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President’s Convocation Address

Lynne M. Kirk, MD, MACP

April 19, 2007

One of the most rewarding experiences I’ve had over the past two years as President-elect and now President of the College is traveling to ACP Chapters in and outside of the United States and visiting other medical organizations around the world. When I visit our own Chapters I am so impressed by the commitment of members and Fellows of the College to ACP and to improving health care within their own practices and communities. When I visit other countries I realize how common the issues are among internists. And the commonality of the efforts we undertake to improve health care globally. We have a lot to share and we have a lot to learn from each other to continue to do the best job possible.

Another task of the ACP President I have enjoyed much more than I thought I would is that of writing the monthly President’s column for ACP Observer. It has given me an opportunity to reflect on some of my favorite topics such as the value of internal medicine, the different roles of the internist, concerns about our general internal medicine workforce, and how to increase health care for the uninsured. I have found that this and other opportunities for reflection allow me to consider what I have learned as an internist and to integrate that into the larger context of my life and community.

This event we are attending tonight is another opportunity for reflection for all of us. I’d like you to reflect for a moment, both the new Fellows and those of us who are already Fellows, on the reasons why you chose to become a Fellow in the American College of Physicians. As I travel to Chapter meetings for ACP I am frequently asked by members “Why should I become a Fellow of the College”? In fact, a stranger walking into this room right now might ask why in the 21 st century are we all dressed up in these gowns and regalia that date back to the Middle Ages and sitting in a darkened room for an hour and a half when we could be out enjoying the fine cuisine and sights of San Diego?

I cannot honestly say that by becoming a Fellow you will earn more money in your practice. I cannot even say that your patients will value the care you provide more highly because you have attained Fellowship in the College. No, we do this-become Fellows of the College-for our own personal professional fulfillment and to mark a milestone in our career. As we reflect on our reasons for becoming Fellows in the College it is an opportunity for us to think about ourselves as medical professionals.

Justice Louis Brandeis noted that a profession must meet several criteria. First, it comprises work that is intellectual and applies a specialized body of knowledge. Second, this professional work is pursued primarily for others and not just for ourselves. The public in turn allows us as professionals to oversee and largely regulate the discipline of our colleagues. Even though we formulate goals and objectives for the knowledge and skills necessary for a physician, our profession requires more than just expertise and cognitive knowledge. Even though this profession is increasingly identified with our technical expertise, there are moral and ethical implications in the service we provide. Our professional work must first and foremost serve the public’s welfare. This includes responsibilities not only to individual patients, but to society at large.

Our own ACP Foundation in collaboration with the American Board of Internal Medicine Foundation and the European Federation of Internal Medicine outlined a physician’s charter for professionalism a few years ago. This has been adopted by many other professional organizations and many of us use it in our own medical schools. The Charter outlines three principles of professionalism. The first, the primacy of the patient, is an ancient principle dating back to Hippocrates. The other two, patient autonomy and social justice, come out of more recent bioethical principles of the last century. These principles are accompanied by ten professional commitments that further define our professional behavior. The Charter was created in the context of the rapid changes we are facing in health care delivery systems throughout the world. These changes continually challenge our values of medical professionalism.

In an erudite critique of the Charter, Swick and his colleagues enjoin us to call to mind that the word profession comes from the Latin profiteri, meaning to affirm openly. They encourage us to go beyond the Charter’s mandate of a contract with society and recall that we entered our profession with an oath, medicine being the only profession that consistently employs an oath. In a few minutes you will take another oath as you enter Fellowship in the College. By declaring and reaffirming openly our commitments to our patients and our profession we continue the legacy of our profession passed on to us by our teachers and mentors.

Thus becoming a Fellow acknowledges and honors not only your own accomplishments, but those of your teachers and mentors from whom you have learned and your colleagues, students and trainees from whom in the process of teaching, you also learn.

As a Fellow of the College you join a unique professional community. I recently met a colleague, who is an American who moved to Japan four years ago to teach in a residency program at a major Japanese teaching hospital. He related that he was greatly assisted by having a community of ACP Fellows in Japan. He now is a regular presenter at the Japan Chapter meetings.

Another way in which we benefit from this community is when we attend meetings such as this one, Internal Medicine 2007. I find I feel professionally renewed when I attend this meeting. It’s not that I find the solutions to all the problems that I deal with in my daily clinical life. But it is so helpful to interact with colleagues who face similar problems and to learn from their approaches to those problems. I also learn so much clinical medicine that I am anxious to take back to my patients--that joy of lifelong learning. I do find that over the days and weeks that I am back at home, I lose some of that excitement and renewal, but a portion of it always stays with me and hopefully makes me better at what I do.

I try to find opportunities in my daily life to remind myself of those feelings of renewal. One place that this happens for me is at the weekly internal medicine grand rounds at our institution. No matter how esoteric the topic appears to be, I find I learn some exciting new science or clinical application. I also still sit near the back of the lecture room during grand rounds--I’ve never become one of those bold enough to sit down in front. I don’t sit quite as far back as the students and resident do, however. As I look out over the grand rounds attendees from my vantage point in the auditorium I am amazed by the diversity of ages of the audience. A retired general internist from the community who regularly attends is 95 years old. There are several faculty and community physicians who are in their 80s. And of course many of the students and residents are in their 20s. It is wonderful to be in a profession where you can continue to enjoy learning over a career span of seven decades.

Other ways I am able to maintain that renewal include remembering every day why I chose to do what I do and to really connect with my patients and who they are. I always am awed by the talented young people among our students, residents, and junior faculty that I am fortunate enough to teach or mentor.

Becoming a Fellow acknowledges that you have grown both personally and professionally since your medical school and training. It shows that you have carried out the commitments you made when you entered this profession. Those commitments include continuing to acquire knowledge to take the best possible care of your patients, contributing to your community, and in many cases generating new knowledge or translating new knowledge into improved care for patients.

Becoming a Fellow is not just an honor conferred on you as a physician; it is an honor that you confer on the profession. It acknowledges that you realize that the profession has a life and vitality that is larger than any individual.

Let me get back to this medieval garb we are wearing. I’m always very curious about these symbols. Academic gowns kept scholars warm in the unheated stone buildings of the Middle Ages. Today, bachelor’s gowns have open, pointed sleeves and master’s gowns have sleeves that close at the wrist. The gowns we are wearing are doctoral gowns and have bell-shaped sleeves, black velvet trim and three black velvet stripes across the arms. On the night of Convocation, most of us recall when we participated in this ceremony as we became new Fellows. I for one was thankful to wear the roomy gown because I was 8 months pregnant with my son. Maternity wear clearly was not the intention of these gowns in the Middle Ages when the scholars who wore them were exclusively men.

The hoods we wear are derived from a cowl-like medieval tippet which provided warmth. The length of modern hoods signifies the degree achieved: three feet for bachelors, three and a half for masters and four for doctors. The hood is lined with satin; each school is a different color. It is faced with colored velvet denoting our discipline, green for medicine--law is purple and arts and letters, white.

The mortarboard is derived from a tufted, square cap called a pileus quadralus worn by medieval laity. I am wearing a velvet tam that I borrowed from my husband, who is a Dean and holds a Ph. D. This is an option reserved for doctorates.

It is appropriate that this Convocation and these regalia are scholastic symbols. They serve as a reiteration of the historic and continuing role of scholarship in our profession. They affirm the fact that a core of our professionalism as a physician is our commitment to practice evidence-based medicine and to lifelong learning.

Finally, we do not become Fellows only to acknowledge our own accomplishments and honor our teachers and profession. As you become a Fellow you honor your family and friends who have supported you through your long education and career, and your patients who have and will teach you so much. I, like many of you, am very fortunate to have several members of my family here tonight, who continue to be a major source of support for me. They include my husband, Bert, my daughter, Anne, who will be entering medical school in the fall, my stepson Matt, who is in graduate school, and his fiancÚ MaiChi, who is a clinical Pharmacist. My son Kory, who was born the month after I received my Fellowship at the ACP convocation, is back in college at Villanova studying for his semester final exams.

So when I am asked by members “Why should I become a Fellow in the College?”, I never hesitate to tell them that it is one of the most rewarding professional things they will do. Not only will they honor themselves, but also their teachers, their profession, and all those who make sacrifices along with them on this long professional road. I hope that will be your experience as you join this community of Fellows in the American College of Physicians.

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