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- Douglas P Zipes, MD, FACC*
- ↵*Reprint requests and correspondence: Douglas P. Zipes, MD, FACC, Indiana University School of Medicine, Krannert Institute of Cardiology, 1111 W. 10th Street, Indianapolis, Indiana 46202
I am excited and honored tonight to be installed as the 50th President of the American College of Cardiology (ACC).
I give heartfelt thanks to so many of you in the audience—my family, especially my wife Joan, friends, and colleagues—who have supported and guided my career and my involvement in the ACC. I owe Dr. George Beller, my esteemed colleague and friend, a specialthank you for his tremendous year of leadership. He’s a tough act to follow. He blazed a trail with initiatives in education, advocacy, and quality of care, the very foundations of the ACC. I am eager to widen that trail, to build upon the base that we’ve already established, and to launch new initiatives to meet the continually changing needs of the 21st century.
I’d like to extend a warm welcome to all of our new Fellows this evening. You are the young men and women whom we recognize tonight as the future of the ACC and cardiovascular medicine. Each of you has earned your place here as a Fellow of the College. You should be very proud. I know your families are as well.
I remember having the feeling of anticipation you must be experiencing right now. Today begins a new chapter in your lives as physicians. It reminds me of the day when we all graduated from medical school. The day when we first recited the Hippocratic Oath in an auditorium filled with our classmates, our teachers, and our families.
Just as that was an exciting beginning, so is today … for each of us. There is much that I want to accomplish in the year ahead as your President. One of my many goals is to make your practice of cardiovascular medicine as fulfilling as mine has been. So, to that end, I would like to share with you a philosophy that I try to live by … and one I hope will help guide you in the practice of medicine every day.
Treat each day as if it were your last, and each patient as if he or she were your first.
I think of it as a guideline for personal accountability, for setting priorities and for putting your actions in line with your ideals. Let me give you a couple of examples.
I recall not too long ago I was having a terrible day at the office, and I was interrupted by a phone call that somehow bypassed my secretary. Annoyed and angry, I grabbed the phone. The whole world suddenly stopped … and got better. On the other end of the line, I heard a special voice … “Papa …” My granddaughter, Hannah. How a child’s voice can suddenly bring clarity to a stressful situation.
These are the moments that make us remember the important things in life.
Moments like one Saturday, last fall, when I put aside an important manuscript, already overdue, to go see my grandson Tyler play Little League baseball, and watch his dad, my son Jeff, coach. Between innings, Jeff confided in me that he now found himself telling Tyler the very same things that I had told him years ago—back when I coached himin Little League. “Keep your eye on the ball, back foot firmly planted, step into it, and swing level.” That moment was worth missing any deadline.
The same kinds of moments come to us in our professional lives. Moments when we simply know—beyond all training and education—that we are a part of something bigger than ourselves—the practice of medicine and the life-saving work of cardiovascularmedicine.
My youngest son, David, came up to me when he was just a teenager. “Dad,” he said, “I’m not certain about what I want to be when I grow up. You seem so sure, but how do I know if I’m supposed to be a doctor?”
I looked at him for a moment and then asked him three questions:
First: “Do you like biologic sciences?” He answered yes.
Next: “Do you like problem solving?” Another yes.
Finally: “Do you like helping people?” “Of course.”
“Then what choice do you have?” I asked. “You must become a physician.” And I’m so proud that he has.
Perhaps you asked yourselves similar questions as you made your decisions to become doctors. Remembering why you said “yes” will help you cope with the many challenges you will face in the coming years.
As doctors, we are, like everyone else, on a treadmill these days—in a perpetual stage 5 of the stress test protocol. It seems that everyone wants a response to his or her question or problem, now. And, as doctors, we have to juggle a lot more than e-mail, cell phones, and faxes.
We also have to deal with increasingly complex patients and learning to implement the newest medical advances as well as the demands of managed care, declining reimbursement, and erosion of our autonomy. Not to mention trying to squeeze in some family and private time.
Just as work can often separate us from our families, increasing bureaucracy and paperwork can separate us from our patients. That’s when we need to stop, and remember that health care is more than just the latest CT and having the most advanced expert on the case. There are intangibles that influence why some patients get better and others get worse. Intangibles that involve mental attitudes and feelings that may explain why one patient with a seemingly refractory illness recovers and another with an apparently trivial problem dies.
As I look at the future of medicine, I believe there is a vital place for the old-fashioned “art” of medicine, alongside the exciting new medical advances we’re developing every day. Those advances have dramatically reduced death and disability from heart disease and stroke.
We see it every day, in the latest news about celebrities—and even politicians—who are successfully fighting heart disease, along with the countless everyday mothers and fathers, sons and daughters. These faces that we know and those that we don’t owe their lives to the tremendous strides that our specialty has made in understanding the pathophysiology of coronary disease, and in developing new diagnostic and treatment options. And when we factor in the prospects for what molecular biology and genetics will achieve in the future, the possibilities are absolutely staggering.
You new members of this College will someday diagnose and treat patients in ways that are hard to even imagine today. But, as medicine becomes more complex, it’s still all about the simple human act of caring for the patient. That’s what we all must remember: caring forthe patient is caring aboutthe patient.
I remember when I was a patient myself. I had mitral valve repair just a few years ago for a ruptured chordae due to prolapse. That experience taught me firsthand that being a patient means, among other things, completely trusting another person. Actually, many other people—from the orderly to the nurse, the anesthesiologist, the surgeon, the post-op caregivers.
When you’re in that position, you really begin to appreciate the art of medicine: the kind words, the caring gestures, the comforting touches, the laying on of hands, and the family support. What being a patient brought home to me again is that we doctors are humans first. We hurt, we get scared, we have questions, we are fearful of the unknown. If illness can have this effect on us, we who know so much about disease and wellness, imagine what our patients must feel.
Several months ago, I was a visiting professor at the very same institution where I had had my surgery. I started my Ground Rounds lecture by saying that it was good to be back … but vertical instead of horizontal!
I know that some days it’s hard to remember the enthusiasm and idealism we had in medical school and apply it to our patients. To remember how each and every patient mattered so much, regardless of all the challenges and headaches. But be sick, really sick for a bit, and I can tell you, you do remember. You remember how important it can be for caring individuals to truly focus on the patient.
In that moment, you can only hope to be cared for by a doctor who feels like you do: who treats each day as his last, and each patient as his first. For me, that statement really embodies the essence of life and of being a doctor. I truly believe that medicine is caring about others and giving of yourself to your patients. We must never lose the notion of the patient as the center of all we do and why we do it.
That’s what our profession is all about. That’s what the ACC is all about. I hope to excite you tonight—especially our new Fellows—about being a part of the ACC. It is truly an outstanding organization.
The ACC is our voice on Capitol Hill, and our gold standard for CME and for practice guidelines. The “FACC” that now follows your name is a badge of honor, but it’s also more. It brands you as part of a unique organization that values quality—in education, advocacy, and patient care. It is an organization that takes the high road when there are difficult choices to make.
As much as the ACC does already, I hope that this year, in my term as President, the ACC will do even more. I want us to establish a greater global presence—to reach across international borders and share much-needed educational and patient care materials. The Board is already moving in this direction. I have appointed a new task force that will work closely with our international partners to examine all that the ACC should be doing around the world. We will explore how the ACC can expand education and share science globally. I am proposing that we also consider our responsibility to help meet patient and doctor needs in developing countries. Consider one example: There are so many books, journals, and videos that still have plenty of life in them, even though we have moved on to the next edition, issue, or update.
Think of the difference we could make by distributing these still-valuable resources to those who could learn from them. I am confident, as we go forward, that together we’ll discover many other ways the ACC can be of service to doctors and patients in countries that need our help. Perhaps even organizing our talented retirees in a sort of physician Peace Corps.
Many of you know Dr. Henry McIntosh, here tonight as a Past President of the ACC. Back in 1984, he started Heartbeat International, an organization that distributes pacemakers to patients in developing countries worldwide. Using pacemakers as peacemakers, as they like to call it, they now have 43 pacemaker banks in 27 countries. They implant, at no cost, about 300 pacemakers a year. That’s truly phenomenal.
Just imagine what wecould achieve—an international effort for physician education and patient care, not just a few of us but with the entire muscle of the ACC behind it. Imagine the impact on patient care around the world—with just a little effort on our part.
So, let me ask you to think how you will participate in the ACC this coming year and the years that follow. The ACC, through its Development Committee, has just launched a program that will help you support our College and get involved in the areas that are important to you.
This program of member support is near and dear to my heart because I have been the chair of the Development Committee since it began four years ago. I am retiring from that job to be your President. Seeing the launch of a member-giving program is gratifying to me for two reasons. First, it is the culmination of much thought and effort on behalf of many College members and leaders who share my vision. Second, it has given me a way to support my passion—fellowships in clinical investigation. I’m pledging a personal gift this year to initiate more support for these fellowships. I don’t have to tell you how important this is to the future of cardiovascular medicine. Fellowships are available—through the ACC and other organizations—but the opportunities for funding do not meet the demands. I would like to help the ACC create an endowment that will support even more fellowships in clinical investigation. Who can predict the marvelous advances that can come from such trained people?
You, as new Fellows of the ACC, are the future of cardiovascular medicine. You must have the support necessary to learn, to discover, and to break new ground in clinical medicine.
The Guidelines Applied in Practice—or GAP project—is an example of a ground-breaking effort that the ACC created to address your clinical needs at the point of care. Its goal is to improve communication between patients and their health care team and, ultimately, to improve the quality of patient care.
Launched a year ago, the program’s first results were presented yesterday here in Orlando. This project, which used acute myocardial infarction as the first test case, developed tools to facilitate adherence to ACC/AHA clinical practice guidelines to improve the quality of patient care. Its implementation has increased the utilization of beta-blockers, aspirin, and counseling for smoking cessation in the participating hospitals. The GAP project also addresses patients’ own involvement in their care. My daughter, who is a psychologist, has always impressed upon me the need to empower patients by giving them an active role in their own treatment. Through the GAP program, patients are given information about their condition and a discharge plan that is discussed with their doctor. I will continue to support the growth of this superb project.
Education. It lies at the heart of the GAP project—and so much of what we do. It is, indeed, the ACC’s top priority. I spoke earlier of Dr. Beller blazing a trail, and that description applies aptly to another project begun recently and one that I will continue to help grow. ACC members have told the College they want a resource that will allow them and their patients to have access to cardiovascular knowledge anytime, anywhere. The Knowledge Delivery Enterprise, called “KDE”—A Joint Learning Initiative of the ACC and AHA—is the ACC’s response to this request.
This comprehensive clinical tool is being developed to bring real-time medical knowledge to physicians and patients. When complete, this online database will provide information at the point of care and more—all deliverable, on demand, to your handheld computer on your laptop, 24 hours a day. We still have a lot of hard work ahead to develop KDE … but it’s an exciting road. We’ve made reservations, and we’re ready to travel.
There’s one more important change that’s happening this year. This one is fairly fundamental—and absolutely essential. I’m talking about the creation of a new organization, a so-called 501(c)(6) organization (that’s what the IRS calls it), that will allow the ACC to significantly increase advocacy and lobbying efforts on behalf of you and your patients, at both the local and national levels. The College is classified as a charitable organization because of our focus on education. The problem was that this IRS status limited what we could spend on advocacy. Creating a 501(c)(6) was the only way for the ACC to achieve both goals … education and advocacy. It won’t change the College’s relationship with you, and it won’t change any of the College’s core values. We will remain the same organization, and you will see few differences on a day-to-day basis.
From the legal side, it’s a tax change. But from where I sit—and where all of you sit, as Fellows—it is something much, much more. It is the beginning of our ability to truly answer your call—for us to speak with one voice when advocating for important cardiovascular issues, both nationally and with our chapters; to speak out on behalf of our patients and our members in the legislatures and the regulatory commissions; to notgive in to bureaucratic inefficiencies, greater regulation, and unrealistic constraints on patient care. These are the forces that are driving health care away from the core value of living each day as our last and treating each patient as our first.
Greater advocacy power will give us the opportunity to battle onerous billing documentation requirements and to fight for NIH funding, patients’ rights, physician autonomy, and high-quality cardiovascular care.
But with all of the new things we are doing this year, I will make sure that we continue to do some things the same: to keep and hold fast to our core values, to remember our patients as the reason we chose this great profession.
That’s what it’s really all about this year and every year: to remember what makes us physicians and to reaffirm that pledge at the beginning of each and every day. To remember our healing roots that go back thousand of years, to remember the Oath of Hippocrates that forms the basis of how we practice medicine.
- American College of Cardiology