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President’s Convocation Address

Sandra Adamson Fryhofer, MD, MACP

March 29, 2001

Good evening. And let me begin by offering my personal congratulations to the new Masters, Fellows, and awardees of the American College of Physicians- American Society of Internal Medicine- the nation's largest medical specialty society, representing over 115,000 doctors of internal medicine and medical students throughout the country.

Although I've have said those words hundreds of times over the last year, they still fill me with pride- pride in our college and pride in our profession of internal medicine. Tonight, I want to share some thoughts with you about our college, our profession, some of our accomplishments, and our hope for the future.

But before we get started, first, a word of thanks- I can't think of ANY profession where the support from spouses, family and friends, is more important than in ours. But, you know, we don't say, "Thank You" often enough. So, in that spirit, I'd like to express my thanks to my family for all their support over the years - in medical school, residency, starting my practice, moving my practice, and now in service to the college:

To my husband, George, our children, Sandra Lynne and George, and my mother, Melba Adamson, Without their support, their almost daily support, I couldn't – I wouldn't be up here tonight. You've loved me. You've supported me. You've encouraged me. You've always been there when I needed you. And you've never have been shy about telling me what you REALLY think! For example, when I was getting this speech together, my husband George, who is a 15-year veteran of these convocations and president's remarks, reminded me that the Gettysburg address was written on a piece of White House stationary and took only two minutes to deliver. Do you think he was trying to tell me something?

OK, I'll try to be brief but I do have a lot to share-- Make no mistake about it, we're all here tonight to honor YOU- YOUR individual excellence and YOUR distinguished contributions to internal medicine. Tonight's a celebration and it's also a renewal- a renewal of vows, of knowledge, and of tradition. The convocation with all its pomp and circumstance is one of the College's rich traditions.

Just look at these robes we're wearing. Even these gowns have special meaning. Did you know that only holders of a doctoral degree may have velvet on their gowns, and that only doctors can wear a gold tassel on their cap. Also, the doctor's hood is longer that that of any other degree. And this beautiful deep green color on our hoods symbolizes the green of herbs, humanity's first healers. Doesn't this event conjure up all kinds of memories! Doesn't this academic regalia bring back the excitement and joy of graduating from medical school! Well, if you'd been back stage before the ceremony, you would have seen that same excitement among the new fellows and awardees.

As I said earlier, this is a time of celebration. But it's also a time of reflection- a time to remember the support and encouragement of those who helped each of you achieve this goal- Family, friends, mentors. -Many are here in person; some are here only in spirit. I encourage you to take time this evening to reflect, to reflect on the events that got you here.

For me, the road to this evening began with Nick Davies. Nick was a kind, brilliant, and insightful physician. Years ago he also saw a need to get more women, more young people, and more full time practitioners involved in the college. When I was just an associate fresh out of residency, he introduced me to the college's clinical practice subcommittee and nurtured my growth in the college. Tragically, Dr. Davies died in a plane crash in 1991 one decade ago- on the eve of becoming president of the ACP. I'd like to think he's looking down on all this like a proud father.

I know each of you, like me, has had similar friends, family members, and mentors who've encouraged you, influenced you, and helped you succeed. Please join me in giving all of them a round of applause.

**Ladies and gentlemen, we are undergoing a major change in this country. The health care environment, the way medicine in America is practiced is ALSO undergoing a major change. We have UNDERinsured people. We have OVERinsured people. And we have people without any insurance at all. Some hospitals are posting record profits, while others are declaring bankruptcy and turning off their lights altogether. HMOs are either increasing access to care, or denying it in record numbers, depending upon whom you talk to. Optimistic young doctors are graduating from medical schools, while experienced physicians are leaving the practice of medicine altogether.

We are the world's wealthiest country… People come from around the globe to seek medical care at our facilities, and yet many Americans can't afford even the most basic medical care.

In becoming a Fellow of the college, by putting FACP to the end of your name, you demonstrate your commitment to addressing these issues and show our support for our core values which include: Leadership – Excellence - Respect - Compassion - Professionalism. With so many forces tearing at us, trying to lead us astray, these core values are more important NOW than at any other time in the history of medicine.

Tonight, we'll focus on 5 areas in which the College, over the last year, has repeatedly advocated for our patients and the profession.

  • The uninsured
  • Women's Health
  • Antibiotic Resistance
  • Adult Immunization
  • Patient Safety

**Certainly, one of the most pressing of these problems IS the issue of the uninsured. As many Americans have prospered, the number of uninsured has grown to nearly 43 million. Despite the tremendous economic prosperity of the last decade, the uninsured population has reached an intolerable level. Over the past year, the College has increased public awareness of the real health consequences of not having health insurance. Our Decision 2000 campaign has helped educate tens of millions of Americans about the real health care problems faced by uninsured Americans. As a result, this issue got much more attention during the 2000 congressional and presidential campaigns, Who would have ever thought a year ago that the presidential candidates would be arguing with one another about who had the best record of reducing the plight of the uninsured?

It's simply unacceptable that tens of millions of U.S. citizens must go without health insurance just because they can't afford it. Access to affordable health care should NOT be a luxury- it must be the right of all citizens. We remain firmly committed to this goal.

The College is also committed to correcting the problems faced by people who have coverage but who regularly fall victim to a managed care delivery system that has lost sight of the interests of our patients. It's not enough to have coverage: Americans need health coverage that provides CARE, NOT a flawed managed care delivery system that harms our patients through denials, limitations and physician incentives designed to DECREASE care rather than improve it. We need a national patient bill of rights to ensure that NO insurance company or managed care organization can interfere in the delivery of care to our patients. And if they do, they must be legally accountable.

As a result, the college just co-sponsored a national bi-partisan patient protection act. It's our hope that in the year 2001 this bill will finally become a reality. Together, we will continue to help extend health care coverage to those without it, and also help those WITH coverage get the care they deserve.

**During the past year, the college has also continued to educate the public about YOU- what internists like you and I do, what internal medicine really is all about. Our Doctor for Adults public awareness campaign has continued to deliver the message that internal medicine is uniquely suited to provide primary care to adults. We expanded our campaign this year to focus on women's health by informing the public that women's health is more than just a Pap smear and a mammogram, although both are so important. We spread the word that internal medicine is the best discipline to deliver health care to women from head to toe, from adolescence to senescence.

**This year, the college also addressed a common clinical problem inappropriate use of antibiotics. In one recent year in the United States , of the 51 million visits for colds, respiratory tract infections, and bronchitis, 50 to 66% resulted in a prescription for antibiotics. In fact, up to 75% of antibiotics prescribed each year are associated with treating respiratory tract infections, most of which are caused by viruses! Yet we all know that antibiotics don't work for colds or any other viruses!

This problem of over-prescribing and inappropriate use of antibiotics is of our own making. And unless this situation is corrected, an even worse one is on the horizon. Recent studies suggest that the increase in drug-resistant infections directly correlates with overuse of antibiotics.

**The College is also working to increase immunization rates among adults. We internists know all too well that pneumonia and influenza together are the fifth leading cause of death for our seniors. Each year, pneumococcal disease alone is to blame for hundreds of thousands of cases of pneumonia, bacteremia, and meningitis. And although these diseases are preventable with a vaccine, immunization rates in seniors over the age of 65 were only 63% for the flu shot and only 43% for the pneumonia shot - which is way below where they should be.

People ought not be dying from preventable diseases they can be immunized against. Vaccines are certainly among the greatest public health achievements of the twentieth century. But we still have a long way to go to ensure that our patients receive this needed protection. I encourage you to join us in this program. Make sure your patients are getting the vaccinations that they need.

**The College has also worked to increase the safety of our patients in our health care system because we know that far too many preventable errors occur. At the same time the College believes that the focus must be on reform of the system not the punishment of individuals. We've got to stop the finger pointing and create a patient safety program that saves lives and prevents injuries. The challenge for all of us is how to address patient safety in a way that will create a culture of care and enhancement of safety - not fear. You'll be hearing more about this over the next year.

**Now let's talk about membership. As internists, we all know how important it is to check the vital signs of our patients. And for an organization like ours, the most important vital sign is our membership and how we're doing. As we begin this new millennium, I am pleased to tell you that our vital signs are strong, and are beginning to more fully reflect the diversity we celebrate.

I'm particularly proud of the college's record on gender diversity. Women now make up 21% of our membership overall, and 35% of our associates. Some have actually referred to this year in college history as "The Year of the Woman." In addition to a female President, the President-elect Designee, the Chair of the Board of Governors, the Chair-elect of the Board of Governors, and the Chair-elect of the Council of Associates are all women. The number of women in other leadership positions has doubled between 1999 and 2000: from 7 to 14 Governors, and from 4 to 8 Regents.

But there's still much to be done in the area of ethnic and cultural diversity. However, we are making some headway. International medical graduates account for 25% of Fellows here this evening. And I urge each of you, get involved in your state chapters and our national activities. Volunteer your time. We need your ideas, your input, and your voice.


Every one of these initiatives I've discussed requires meticulous planning, coordination, execution, vision, management, and leadership. I continue to be amazed by Executive Vice President Dr. Walt McDonald, and the magnificent team he's assembled. The staff's energy and commitment is palpable, and it's borne tremendous results.


Now, let's change gears for a moment. I want to say a few words to you - not as internists, doctors, or even Fellows of the College-- but as people. Sometimes we forget we were people before we became doctors. Internists are some of the most special people I know. They're renaissance men and women. Some are poets, artists, musicians, performers, athletes, sportsmen, writers, dancers. The problem's that with all the demands of managed care and the increased patient volume, the time we set aside for ourselves is often the first to go.

Don't let it happen. Take time for those activities that relax you - that renew you- that recharge your batteries. Make time for yourself. Make time for your family. Don't lose touch with your OWN HUMANITY because it's that very humanity that provides the most important connection with your patients. And take time to practice what you preach- to get the exercise and rest that we ALL need to stay healthy. And start this week.

Enjoy the Annual Session. Enjoy the entertainment, restaurants and nightlife that my hometown, Atlanta , GA has to offer. Go to the receptions for your medical schools and states on Friday evening. And remember that the Annual Session provides the chance to make new friends and catch up with old ones. The camaraderie, fellowship and friendship that the College engenders is a priceless benefit of membership. Find it this week.

In closing, on behalf of the College, I again offer my deepest congratulations to each of you on your achievement. You have a lot to be proud of. You're part of an organization that does tremendous work for internal medicine, our patients, and the public. Within your ranks, you hold the College's future. From you, will come the ideas that will shape medicine in the coming decade. And from your ranks will come the College leaders that will make those aspirations a reality.

Because of your talent, your enthusiasm, your dedication, and your commitment to our shared ideals, I know the College is in good hands, and that the future of internal medicine is a bright one.


Thank you.

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