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To Run and Not Grow Weary

June 19, 2012

2012 Annual Meeting
Hyatt Regency Hotel
Chicago, Illinois

Jeremy A. Lazarus, MD
American Medical Association

Thank you for this profound honor.  As you know, the summer Olympics start soon in London. 

I mention this because my journey to this stage has been – for me – something of an Olympic race itself.

I love watching athletes compete. And at the Olympic level, they inspire a pride of accomplishment in each of us, and each of us feels part of their success. 

When an American athlete wins, we cheer. When they stand on the podium with a medal on their chest, as the national anthem plays, we share their tears of joy.

 Now some of you may know that I’ve run a race or two in my time, but I can tell you, running 13 marathons or completing 13 triathlons is something completely different than becoming the 167th president of the AMA. 

This was much harder. 

The truth is, I’ve learned we all need each other’s support to make great things happen.

Tonight, there are many people to thank – those who supported me and encouraged me to keep on going.  You are the ones who didn’t think I was completely crazy to keep on going race after race…well, most of you. 

I'm reminded of what Olympic marathoner Don Kardong said: “No doubt a brain and some shoes are essential for success, although if it comes down to a choice, pick the shoes.  More people finish marathons with no brains than with no shoes.”

Rest assured I’ve laced up my sneakers for the start of my run as AMA president.

And I look forward to making great strides together with you, who represent the best of our profession.

Just like the Olympic athletes, when one of us wins, we all win.  It’s all of us on that podium, wearing the medal.   

Now, my path into this profession may have been different than that chosen by many of you.

It turns out that my high school, here in Chicago, was named for Nicholas Senn, who happened to be the AMA’s 49th president.

Say what you will about foreshadowing or fate, but given my skill set at the time, it was probably for the best that I didn’t go someplace named for another prominent Chicagoan – say, Michael Jordan Prep, or Mike Ditka Magnet School. 

Could’ve been a disaster.

For me, medicine and then psychiatry became a calling. When I was in college, my brother died in an accident.   

That tragedy fueled my desire to do something that made a difference to help people.  To become a physician.

I wanted to help repair shattered minds – to guide people through the minefields of depression, or personality disorders – or crushing changes in circumstance. 

I wanted to help someone who was troubled – lead a fulfilling, normal and healthy life.

I wanted to pull a profoundly depressed person back from the ledge of a potential suicide, and watch him grow from a troubled adolescent - to a productive adult.

In 40 years as a psychiatrist, I’ve been fortunate to help many people.  For me, that’s what it’s all about.

For our specialty, taking a person whose mental health is in jeopardy – and helping them toward recovery – is like watching someone walk again, or curing cancer. 

When something is wrong in the brain or the mind, it affects the whole person. The challenge is in how we determine what’s really going on – whether it's psychological or neurochemical or both.

It’s no coincidence the words, psychiatrist, and psychic, are in some way connected.  We are trained to listen both to what is said out loud – and what isn’t said at all.  

Listen to all sides – and then help people find their own path.

By listening – and working to find common ground, I want to bring greater unity to our AMA.

And while we can be thoughtful and deliberative and not act in haste, we recognize also that we stand at a healthcare crossroad.

Our patients cannot afford the luxury of indefinite time for us to simply talk about the issues.

In the 21st century, we can advance and grow only by incorporating the insights of physicians from all specialties, cultures, practice settings, states and regions, and ideologies.

There’s a real opportunity, regardless of the political paralysis in Washington, for us to unify to promote the practice of medicine – to  AMA members and nonmember physicians alike – around the country.

But any success will materialize only if we are unified on the issues that matter most to us, and our patients.

Ask a random physician about what the AMA does and how it represent physicians . . . chances are you would get a variety of responses.

So we’re working to harness the legacy of the AMA – what was – in a way that helps us all define what the future of the AMA can be.

You’ve heard a lot about the “AMA equation” this week.

But it bears repeating: The AMA is the sum of many parts:

Our House of Delegates, with more than 185 physician groups represented.

Membership – in which physicians engage each other – and learn from each other.

The tools and expertise we provide to help physicians manage practices.

Our pacesetting work in ethics – our efforts to end disparities – and our crown jewel publication JAMA and others – that make us a leader in  research and education.

And advocacy – giving voice to physicians in courthouses, statehouses, the media and in Washington, DC.

We are proof that those with opposing views can see the bigger picture and do what's best for physicians and patients.  That’s how we all win.

One recent example is the 200 million dollars returned to physicians because of AMA leadership in the United Health settlement. Or the needed delays the AMA won in implementing costly and confusing ICD-10 measures.

In these ways, the AMA touches the vast majority of physicians in this country – members and non-members – in tangible ways. 

And the AMA is well-positioned to influence an uncertain future.

Nonetheless, to improve health outcomes, reform medical education and shape health care delivery and payment systems so they work better for physicians – are not modest ambitions.

To meet these challenges we sometimes go over them. Or go under them, or around them. Sometimes we ask for help – ask for a hand up to clear the obstacle. That’s what achievers do.

I’ve been with the AMA and in the medical profession long enough to understand and respect the differences we have.

But I’ve been witness to our mutual interests. And how powerful we are when we work together to fulfill them. I ask you to help me explore that aspect – and expand it.

This year, the AMA celebrates its 165th birthday. Since our founding, we’ve been a player on the national stage.

But great organizations with a long history do not need to live in the past.   Respecting tradition does not mean we can’t create – and pursue – our future.

The years ahead are a new race to be run – and to finish we’ll need more than just talented physicians.

The AMA has shown both courage and a  willingness to face what’s ahead – to shape it – confront it – and when sensible, to conform to it.

To succeed is to evolve. It reminds me of when Woody Allen compared a relationship to a shark – that it has to move forward or it dies.

It’s not enough for the AMA merely to act, but to keep at it. To refuse to quit. To face challenges and rise above them.

One of the most important lessons I have learned in medicine, in my pursuits – in my life – is the value of persistence. 

As I mentioned, competing in marathons and triathlons has been a passion for me. 

I enjoy the challenge and pushing myself beyond what some may find reasonable.  And running 26.2 miles or finishing a 140.6-mile triathlon is no cakewalk.

Mary Wittenberg of the New York Road Runners Club described it this way. She said:

 "Virtually everyone who tries the marathon has trained for months. That commitment, physical and mental, gives it its meaning, be the day’s effort fast or slow.  It's all in conquering the challenge."

This persistence – this effort – helps give meaning to what the AMA accomplishes on behalf of physicians and patients, every day.

This is what we have in common.  Each of us has already run a marathon.

You completed medical school. Or you run a medical practice – a small business.  Or make split-second treatment decisions where life and death are in the balance. Sometimes all of these.

You, like me, want a positive outcome even when the unexpected happens.

An example.  In one triathlon, I was on the bicycle leg of the race going over Vail Pass in Colorado.

I rounded a curve and came upon a woman who had wrecked her bike. She was sprawled on the ground, injured, exhausted, dazed from a concussion.

With her was a fellow competitor – also a physician (and fortunately an ER doc) -- administering first aid.  I stopped as well – and when I could not be of further help, went on my way.

But the doctor who stopped first ultimately suspended his race.  He stayed with his new patient for two hours – and sacrificed his chance to complete an event for which he’d trained for months. Why? Because he’d trained for years to be a physician.

The well-being of the patient always comes first – even when it isn’t our own patient.

This selfless service has been a hallmark of who we are, as physicians, since the dawn of time.

And it’s one of the valuable lessons I’ve learned from my own encounters with the hard ground.  Not to give up.

In this most contentious time in our country, the AMA will do more than step up to a podium.

We will run – we will win the race to provide medical and mental health care services to all, and we will hear the cheers of those too often silent.

The AMA rejects the idea of media ‘spin doctors’ – who hold no medical degree – attempting to dictate our future. We’ll stand with physicians and take back our message.

The AMA rejects the idea that bowing to the policies of government and insurance industry bureaucracies are simply inevitable costs of doing business.

The AMA rejects the notion that legislators can impose themselves into the patient-physician relationship and legislate how we practice --

Whether it concerns what we can ask or say to our patients – or what tests and procedures are appropriate.

We fight for the interests of physicians. Sometimes we have prevailed, sometimes we haven’t, but we’ve been on the course, pushing our limits, testing our endurance. 

Not always winning – but always being heard and always finishing. 

The documentary filmmaker Bud Greenspan, who chronicled the Olympic Games for almost 60 years, once described a moment he believed best captured the Olympic ideal of perseverance and commitment.

In Mexico City in 1968, the Tanzanian runner John  Ahkwari finished last in the marathon.

Midway through the race, he had fallen and torn a deep gash in his leg. In agony, he limped into the stadium 90 minutes after the winner, his leg bruised, bandaged and bleeding. For everyone else, the race was over. The stadium was nearly empty, the lights dimmed.

Bud Greenspan was still there, his cameras still rolling. He asked John Ahkwari why on earth he kept going with such a serious injury, with no hope of winning.

He replied, “My country did not send me 5,000 miles to start a race – they sent me to finish it.”

That thought will guide me as AMA president.

Training for medicine was much like training for a marathon or triathlon. You learn your strengths, focus on what you do best, do it – and don’t quit.

If you get off course on the swim, adjust your stroke. (Unless you're fortunate enough to see Dr. Cecil Wilson's sailboat in the distance)

If you get tired on the bike, shift to a lower gear.

If you can't run, walk.  If you can't walk, take a break and try again.

That is an approach we can take to address the newest challenge we face – health system reform.

It means changes for those previously without coverage, changes in payment methods, changes in how care is delivered. 

The Affordable Care Act will soon cover 32 million people  without health insurance, provided neither the Supreme Court nor a new president overturns the law.

It requires insurance market reforms.

It invests in quality, prevention and wellness.

And it does something else – it starts us down the road to a very different system of payment and delivery.

We’re hearing jargon like “Accountable Care Organization,” and “medical home,” and “integration.”

We’ve come far since the days of a family doctor with a black bag holding the tools of his trade.

Today, a physician may text a patient on an iPad while viewing their medical history and coordinate care among a team of physicians and other health care professionals.

Such physician-led teams are crucial components of medicine’s future.

As more patients live longer and accumulate more complex medical conditions, their care will require more coordination, more use of clinical data, and professionals working together.

To be part of a team – and following guidelines and best practices – doesn’t mean you’ve lost your ability to think, to create, to act on behalf of your patients.

In the mental health field, a good example is the DIAMOND Initiative in Minnesota.

Psychiatrists are paid to consult with primary care practices on the best way to manage patients with depression. It’s resulted in dramatic improvements in patient outcomes.

The current system discourages this, since specialists are paid for face-to-face visits with patients, but not when they advise the primary care physician.

In 2008, this House of Delegates adopted principles that support this approach.

The AMA has also backed the medical home model for mental illness and the principle of parity for mental health coverage – and is part of the Coalition for Fairness in Mental Illness.  We've made tremendous progress, but we can do more.

As AMA president, I will note the need to better integrate mental health care into other aspects of medical care – to provide more resources to treat more people. 

Because you can no more separate the heart from the mind of a person any more than you can separate the heart from the lungs and expect them still to function.

I'll also want to highlight the health impact of violence on both the mental and physical health of those abused…

Just like we'll need you to make a concerted effort through our Joining Forces Initiative to help our returning troops, veterans and their families who suffer with traumatic brain injury, post-traumatic stress disorder or post-combat depression.

The wounds of those who have borne the battle are not always visible.

We’re not just playing defense. Just like in football, you need a good offense, too.  We’re being proactive, not just reactive.

Education on exercise, preventive health and nutrition starting in early childhood that continues through a lifetime will help create a healthier society.

One with less obesity, cancer and the other illnesses that debilitate the very people we care about – and which exact a staggering societal and financial cost.

For them, physicians must be the role models for our patient’s health – and for each other’s.

We have a duty to care not only for our patient’s health, but for our own, both physical and psychological.

That’s hard for many physicians to admit – that they, too, may sometimes need help or guidance.

When we treat our patients – especially our youngest ones – remember that you might be treating or inspiring a future physician. 

Our family internist, Dr. Lerner, who suffered from poor circulation in his legs, nonetheless would climb four flights of stairs to make a house call.

The doctor I saw was the doctor I knew, and to me, he represented the profession and as Dr. Carmel would say, he was my hero.

To me, his actions said: Treat people the way you want to be cared for, because too often, this is an uncaring world.

As physicians, as AMA members, we are the face of this profession, this organization.  We are also its voice.

Let’s be willing to sing from the same page. Those of you who have sung in choirs know how a collection of varied but trained voices can lift a crowd to their feet.

When the AMA combines our many voices in harmony – we can do just that.

For me, it’s not just a metaphor. I paid my way through college and medical school by directing synagogue choirs. 

There, you have to combine many disparate voices – and help them sing in harmony.

As director, you work with sopranos and tenors, altos and baritones, contraltos and basses.  And in some choirs you have to designate a section called the “lip synchers”.

But even if a voice is out of tune, or the pipes rusty – I learned that even a monotone can learn a second note.

So we need to rise up – raise our voices – and sing out for medical liability reform, to end frivolous lawsuits, to end the fear of being dragged into court for no good reason, and to slow spending on defensive medicine. 

Sing out, and demand the Sustainable Growth Rate be scrapped – and be replaced with a system that recognizes reality – and reflects the actual costs of medical care – in all its effective forms.

Sing out for private contracting legislation, and physician-led delivery and payment reforms.

Sing out our commitment that Americans need health insurance coverage and that we finally end health care disparities.

Sing out – for an equitable health care system. Where all its elements exist in harmony.

We trained all of our adult lives to be the best physicians we can be.  Now is the time to combine our voices and make a joyful noise. Rise to this occasion. Be persistent. And keep going no matter how rough the terrain, or how tiring the course. 

I’ll be alongside AMA staff, every physician, and this House of Delegates.  Together, we can finish this – and we can win.

Among the most inspirational words I've ever seen were at the 130-mile marker of a triathlon course, in the 100-degree lava field in Kona, Hawaii. They were from Isaiah, and it read:

 “They that hope in the Lord will renew their strength. They will soar like wings on eagles. They will run and not grow weary – walk and not grow faint.”

And to that I will add: we will rise up and be heard. We will run this race, together.  We will persist. And together, we will cross the finish line. Thank you.