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President’s Convocation Address

Munsey S. Wheby, MD, MACP

2004

I would like to add my welcome to you all to the annual Convocation of the American College of Physicians. I especially welcome my wonderful and very supportive wife Jean, our three children, and their spouses. I am so happy that they could be here.

The major purpose of our College’s annual ceremonial assembly, which we call Convocation, is to honor you who are becoming Fellows of the American College of Physicians and will now use FACP in your title. These initials indicate that your peers – your internist colleagues – have recognized you as physicians who not only provide excellent care to patients but also demonstrate the professional qualities of continuing your medical education, being involved in and of service to your community, and, very often, contributing to teaching young professionals and your peers.

Here are the official words your College uses to describe this honor: “Fellowship is an honor recognizing personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.”

Dr. Steve Beuttel will shortly provide you with more details about our new group of Fellows, but let me tell you a few interesting bits of information.

The group includes three married couples: Drs. Kris and Matthew Thomas from Rochester, Minnesota; Drs. Carol and James Stanford from Kansas City, Missouri; and, Drs. Dugan and Frank Maddux from Danville, Virginia.

Almost every one of our states is represented in your group, although, as you will hear, there is an impressive international flavor.

For family ties you have Dr. Erik Libre, son of the current ACP Governor for the District of Columbia, Dr. Eugene Libre, FACP.
Your College salutes each and every one of you.

In addition to honoring our new Fellows and presenting a number of prestigious awards during this convocation, the College will award Mastership designation to 45 internists in recognition of their outstanding contributions to medicine.

Included in this new group of Masters are two Nobel Prize recipients, Dr. Joseph Goldstein, who gave the opening ceremony address and received his Mastership this morning, and his co-Nobelist colleague, Dr. Michael Brown. Their research efforts and those by other internist-investigators have made important contributions to our understanding of the basic pathophysiology of human disease. The College recognizes the magnificent contributions that these researchers and their discoveries make to improve the health of all people. These activities directly support the mission of our College, which is “to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.”

Most of you new Fellows are being honored because, like many of us, you further the ACP mission by providing excellent care to patients one at a time. My following remarks will be concerned with the care of patients.

In addition to the mission that I just quoted, the College espouses core values which include, among others, sensitivity and empathy toward the needs of others. I want to revisit these core values as they relate to a critical aspect of patient care: the patient-physician relationship.

As internists individually dedicated to these values, we must never forget who and what we are, or whom and how we serve.

Amid the daily demands of practice and teaching, it is sometimes easy to lose sight of our primary purpose as physicians: providing compassionate care to our patients.

Sometimes we need to remind ourselves that being a good doctor is not simply a matter of maintaining knowledge and technical skills. We must also nourish and exercise those humanistic qualities that our patients and their families most want and need in their physician: kindness, personal warmth, and compassion.

Today, measurements are being developed to assess our clinical performance, but the humanistic qualities I've just cited are much more difficult to measure. These qualities may not be included in the measurement of our work or for reimbursement, but this doesn't mean that they are not important or that they don't have real value, for the patient or the doctor.

We ourselves know when those qualities are missing, when the heart seems to go out of what we do, and our practice devolves to fending off “hassles” instead of engaging with our patients.

During more than 35 years of practice, I cared for persons with serious hematologic disorders. These patients often required toxic chemotherapy. For many, the outcome of such arduous treatment was far from certain.

I frequently wondered how my patients dealt with the terrifying uncertainty that is often at the heart of illness. I wondered too whether I had done enough to ease their discomfort and help them maintain hope.

These reflections came into much sharper relief when I experienced several uncomfortable but self-limited illnesses and saw things, albeit briefly, from a patient's perspective. These illnesses and the insights I gained provoked me as a doctor to "suffer with" my patients more than I ever had before.

"Suffering with the patient" is the classic definition of compassion in medicine. It is an imaginative leap into another's shoes, a move enabling us to appreciate firsthand something of what it feels like and means to be that particular patient.

Compassion in the patient-physician relationship can influence outcomes and change a patient’s ability to confront an illness. In December 2001, Teresa Gilewski, an internist-oncologist, wrote in the Journal of the American Medical Association about compassion's subtle yet forceful therapeutic power. She pointed out that it is easy for physicians to focus on the power of medical science and technology — and forget about the potentially profound influence of compassion.

We need to remind ourselves how important compassion can be in helping patients cope with illness and find healing. Compassion can easily be made part of our daily practice. To quote Dr. Gilewski: “The opportunity for compassion presents itself every day in every office, in every patient room, and in every hospital hallway.”

Let me share with you a short poem which I found to be extremely powerful and which concerns compassion in the patient-doctor interaction. It affected me deeply because it was written by a good friend, Joyce Butterworth, about her husband, who was a physician-colleague of mine. It was published in the Spring 2000 issue of The Pharos of Alpha Omega Alpha. It is entitled: “The Sentence.”

* * *

The Sentence

This summer, waiting in the hospital room
The mute television capturing my eyes –
Yours, newly sunken, uncomprehending,
Head heavy on the pillow
We listened to the click of heels rounding the door.

A neurologist, her face unreadable,
Flipped through charts
And rendered the sentence –
“CAT scan shows brain tumor
Glioblastoma
Three months to a year.”

They had said she was not one to hold your hand
But knowledgeable, smart –
Worth the risk of being crushed
By truths told heartlessly.

An eternity of silence until I said,
“That’s not good news.”
She answered, “No.”
She did not hold your hand.

Alone with you by the narrow bed
I touched your damp tousled hair,
Your full sweet lips
And reached for your hand
Praying I might keep it warm through the winter.
- Joyce Craig Butterworth

* * *

Where was the compassion? And what difference might it have made, to the patient and to the patient's wife? What difference might the feeling and expression of compassion have made to the doctor here described?

Compassion forms the basis for developing the trusting relationships that are the true source of satisfaction in practicing medicine, and we must make it a core element of our everyday clinical competency. Only by doing so will we be the physicians our patients want and need. We must also make sure that medical students and residents experience and emulate physicians who exhibit compassion every day in patient care. By observing compassion at work, this next generation of physicians will learn its artful practice.

Finally, we must allow ourselves to engage on a human level with our patients, for their sake and for ours. Being able to do this depends on our having the inner resources to care – depends, indeed, on our having compassion for ourselves in our busy, demanding professional and personal lives. That we keep ourselves in good physical, emotional, and spiritual health has everything to do with how effectively we can serve our patients. That each of us cultivates a rich and balanced life has everything to do with our being good doctors.

Your College recognizes how important this is, how each physician has a responsibility to care compassionately for him- or herself. To this end, a year ago the College modified one of its goals and also established a new core value which states: “We maintain healthy personal and professional lives to most effectively serve our patients”. The College is committed to helping individual physicians, and internists collectively, flourish as whole persons.

In closing, let me use a quotation you all have heard, the simple closing statement of Francis Weld Peabody, MD, in his 1927 Harvard Medical School address: "One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient." May sustaining that interest – that compassionate curiosity, combined with deep care for ourselves as well as for our patients – may this remain our practice, our challenge, and our goal.

Again, I extend my congratulations to our new Fellows and Masters and award recipients. Please enjoy tonight with your families and colleagues.

Thank you for your attention and for affording me the privilege of serving you as your President. It has been a most educational and enjoyable year.

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