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My Heroes Have Always Been Doctors

June 21, 2011

AMA Annual Meeting
Hyatt Regency Hotel
Chicago, Illinois

Peter W. Carmel, MD
American Medical Association

Thank you all for being here.

As I take on the responsibility of representing our organization, I recall the words of that great master of verse ... Willie Nelson.

Willie sang, "My heroes have always been cowboys. I grew up a-dreamin' of bein' a cowboy, and lovin' the cowboy way."

Well folks, my heroes have always been doctors.

I can't recall a day in my life when I did not admire doctors, did not want to be a doctor, nor doubted I would one day become a doctor.

Perhaps that's because my first hero was a doctor.  He treated patients and saved lives right in our childhood home in Brooklyn — my dad, Dr. Philip Carmel.

Growing up, the whole family played a part in dad's medical practice. For me and my sister, the rule was simple but important:  never disturb our patients.

Now as a kid, that job could be quite annoying.  I was painfully aware that dad's patients were always just on the other side of the door.  A very thin door, which made it difficult for me to exact true justice on my bratty little sister — who probably deserved it! 

Hey Katie.

Much has changed since my father practiced medicine. Technology has progressed by leaps and bounds, and we've entered an era of specialization my father could only have dreamed of.

But one thing has not changed. That  reward, which no government agency can slash, no insurance clerk can deny, and which the IRS has not yet figured out a way to tax ...

The currency of affection and esteem that bonds us to our patients.

The feeling you get when a patient walks into your office and says, "Doctor, please help me."

The feeling you get when you answer, "Yes, I can." And "Yes, I will."

A few weeks ago, I was honored to deliver the commencement address at the University of Medicine and Dentistry of New Jersey.

Before the ceremony began, I was putting on my academic robes in the VIP area, when I spotted our University President — Dr. William Owen — across the room.

Bill was deep in conversation with someone, and I thought to myself, "That guy looks familiar."

I went over to shake Bill's hand, and he introduced me to the honoree — Dr. Sidney Pestka — who was receiving a special award from the university.

"So that's it," I thought.

Dr. Pestka, as many of you know, made the monumental discovery of interferon.

By doing so, he revolutionized the treatment of hepatitis, cancer, and a score of debilitating diseases.  Had I seen his picture in a magazine or newspaper?

So the three of us were chatting, when a woman approached — Dr. Pestka's wife.

And I thought, "That's strange. She also looks familiar "

As soon as Mrs. Pestka saw me, she gave me a hug and said, "Dr. Carmel, it's so nice to see you again!"

Then it hit me.

Back in 1985, I'd operated on their son, Steven.  He was just a boy at the time, with a large pituitary tumor pressing on his optic nerves, causing visual loss. I'd removed the tumor and followed him for a few years.

I asked them how Steven was doing now, and they told me that in fact he'd followed in his father's footsteps.

He attended medical school at the University of Pennsylvania, completed his internship and residency at the University of Chicago, and did a fellowship at the Mass General Hospital. A real slacker.

Today, he heads the Hospitalist Division at Newton-Wellesley Hospital in Massachusetts. Better yet, he's the proud father of four.

While the serendipity of that moment was special in itself, even more special was hearing just how far Steven had come. This little boy, who'd been so at risk in 1985, was now treating patients himself.

I thank Steve for allowing me to tell his story, and for joining us here today.

There aren't many jobs where you can have that kind of an impact. Healing ... curing ... helping patients overcome incredible obstacles.  These are some of the most rewarding experiences we know — priceless!

And I'm sure there's not one physician in this room who doesn't feel that way.

During this time of historic change for America's health care system, it is important for us to remember that practicing medicine is a privilege. And with that privilege comes a special responsibility.

That is the conversation I want to have with you this evening.

As physicians, our first responsibility is obvious — it's to our patients. Each man, woman or child who walks through your door.

Just because it's obvious, that doesn't mean it's easy. For me personally, my first week of biochemistry quickly taught me that medicine would not be easy.

Our responsibility to our patients is defined by three words: knowledge, empathy and integrity.

In no other field is the pursuit of knowledge more critical than in medicine. New diseases, new therapies, new procedures and new technologies are discovered every day.  As physicians, we must push ourselves to continually master new knowledge. Because in our profession, that knowledge may make the difference between life and death.

But what good is knowledge to the patient who has just been told they have inoperable cancer? For that patient, knowledge is not enough. Caring, instead of curing, may be their only source of comfort.

That's empathy. As physicians, we must combine knowledge with compassion. Because when do patients come to us? When they are feeling most vulnerable. Sharing that vulnerability is a privilege and a sacred obligation.

But our responsibility to our patients does not end there ...

In his "Physician's Prayer," the 12th Century philosopher Maimonides wrote, "Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, nor ambition for renown, to interfere with my profession."

We call that integrity. As physicians, we must never let our judgment be clouded by a sense of entitlement. We must never trade objectivity for a steak dinner or a spa weekend. We must never let the desire for personal gain or autonomy stand in the way of patient interests. 

Physicians value autonomy.  But today, the best physicians are those ready and willing to collaborate — to work in teams, and to pool knowledge on behalf of our patients.

Our second responsibility as physicians is to our community.

Throughout the country, American communities face an epidemic of chronic disease. Today, two-thirds of adults and almost one third of children are either overweight or obese. The number of Americans with diabetes has tripled since 1980. More than 17 million Americans have a history of heart attack or coronary artery disease. And every 40 seconds, someone in the United States has a stroke.

As physicians, stemming the tide of chronic conditions that threaten our nation must be a top priority.

So the next time a patient walks through your office door, take advantage of that opportunity.  Be sure to engage them on their lifestyle behaviors.

One individual, one at a time, we can make a real difference. The AMA gives you tools to do this — even within the eight minutes allotted by contemporary scheduling demands.

For example, the AMA is collaborating with the AMA Foundation on a national campaign to prevent family obesity. That program, called "Healthier Life Steps,"  will work with physicians this summer in Albuquerque, Memphis, and Newark.

Our goal is not only to build public awareness, but also to provide physicians with the tools patients need to manage their weight — from self-assessment forms, to action plans, progress calendars, and even online tools.  Be sure to take advantage of these resources as they become available.

Campaigns like this lend themselves to coordination with larger community efforts. In Newark, we will send physicians and medical students into the school system to counsel children on healthier lifestyles and perform BMI Measurements. We call that program "Physicians against childhood obesity in Newark."  And we are working closely with Newark's Mayor, Corey Booker, and with First Lady Michelle Obama's "Let's Move" effort.

Wherever you live, whatever your focus, get involved in community outreach.  Push for an end to healthcare disparities. Push for increased access to care. Push for disease awareness, education, and prevention. As physicians, it is our obligation to be pushy. And I'm quite confident we can be good at it.

Our final responsibility is to our great and noble profession.

More than a year after the Affordable Care Act became law, there is still unrest in the House of Medicine. Across the country, many physicians feel under assault ... burdened by administrative and technology requirements, confused by new delivery models, and terrified at the prospect of increasing patient loads — without sufficient support.

But America's physicians are not alone. The AMA can help. Every day, round the clock, new rules and regulations on health care are being developed. And every day, round the clock, the AMA  responds to them.

When CMS issues unreasonable criteria to qualify for EHR incentives — the AMA demands exemptions.

When the government attempts to slash Medicare payment — the AMA launches a full-scale campaign to stave them off.

When insurers engage in unfair practices — the AMA goes to court and fights — and wins — on behalf of you and your patients.

Quality ... Patient safety ...   Practice management.  . . Scope of practice ... the list goes on. Whatever the issue, whatever your state — the AMA is the trusted advisor that America's physicians need and can count on.

So tell your colleagues. Let them know the profession is stronger because of the AMA. And let them know the AMA continues to help them through these tumultuous times.

Equally important, remind your colleagues that health system reform is still evolving. And today, every one of us has the opportunity to shape its course.

The Affordable Care Act achieved historic victories on behalf of America's patients. It expanded coverage to millions. And it eliminated some of the worst abuses of the health insurance system. Now, Congress must address the issues that threaten physicians.

History tells us that civil authorities seldom get the rules for physician conduct right. For example, the code of Hammurabi, written three and a half millennia ago, stated "If a doctor operates on a nobleman, making a long incision with a bronze lance, and if that patient dies, the physician will have his hands cut off."

Now I don't know about you, but if my hands were at stake every time I entered the operating room, they'd be shaking so hard I wouldn't be able to operate.

Let's help Congress get it right.  Let's fight for the changes America's physicians need:

•   The ability to treat patients free of red tape and bureaucracy;

•   True, meaningful medical liability reform;

•   Fair and adequate Medicare payment — so that no senior or military family has to worry about their physician's office closing;

•   Funding for sufficient graduate medical education positions;

•   Debt relief, so that residents and fellows don't begin  their careers with 160,000 dollars, or more, in loans

•   Medicaid reimbursement that is at least on par with Medicare — and not just for two years, but for as long as these programs exist — to ensure that every man, woman and child in our country has access to the care they need!

Congress needs to get it right. And the loudest, clearest voice for physician needs, is the AMA. Our AMA.

Before taking my current position in Newark I spent 31 years working at the Columbia Presbyterian Medical Center in New York. Every day I passed beneath an inscription carved over the entrance that read, "For of the Most High cometh healing."

These words — written two centuries before Christ by the scribe Jeshua  Ben Sira — reflect the sacred nature of the work we do as physicians. Ben Sira believed that physicians are called to do the Lord's healing.

In the truest sense, medicine is a vocation. A calling. And all physicians in this room are here because we heard that call.

Maybe it was the call of a child, bravely battling Leukemia when they should be playing ball in the park.

Maybe it was the call of an Alzheimer's patient, clinging to that last memory before it fades away.

Regardless of the specifics, we all heard the same call, "Doctor, please help me."

Just four words ... four powerful words.      

"Doctor, please help me."

And the only thing more powerful ... is the ability to respond with confidence, "Yes, I can." And "Yes, I will."

That's why we became physicians. That's why we're here today.

As we push forward to fulfill our responsibilities — to our patients, our communities, and our profession — it's not necessarily going to be easy.

If you wanted easy, you could have become a cowboy. Cowboys have rough edges, subscribe to a dubious brand of frontier justice, and inevitably ride off into the sunset just when the community comes to adore them.

But doctors — doctors couldn't be more different.

Trade stoicism for empathy.

Trade pistol for stethoscope, scalpel and PDR.

Trade the loner, outside of society, for the healer — willing to shoulder the burdens of others and support them in their most trying times.

That healer is you. That healer is me. That healer is us.

No ... my heroes have never been cowboys. My heroes have always been doctors.

Thank you.