Heroes are everywhere, and many are in medicine

AMA Leader Commentary. By By John C. Nelson MD, MPH, March 21, 2005.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President John C. Nelson, MD, MPH.

Google the word "hero" and you'll find more than 21 million references ranging from military, police and fire heroes to thoughts of the ancient philosophers. Each of us has heroes in our lives.

They call them everyday heroes, the people who act out what the late tennis great, Arthur Ashe, described when he said, "True heroism is remarkably sober, very un-dramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost."

Let me tell you about a few heroes in my life. No. 1 would be my father, Dean F. Nelson, MD, the first obstetrician to become board-certified in Utah back in the early 1950s. He was not only my hero, he was a hero to his patients, revered for his sensitivity, expertise and the outstanding results he obtained.

Dad died at age 56 -- they day before I was to present my senior resident paper dedicated to him. Unfortunately, he never heard it. In those too-few years I knew him, he typified for me what a professional physician was and is and could accomplish.

Another hero would be my most memorable professor, Morton A. Stenchever, MD. A giant in the field of medical genetics, Dr. Stenchever was an educational innovator whose overhaul of the obstetrics curriculum at the University of Utah Medical School took an average program to among the top five in the nation in ob-gyn test results.

A great teacher, he knew the best way to get people to learn is to turn them into teachers. He taught his residents how to teach, making them tutors and mentors to the medical students following in their footsteps. His was a quiet heroism built day by day in countless ways. By moving the fulcrum, so to speak, he leveraged his knowledge, multiplied his effectiveness and remains a hero of medical education to this day.

A third would be my wife's physician, Richard M. Hebertson, MD, who had a profound effect on the way I practice medicine. Personable, witty and thorough, he uses his charming personality to interview his patients in depth, not only gaining routine data but probing in a gentle way to determine the quality of a patient's life, if there were troubles at home, whether domestic violence was present.

Heroic? You bet. No one will ever know the huge number of problems he helped his patients avert, the kind of harm that otherwise would have occurred. He showed me that heroism extends beyond competence to gentle, thoughtful, loving involvement in the whole life of each patient.

Beyond medicine, I can think of other heroes in my life:

A political scientist, Robert P. Huefner, PhD. Dr. Huefner heads the Scott M. Mathison Jr. Center for Health Policy at the University of Utah. I worked with him in evaluating Utah state health data. He has the uncanny ability to ask "scalpel questions" that probe not just data and information, but attitudes and beliefs. To answer one of his questions, you needed answers to five or six other questions. He demonstrated powers of thinking and questioning of heroic proportions. His kind, gentle, incisive probing got answers to questions many of us haven't even thought to ask. Dr. Huefner taught me how to think critically.
Brandeis University professor of national health policy, Stuart Altman, is one of the nation's foremost experts on Medicare reform. His analytic abilities are unchallenged. His compassion and ability to understand widely opposed points of view and bring them to agreement mark him as one of the greatest minds I've seen in action.
Former Utah Gov. Michael Leavitt, now secretary of Health and Human Services, is another hero for resolving divisiveness. In the early 1990s, as governor, he headed Utah's statewide health reform initiative. In public hearing after public hearing, he drew out opposing viewpoints, gave every facet of every argument a full and complete airing, encouraging discussion and debate. In the end, he was able to draw all parties to the table in amiable mutual respect, encouraging buy-in where others would have seen impasse. To me, that is heroism in action.
Gary M. Lower, MD, was a resident when I was a medical student, and I looked up to him. I still look up to Dr. Lower for his ability to demonstrate how physicians have something to add to the process of quality improvement. He is the person responsible for turning quality improvement processes from punitive devices into educational devices.
Brent James, MD, is executive director for Intermountain Health Care's Institute for Healthcare Delivery Research. He also is a person who has dedicated his medical career to improving the quality of care by using data. Dr. James is unafraid to look into the bowels of medical practice to examine honestly and objectively what is going on, and what needs to change. And we all profit from that kind of heroism.
Finally, I would include Donald Berwick, MD, the president and CEO of the Institute for Healthcare Improvement. Dr. Berwick has the courage to take what Dr. James and others have found and put it into practice, making us change for the benefit of our patients.

And what about those Project HOPE physicians -- including Matt Wynia, MD, of the AMA staff -- aboard the USNS Mercy off Aceh in Sumatra? The healing and hope they are bringing the victims of the Southeast Asian tsunami are heroic, to say the least. Or the Iraqi citizens, who literally stared down the muzzles of automatic weapons as they walked to cast their ballots in a free election?

You have heroes of your own, I'm certain, among your colleagues and your patients. Who cannot but marvel at the pediatric oncologist sitting with a family losing its son or daughter, weeping with them, praying with them, caring for them as well as for their child? Heroism is part of the spirit of medicine. It's indelibly written in the history of the AMA. It's what you do as an everyday hero.

Whenever I attend a meeting of physicians, I am among heroes. Few of them will ever receive a medal or a congressional commendation. All of them deserve the highest praise and thanks a nation can give.

The individuals I cited embody the primary values of the AMA -- the science, ethics and caring of our profession. And that is one more reason I am proud to be a member of the American Medical Association.

Dr. Nelson, an obstetrician-gynecologist from Salt Lake City, was AMA president during 2004-05.