Celebrating -- and reflecting on -- a year of principles

In the midst of a U.S. health care system in crisis, for the past year this column has focused on some of the immutable principles that provide direction for our profession. These are the constants, the guideposts if you will, in a sea of change -- change that all too often appears to have as its hallmark neither design nor reason. I believe we have a responsibility as physicians to be a force for design and reason as we seek needed reform of the health care system.

This last column is a summary of the year of principles.

Unity: The elemental force by which the disparate voices in the family of medicine join together in a unified voice speaking for America's physicians and the patients they serve. It is the critical ingredient in implementing decisions we arrive at through healthy debate followed by agreement on a course of action.

Integrity: Firm adherence to a code, especially a moral code, easy to understand and vital to maintain the honesty, reliability and legitimacy of medicine. Without it, there can be no workable patient-physician relationship. It is integral to our profession.

Partnerships (1): The leveraging of individual influence and effectiveness through working with others. This is an essential part of how the AMA works, particularly through the Physician Consortium for Performance Improvement, joining specialty and state societies and others to promote our quality initiatives through development of evidence-based performance measures.

Value: A reminder that American medicine continues to bring value to the country through increased life expectancy and decreased morbidity, bringing greater quality of life and enormous economic benefits to our society.

Clear thinking: In a culture that often prizes emotion over thoughtfulness, the irrational over reason, and shallowness of motive over depth of consideration, it is more important than ever for the profession of medicine to keep its head, to think straight and to think hard. Ours is an evidence-based science in a world badly in need of sober judgment, cool analysis and the vital skills most needed to solve the vexing problems of the U.S. health care system.

Caring: Central to what we as physicians do. It distinguishes us as a profession. And those golden moments when you and I have been at our absolute best have been the very moments when we cared the most. It is in the public arena where the caring efforts of the AMA and all physicians are so critical now in reminding Congress of its promise to provide health care to seniors through Medicare.

Resolve: The dedication, the laser-like focus on the real needs of our patients. The example used was the threatened cuts in Medicare payments to physicians that brought risks of decreased access to care.

Leadership: The leadership principle coincided with President's Month, noting that American medicine leads the world and that our patients look to us for leadership, not only in medical matters but in matters of civic and national policy, public health and public well-being.

Purpose: Knowing where one wants to go and how to get there -- the Sacagawea effect. Our destination is reform of the U.S. health care system with a goal of access to quality, affordable health care for everyone.

Partnerships (2): The mechanism whereby a unity born of common purpose results in effective actions to reach desired goals. It is through partnerships that we leverage our strengths to achieve that which acting alone we might not find possible. Together (as partners) we are stronger.

Trust: The cornerstone of human relationships. Nowhere is it more important than in the patient-physician relationship. It is characterized by transparency, granted to us by virtue of being physicians, and preserved by how we treat our patients over the long haul.

The end of my year as board chair finds me with a clear realization of the challenges we face as a profession, but with confidence in our ability to deal with those challenges.

I understand that the importance of a sense of urgency, because of the immediacy and severity of problems we face, must be tempered by an understanding that we are involved in a marathon, not a sprint. And this race will require large measures of persistence and determination.

The final principle is gratitude: The immense appreciation I have for being able to serve our profession and you in the past year. I have been honored by the opportunity.

Thank you.