Lessons learned on a journey to the soul of medicine

A message to all physicians from AMA President J. Edward Hill, MD.

By J. Edward Hill, MDis a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06. Posted May 15, 2006.

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When I was elected AMA president 11 months ago, I urged physicians to always consult an internal, moral compass when wandering the wilderness of Medicare payment problems, personal injury attorneys, bureaucracies and third-party payers.

It was a lesson I learned while lost in a real-life swamp as a youngster -- and which I have been reminded of frequently during a year in which I used my compass time and again.

I used it when I discussed the AMA's approach to getting coverage to the 46 million Americans with no health insurance -- a national disgrace that needs a fast and permanent solution.

I used it when I talked to physicians about enhancing the safety and quality of medical care for all Americans, regardless of race and ethnicity.

And I used my compass when I discussed those issues that cause physicians and patients so many fitful nights, such as cuts in Medicare payment, the medical liability crisis and the chronic increases in the costs of medical care.

Despite the universal frustrations that physicians feel with the current environment, most I've met in my travels have maintained their optimism and their pride in profession.

This was one of the best perks of being AMA president -- I've enjoyed a unique opportunity to witness firsthand the state of American medicine and our health care system, warts and all.

I was excited about the innovative teaching techniques I saw at our medical schools, such as the state-of-the-art labs for clinical skills, and strong curriculums for ethics, science, even the humanities.

And I was reassured to see the altruism and strong work ethic of the next generation of physicians -- a demographic group that, in the media, often doesn't get the positive press it deserves. Many of us older physicians could learn something from them about maintaining a healthy balance among work, family and community.

I was inspired to see the volunteer efforts of physicians on the Gulf Coast of Alabama, Louisiana, Mississippi and Texas in the wake of hurricanes Katrina and Rita. The hardships faced and heroism displayed by the medical communities there opened my eyes and touched my heart.

I saw this in New Orleans -- flooded, devastated and partially abandoned. The city has lost two-thirds of its physicians and three-fourths of its staffed hospital beds. Charity Hospital, once the linchpin of the city's health care system, now operates under tents inside a derelict department store.

I saw this on the Mississippi Gulf Coast; totally wiped out by Katrina, but not abandoned. I saw the remarkable resilience of the medical community and the community as a whole -- especially the efforts of the faith-based community, which was and is an inspiration to the entire country.

Through it all, the remaining doctors and medical staff carry on under some of the most difficult conditions imaginable to continue to care for patients who already have suffered enough.

I was inspired on a trip to Asia by seeing children exercising with their classmates every morning to start the school day. What a boon it would be for America's children -- and America's future -- for U.S. schools to have compulsory physical education, starting with kindergarten -- and even earlier.

Instilling healthier habits in our young people is a passion of mine. Improved health education would help children learn better and reduce the amount of money spent combating preventable illnesses and behaviors. These include the use of alcohol, tobacco and other drugs, obesity and unsafe sexual practices. Together, these health scourges and others cost the economy nearly a trillion dollars a year -- and cost hundreds of thousands of people their lives.

I was pleasantly surprised to see civic groups all over the country pay attention to the AMA's message on this issue and other urgent public health problems. Most audiences I spoke to listened to the AMA's message, asked good questions and were open to the AMA's solutions.

It reminded me that physicians still hold a powerful position of trust among the American public and that trust is something we need to continue to cultivate and earn.

That trust gives us authority. But the physician-members of the AMA may not always appreciate the enormous amount of influence that our authority gives us in our communities, at our statehouses and in the halls of Congress and the federal government.

Our authority gives us power, and that gives us momentum on issues such as Medicare physician payment and medical liability reform. We flexed those muscles in March, for instance, when hundreds of medical students, physicians and their spouses visited Capitol Hill to spotlight the Medicare physician payment crisis.

We reminded Congress that most U.S. physicians run small businesses. We simply can't make ends meet with lagging reimbursements and high liability premiums.

Unfortunately, too many people think all doctors make a lot of money, regardless of location or specialty. Trust me. I've worked in rural Mississippi. I know how far that is from the truth.

Regardless, power is a finite resource, and we pour some of it out of the bucket when we advocate on these issues.

Authority, on the other hand, is the well from which we draw power.

We strengthen our authority when we advocate on issues like the uninsured, disparities and healthy lifestyles. It's difficult to argue with our altruistic belief in empowering patients. In the days ahead, we must continue to build our authority as the strongest voice for America's patients.

And at the same time, we need to always remember to consult the compass that each and every one of us carries in our hearts and minds.

This compass will always point the way toward the soul of medicine -- healing the sick, comforting those beyond treatment, preventing harm, connecting to a higher cause, and most of all, caring for and about people and populations.

These values represent the soul of our profession and our American Medical Association. And I hope, in some small way, that I helped advance those values as AMA president.

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.

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