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A Foundation of Tradition, a Tradition of Change

Inaugural Address
AMA Annual Meeting
Hyatt Regency, Chicago
June 10, 2014

Robert M. Wah, MD
President
American Medical Association

I asked for somewhat different arrangements on the dais this year – adding specialty society presidents and leaders of AMA sections. I was Chair of the Young Physicians. And the sections are one of the great strengths of our AMA.

This is a visual metaphor of the totality of medicine.  And the sound of medicine as well. Adding voices to amplify the AMA's presence on the national stage.

Where it has stood for 167 years.  Atop solid ground in a storied tradition. A space of synergy among old and new – states and specialties – colleagues and friends. And the ever advancing art and science of medicine.

Augmented by the willingness and courage to change. Change that respects our traditions.  Protects them. Expands on them. And yes, perhaps, improves on them.

A tradition that set standards in medical ethics and science.  That built a framework for medical education. A tradition that now embraces a bold strategy to improve outcomes for patients, the environment for physicians and the training of students.

Note that I'm speaking of tradition – not convention. Convention – is routine. Static. Thinks only inward. And looks – only backward. But tradition is flexible. Tradition recognizes reality – overcomes obstacles – learns to adapt – and inspires innovation.

Tradition is a foundation.  Not a prison.

The AMA has not shied from change. Instead, we have seized opportunities for renewal. And what is opportunity? Opportunity is what happens when optimism meets a challenge.

Few organizations boast the AMA's rich traditions and its flair for ceremony. One is the U.S. Navy, where I served more than 23 years.

I've witnessed the respect for tradition in both organizations. I've seen the courage to try something new – or do things differently. To build on traditions – not be bound by convention.

In both medicine and the military, training often focuses on preparing for the unexpected.  Events may surprise us, but our reactions should not. It instills a way of thinking – a willingness to act – and the ability to perform as a team. That makes overcoming the unexpected – possible.

Here's an example – an exercise some of you veterans might recall, part of training for chemical, biological or nuclear attack. It was the dreaded "gas mask exercise." Known also as the "Confidence Chamber. "

Here's how it works. We were taken to a concrete block building in an isolated field. The only light comes through a few small windows. We were given brief instruction, and then asked to put on our gas masks.

Then they roll a tear gas canister into the middle of the room. Dealing with tear gas with the mask on? Not such a big deal. But then it gets complicated.

We were told to remove our masks, even as the canister continued spewing tear gas. We then had to help each other clear the masks and help each other put them back on.

We were being taught how to react to the unexpected. To rely on a shipmate we may have only just met on the bus ride out there. It involves teamwork and trust – and how to overcome adversity by using both.

Of course, these lessons were taught and learned long before the creation of the "confidence chamber."  Since ancient times there have been sailors. Brave souls who cast off into the unknown, who used discipline to function, common sense to adapt – and visionary thinking to survive.

The Navy has a saying – back then, the men were iron and the ships were wood. A ship's crew forms a society. Confined to a certain space, reliant on each other, tapping a variety of talents, working together to keep alive a floating community amid a hostile environment. Sounds a little like the AMA at times.

From this ancient history – from this sense of adventure – from this impulse for exploration – the Navy draws its tradition – and its core values – of honor, courage, and commitment. And they use that tradition as both a foundation for leadership – and innovation. Something I've seen up close in my own experience.

I'm proud of the impact military medicine has had on and off the battlefield.  I've served during two wars. We treated nearly 50,000 injured personnel.

 More important, we lowered mortality from 25 percent to five percent.  Marines who see a medic within an hour of injury have a 96 percent chance of survival. 96 percent.  This remarkable progress is grounded in advances in all aspects of trauma care, from the point of injury through treatment toward recovery.

And much of it made possible using data and through innovations like the Joint Trauma System – a program that improves delivery across the continuum of care by taking in data directly from the front lines, analyzing it, developing best practices, and returning it to the field of battle.

In the Navy, I made the transition from clinical medicine to health information technology. Eventually I was privileged to manage the health IT program for the US military. It was a $900 million proposition that includes 65 hospitals and 10 million patients.

I also helped set up the Office of the National Coordinator – ensuring every US citizen has an electronic medical record in this decade.  And now I've expanded to a global perspective on clinical IT in my current role at Computer Sciences Corporation, CSC.

Fortunately, I didn't have to start from scratch. When I arrived, the military already had a proven record of success in this area. For instance, I haven't written a prescription on a piece of paper in a military clinic for 20 years.

And here's the important lesson that I've learned about digitization of healthcare: If it's to fulfill its vast promise it must be shaped and led by physicians. We all know implementing new technology can be a rocky road – and I'm not talking about ice cream.

The road is smoother if we keep in mind our goals. Like for e-prescribing, it's not just to get the label remotely typed in the pharmacy – the real innovation is that it might prevent a drug-drug reaction, or a drug-allergy reaction – or a duplication of medication.

The real innovation is in the ways it improves the care – and the lives – of our patients. Not high-tech for tech's sake, but an application of science that promotes well-being. And advances tradition.

As medical records transition from the convention of paper to the innovation of digital  and as we connect and network the resulting torrents of data, the next logical step is to analyze all this information.

Study it and use it and share it in new and innovative ways that we never could do with a pad and pencil. Just as the Joint Trauma System has used technology to reduce mortality in the last two wars. It's the use of better information, delivered at lightning speed, to make better decisions in healthcare.

Given my interest in information technology, it's probably not surprising that I've been a fan of "Star Trek" since I was a kid. I am a bit of a Trekkie.

I often hear controversies about Captain Kirk and Mr. Spock.  Who is better, who should one aspire to be?  Who's like Kirk and who's like Spock? I find the speculation…fascinating.

But the character I want to talk about is Dr. McCoy – Bones. A physician. A key member of the Enterprise leadership team. Willing to collaborate to solve problems, but also willing to question decisions from a scientific perspective.  An advocate for health – a driver of change.  Dammit Jim, he's a doctor!

Bones bridged the gaps among the extremes of logic and instinct, rules and regulations, rational thought versus impulsive action, scientific knowledge and human compassion. He was a simple country doctor – on a 23rd century starship.

And at a moment when we're inundated by amazing new technologies, we need a similar approach as we apply them to treat the very human issues facing our patients. Because where health information technology, cloud computing and cyber-security intersects – we'll find our patients.

While it sounds like science fiction, it's really just an ancient tradition – respecting the doctor-patient relationship and keeping it in confidence – while tapping new technology as yet another tool to help us take better care of our patients. Physicians must harness technology; not let technology harness us.

And with that Prime Directive in mind, we can be open to new ideas, new techniques and new perspectives. To build on tradition. Not be bound by convention.

Now to build on that tradition, one must survive and thrive. That's what we're doing here, right now – at our AMA.  Organized medicine is essential to help physicians navigate our own confidence chamber.

To confront the fog of issues that swirl around us. SGR. ICD-10. IPAB. Medical liability reform. Medicare data dumps. The Sunshine Act. Narrow networks. And the onslaught of legislative intrusions on women's health that are barging into our exam rooms.

Think of all we do. The AMA represents physicians across all specialties, geography, practice settings and career stages. Our members work together to address the pressing issues we and our patients face – together.

I'm excited about our long-range strategic plan:

  • Improve health outcomes for patients;
  • Improve physician satisfaction and practice sustainability –.
  • Improve medical education to better prepare the next generation of physicians.

Our goals are ambitious but obtainable. Moreover, achieving them is crucial if we're to shape a better future.  And not have it shaped for us. Even as we celebrate tradition, we recognize that any tradition is built on seizing and maximizing opportunities. At that place where optimism meets challenge.

Heritage of China

That's a hallmark of our country's history.

The relentless pursuit of renewal and improvement. Attracting people and their traditions from around the world – and integrating them into a national mosaic.

My grandfather immigrated to eastern Oregon early in the last century. It was then home to thousands of Chinese who came to work in the mines and build the railroads. They left China to escape abject poverty – and to seek freedom. To leave oppression – to find opportunity.

Like so many immigrants they risked it all to work in a foreign land, of unfamiliar tongues and an alien culture. A place where tradition met the unknown.

 Some welcomed their labor – others did not. One of the largest Chinese settlements in eastern Oregon was Canyon City. In 1885 a mob burned it to the ground. The Chinese fled to a smaller nearby town called John Day and settled in swampland strewn with rocks that no one else wanted. 

About 3000 Chinese called John Day home. At its hub was the Kam Wah Chung building.  A general store that served as the center of the community.

And minding this store were two men, Lung On – and Doc Hay. Lung On was an entrepreneur, who spoke and wrote English and ran the business. Doc Hay was a traditional Chinese doctor. He prescribed ancient Chinese herbal remedies.

Soon, non-Chinese patients sought out Doc Hay for cures and treatment.  They came from as far away as Canada and Oklahoma. All this, even though he was totally blind.

And when Lung On – the entrepreneur who spoke English – died, the call went out for someone to come help Doc Hay.

Answering that call was one of his relatives. Bob Wah. My grandfather. And he worked at Kam Wah Chung until Doc Hay died. And when my grandfather died, the building was willed to the city. When they reopened it, what was found was like a time capsule of life in the early 20th century.

Dusty cans of food still on the shelves.  Money in the cash register. And a trunk under Doc Hay's bed filled with uncashed checks. Twenty three thousand dollars worth. Most in tiny denominations – 75 cents – a dollar twenty. Most written before and during the Great Depression.

They were vivid reminders of a man's dedication to the people of his community during their hard times, in both their personal health and their personal finances. Today, the Kam Wah Chung building is a museum and a national historic landmark.

In these communities, people persevered.  They succeeded through hard work, a relentless pursuit of excellence and no small amount of luck. Like all immigrants, they saw change as an opportunity.  

Their optimism – met the challenge. And through their success, their community – and our country – is better for it.

This heritage is as central to my story as my service in the military and my time in the AMA. Even as I explore the technological marvels of today, I'm touched by the example of Doc Hay, a healer who used traditional methods from a distant time and place. Kind of like a simple country doctor – on a 23rd century starship.

But at any time and place, it's a privilege to take care of patients. At an interim meeting a few years back my wife suggested we find a quiet restaurant, just the two of us. We sat down and soon noticed a woman at a nearby table staring at us.

My wife, her hopes for a quiet meal slipping away, said "I don't believe it – that person knows you!" And sure enough, the woman walked over and says: "You saved my life."

That kind of interruption is always welcome. And brings a deep sense of satisfaction. The knowledge of the great privilege it is to take care of patients.

I had helped her through a health emergency. She remembered – and she was grateful that a physician was there – to do the job. We all have these very powerful stories. 

We must remember this – and celebrate our profession and the unique position we hold in society. And recognize the responsibilities that go with it.

When the cry goes out "is there a doctor in the house?" We respond. Accidents, disasters, disease, acts of violence. Acts of war. Physicians run towards danger, not away from it. We are the doctor in the house. We are the doctors – in this House.

As I stand here, surrounded by colleagues, immersed in the AMA's history – I am humbled by what we've accomplished.

But I'm also energized and inspired by the hopes and dreams of what more we can do, together. For our patients, for our communities and for this country.  We can boldly go – where no physician has gone before.

Together, we can draw strength from our bonds.   Escape the confines of convention.  Expand our horizons.  And build a new tradition. Thank you.

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AMA President Robert M. Wah, MD