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President’s Convocation Address

William J. Hall, MD, MACP

April 11, 2002

Bearers of the Ring

I am going to direct my remarks tonight primarily to you, our candidates, who are about to be inducted into Fellowship in the College. You are all here because in the eyes of your peers-the harshest critics of them all-each one of you has been judged to be exemplary in the way you conduct your professional life.

In a few minutes a time-honored and important ceremony will be taking place when each of you will be asked to take a pledge affirming your commitment to the principles of this venerable profession of Internal Medicine.

You are a most interesting group, with the diversity that is becoming so characteristic of our organization. While I would very much love to recognize each of you individually, we would have a long night! Instead, let me introduce just a few of our newest Fellows to exemplify this diversity.

Drs. Judith Setla and Peter Cronkright are general internists in upstate New York. In addition, they are husband and wife, a duel-career family--an increasingly common and healthy phenomenon in our College.

Drs. Nayan Shah and Umedchandra Shah are practice partners in Hollywood, Maryland. Both are graduates of the University of Bombay, and they are also brothers-in-law. In fact, when I called them last week, I discovered that there are 14 members of the extended family practicing in the same group. Thank you to the Shah family for enhancing our genetic talent pool with you family.

Dr. Carol Mary Black joins us from the United Kingdom. In addition to gaining fellowship in the College this year, she is also President-elect of the Royal College of Physicians of London, an organization I will comment on in a few minutes.

Dr. Paul Burleson is from Naples, Florida. He has been on the faculty of the University of Alabama and served as the first President of the Alabama Society of Internal Medicine. Dr. Burleson is 85 years of age.

Thank you for being with us and thanks to all of you.

I suspect many of you are just slightly bemused and a little uncomfortable marching in this processional in cap and gown. Clearly in my travels this year around the country, one of the most common questions I have been asked is, "What is the significance of Fellowship?" I think it is only fitting that we consider together what it really means to be elected into Fellowship in this organization?

So permit me to explore with you the true significance of this ritual and the implications for the years ahead. For your families present here tonight, perhaps you too will see your spouse, child or parent in a different light.

In preparation for tonight, I've looked into the history of the concept of fellowship. I started my inquiry with a search for the origins of fellowship, especially in medical organizations.

Like so many other traditions of our College, we have emulated the rich tradition of the Royal Colleges in the United Kingdom. We trace the origins of our own College only back about 80 years. In contrast, The Royal College of Physicians of London received its charter from King Henry VIII in the year 1516, and the Royal College of Physicians of Edinburg received its charter in 1681 during the reign of Charles II.

These societies in turn trace their origins back to antiquity. In fact, all learned societies have found it advantageous to have a special class of membership to allow recognition of those who are the standard bearers. And so all of you and all of us assembled here tonight are engaged in one of the oldest and most consistent rites of professional passage in civilization.

Actually we are indebted to the UK for two concepts of fellowship. The first, being this long tradition of fellowship in the Colleges, and the other being a somewhat more recent one, namely, the writing of J. R. Tolkien, who of course wrote the "The Lord of the Rings."

Now it may have been quite a few years since you have last read Tolkien. However, as many of you with children know only too well, the first of three motion pictures is now all the rage in this country, and this film is named, appropriately for us tonight, "The Fellowship of the Ring."

For those of you who haven't seen the film or read the books, a brief overview of Tolkien's story is appropriate.

The future of civilization of a mystical kingdom called Middle-Earth rests in the fate of a magical ring that has been lost for centuries. Powerful, evil forces are unrelenting in their nefarious quest to subjugate the world. But fate has placed it in the hands of a young fellow named Frodo, who inherits the ring. A daunting task lies ahead for Frodo when he becomes the ringbearer: He must make an important decision that in a way all of us are called upon to make.

Should he simply discard the ring with the justification that the world's problems were of no concern to HIM? Or, though poorly equipped, he can accept the responsibility to do something about it. He accepts the responsibility to do something very dangerous.

He will take the ring to a horrible place called Mount Doom where it was forged and the only place where it, and the associated evil forces, can be once and for all destroyed. The journey, however, will be perilous and he will encounter all sorts of monsters and dragons on the way.

Right from the start, he knows he cannot do this alone. He is quickly joined by a small group of like-minded volunteers who band together for the dangerous journey. It is only through their collective strength that they find the courage, as Garrison Keillor reminds us on Saturday nights, "to do the things that need to be done."

They form the fellowship of the ring—and you will have to go see the movie yourself to find out if that particular form of fellowship turns out to be a good idea.

No doubt you can see where I am going. I think there are many parallels in this retelling of a very common ancient tale with what we are about to ask you to do as Fellows in this College. No, we do not inhabit Middle-Earth, few of us are brave Frodos, and none of us has magical powers--or are we so sure?

In Dr. McDonald’s insightful address this morning, he reminded us of the enormous challenges we face in American medicine today.

Many forces out there are seeking the magic ring to influence health care in ways that most of would say is not in the best interests of our patients. Unfortunately for us, there is no single dragon we can slay to improve this world. Yet our monsters do have names: problems of quality and patient safety, the plight of the uninsured, access, regulatory excesses, gender and racial inequities, and on and on.

And the great paradox of course is that these growing problems are occurring at precisely the time in history when the diagnostic and therapeutic tools available to internists have never been more powerful. Can anyone seriously doubt the alchemy and magic you have in your hands to treat congestive heart failure, deal with cancer, prevent future disease with your knowledge, find the time to hold the hand of a dying patient and help them die with comfort and dignity. If this is not magic, what is?

While tonight is an evening of celebration for your accomplishments, like a demanding host I must also tell you it is also an unmistakable appeal to have you do much more. Like Frodo and his companions, you are the new breed of Fellows who have the talent, the respect of your peers—and our mandate to make a difference. But you must decide.

Now then, as a newly minted leader in this organization, how can you make a difference when you return home?

I would suggest that the first step is a moment of self-reflection. Marcel Proust once said "the voyage of discovery lies not in seeking new vistas but in having new eyes."

I suggest that you focus your vision on the very attributes which got you here and next, how you can build on those strengths to make a difference not only in the well-being of your patients, but also that of your colleagues and your communities, and perhaps even yourselves as well.

One of the most gratifying experiences I have had this past year is the privilege of meeting so many Fellows of the College in their own home settings at regional meetings around the country. I have come to call them my heroes--men and women of extraordinary talent and accomplishment in communities large and small. As the year has gone by, I have tried to celebrate a few of these individuals in my monthly columns and identify a number of attributes that these successful internists share, because underneath our diversity we share some common traits.

Tonight I'd like to highlight three characteristics that seem to be quite universal and highly predictive of success. I suspect most of you share these qualities.

First, these internists have a distinct clinical style, something we used to call "bedside manner," but might more appropriately be termed the art of healing. In a poem by the same title, W.H Auden said, "Healing is not a science, but the art of wooing nature." Wooing nature; I love that term. These internists have learned how to patiently deal with the vagaries of chronic illness, rarely, I suppose, "curing," but always bargaining with nature to improve the quality of their patient's lives. It is a unique partnership, and it lies at the very core of what a good internist does.

These healers are easy to spot at local meetings and Annual Session. While they are not necessarily at the podium professing, some are. They are predominantly the internists in the audience who share their insight, wisdom and kindness in conversation. They have taught me a valuable lesson: You cannot heal from the pulpit, but only from the pew.

It is not surprising that these internists are well-represented in the ranks of Fellows in the College. The lesson here is that Healers not only practice exemplary medicine, but they also powerfully influence others who want to emulate them.

Unfortunately, the increasing pressures of clinical practice make this style of practice increasingly difficult. But you, many of whom share this attribute, must continue to teach by example. Do not underestimate your power to create good by doing what you do best. It is an enormous treasure, and the health care system and the College needs you.

Secondly, in a society that increasingly seems to value less and less any sort of group activity, these internists are constantly investing in what some observers call "social capital." That is to say, they are joiners--in ACP-ASIM activities and in various causes in their communities.

They, like Frodo, recognize that if you want to change the world, it is prudent to involve some trusted colleagues for the journey. They spread their enthusiasm among their peers. They recognize how appreciative we all are when a highly respected colleague seeks our counsel. In this way, their impact on their colleagues and communities--and their elected representatives--is nothing short of astonishing. So continue to lead in your communities by finding time to devote to worthy causes, and always try to involve others. You will be surprised how favorable people respond!

The final attribute is the most important and most basic. It is sometimes referred to as Character, but I've learned that a better term might be "Virtue."

In classical philosophical terms, virtue describes a set of personal values developed by years of self-reflection and mentoring by family and respected colleagues. It is the inherent tendency to intuitively do the right thing.

When transposed to our clinical world, virtuous personal values allow us to easily establish trust and confidence with our patients. Virtue is the basis of professionalism.

In my experience, Fellows in this College know themselves very thoroughly and have more satisfying relationships with their patients as much by who they are as by what they know. Virtue is a trait worth recognizing and preserving in your careers. Your colleagues, especially younger ones, will recognize this trait and seek you out. Bring them into the fellowship.

Please enjoy tonight with your families and colleagues. Through your attributes as healers, community leaders and virtuous internists, you have earned our admiration. But remember you are now the Bearers of the Ring.

Thank you for your attention and for providing me the privilege of serving you in the best year of my professional life.

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