
Weeks would pass, and the truth of those observations came back to me as I volunteered back home in Tupelo, helping care for the evacuees -- patients streaming north to escape the aftermath of hurricanes Katrina and Rita. We all worked together at the center the Red Cross set up in our local Tupelo Coliseum -- doctors, nurses, pharmacists, aides, citizens, all volunteered, without being asked.
Through it all, the one thing that touched me the most -- the thing that stands out so dramatically for me -- was the total, complete and universal gratitude of every single patient we saw.
It was amazing.
It was humbling.
Every patient I saw said those in the clinic were the kindest people they had ever met. And that is what I meant last June about the soul of medicine. More than faulty payment systems, a broken liability system or the pressures from underwriters and Washington over pay-for-performance, more than anything else we say or do here this week, is that real calling of medicine.
Everyday heroes? Certainly. Stronger together? Absolutely.
But, first, last and always, we are physicians, treating those in need, and receiving the kind of compensation no accountant will ever be able to quantify.
In my mind, it's that tremendous, emotionally explosive response from our patients that nourishes the soul of medicine. You know what I'm talking about. You see it and you feel it. And our patients know it, too.
In fact, just a few days ago, a national poll by Harris Interactive told us:
- 59% of Americans have complete trust or a great deal of trust in their physicians.
- Another 27% said they had a fair amount of trust.
That's 86% of the nation with a strong sense of confidence, hope and belief in us.
What's more, the trust level goes up with age. No fewer than 93% of those 55 and older say they trust their physicians. By comparison, the most recent Gallup Poll of public opinion of Congress came in at the lowest level in over a decade, 29%. And the public's overall satisfaction with the way things are going is at 31%, the lowest since 1996.
There's just no comparison with the trust level we enjoy. But now, let me ask you a radical new question.
What do we do with that trust? How do we increase it, shape it? How do we transform that trust into action, into activism?
Let me suggest a few things.
First, we know our patients will tell us things they won't even tell their spouses or their best friends.
Second, we know that our patients take action based on our recommendations, our prescriptions, our guidance. They expect us to prescribe and to help them get better. They confide in us, because they know we need to know. And they know that we can translate that knowledge into cures.
Third, we have plenty of examples of how others have transformed trust into activism, converting reliance into results, belief into bold actions.
Lastly, we know something else about transforming trust to action. We've seen from our own AMA experience that we are a force for partnering, for building coalitions and commissions and task forces that actually do something, to bring fairness, equity and high quality to our health care systems.
So, if anything, we need more -- a lot more -- of that.
- Partnering with the insurance industry on reform proposals.
- Partnering with politicians of all stripes on public health.
- Partnering with educators and community leaders up and down America to attack the eight behavioral problems that sap our society and drain our health care resources.
- Partnering with each other to responsibly and ethically and morally raise the tone of the profession. How often have we seen the reverse of Lincoln's famous metaphor, a house divided, work positive results when this house was united? Division within the House of Medicine weakens us out there. But unity among ourselves multiplies our strength out there.
- Finally, and most especially, partnering with our patients in new ways, in imaginative ways, to build on the success of the AMA Grassroots Coalition.
I can say that because that foundation of trust demands that we seek the higher ground, the higher moral level our compass points to. That foundation of trust now calls on us to apply a reality check to what we're up to.
By that I mean we can advocate confidently and consistently for public health issues, for the good of our patients. We can work for Medicare physician payment fairness, for medical liability reform, for expanded coverage for the uninsured and underinsured -- all for the good of our patients.
I think of the Commission to End Healthcare Disparities, and how more than 45 organizations have banded together to eliminate any vestiges of unequal treatment due to race or ethnicity. I think of conversations with senators and representatives in Congress, of listening to the president of the United States, and to governors and state officials, all looking to join forces with us, to better serve their constituents and our patients.
But always, and in every situation, I think of the look in the eyes of the patients I've seen. We can focus on a few great issues, because they are the great issues of our patients. As we make progress, we will see that level of trust increase.
Results produce confidence.
We are at the tipping point, the point at which our own activism and that of our patients can effect real change.
The American public, our patients, needs to speak up as well.
That's the reality check I'm talking about. Activity is OK. Results are critical.
What if every doctor in America started talking with patients, with neighbors, with friends about these issues?
What if those sideline conversations during the high school football game suddenly turned to healthy lifestyles, and what the AMA suggests we do here in our town?
What if the people most people trust, the physicians of America, exercised their moral clout?
What if, instead of just going to Washington, we went to the people?
Could we make a change? Could we make a difference? Is it worth trying?
Think about it. Just a few weeks ago, we all were reminded of tremendous change, tremendous difference because just one person turned moral conviction into action. That woman, Rosa Parks, died in October at age 92.
But 50 years ago, Rosa Parks made a decision. In 1955, that courageous working-class woman defied the 100-year-old Jim Crow laws that said black Americans must step aside for white Americans.
She consulted her own moral compass and brought the spotlight of moral outrage to bear on legally sanctioned racial discrimination, North and South.
Her arrest caught the attention of a little-known 26-year-old Baptist minister, the Rev. Martin Luther King Jr. He organized a bus boycott. You know the rest. Decades would pass, and America would change.
And, in 1985, Mrs. Parks said, "I had no idea it would turn into this."
What it turned into changed 20th century America.
Well, it's now our turn. It's our turn to consult our moral compass.
Turning trust into activism is our act, not of defiance but of moral responsibility.
Turn trust into activism.
Guided by a strong, reliable moral compass.
That, it seems to me, could be our manifesto for the 21st century.
It could be that, years from now, you will tell people how you were part of the new AMA and a new medical profession in America. One with a new vision, with focus, with the backing of the American people. A profession that spoke not TO America, but FOR America.
And America acted.
What a great day that WILL be.
J. Edward Hill, MD is a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06.