GREETINGS, ETC.
I ALWAYS HAVE FELT AT HOME AMONG SURGEONS.

I AM A SURGEON, AND I HOPE I HAVE BEEN AN EFFECTIVE
ADVOCATE FOR SURGEONS.

WHEN I WAS IN THE GOVERNMENT YOU AND I WENT ABOUT OUR
WORK IN OUR OWN WAYS, AND NOW IT IS GOOD TO BE BACK.
THERE'S A BASIC HONESTY ABOUT SURGERY.
SURGEONS UNDERSTAND THAT SOMETIMES SOME THINGS NEED
TO BE SAID, EVEN IF THEY AREN'T ALWAYS PLEASANT TO HEAR.

YOU ARE THE MOVERS AND SHAKERS.

THAT'S GOOD.
WE NEED SOME THINGS --AND PEOPLE-- MOVED AND SHAKEN.
THROUGHOUT MY LIFE AS A SURGEON I HAD NEVER
CONTEMPLATED GOVERNMENT SERVICE. FOR ME, PROBABLY
LIKE MOST OF YOU, THE VERY THOUGHT WAS ANATHEMA.
NEVERTHELESS I PROVED RECEPTIVE TO THE FIRST SMALL
BEGINNING BECAUSE IN AUGUST 1980 SOMEONE TELEPHONED ME
AND ASKED CRYPTICALLY,

"DON'T YOU THINK THE SURGEON GENERAL SHOULD BE A

SURGEON." IT GOT ME THINKING POSITIVELY.
EVEN THOUGH IT HAS NOW BEEN SEVERAL MONTHS SINCE I
HUNG UP THE UNIFORM OF THE SURGEON GENERAL, I STILL
SEEM TO BE A RECOGNIZABLE FELLOW.

WALKING ALONG THE STREET HERE IN SAN F RANCISCO, IN THE
NEW YORK SUBWAY, IN AIRPORT WAITING ROOMS, PEOPLE
COME UP TO ME:

"HI, DOC!", OR "KEEP UP THE GOOD WORK" OR,

"I KNOW YOU! YOU'RE THE ATTORNEY GENERAL. KEEP AFTER
THOSE TOBACCO COMPANIES."

If MY PLANE IS DELAYED, I OFTEN END UP HOLDING OF FICE
HOURS IN THE AIRPORT WAITING AREA.
"YOU ARE THE ONE WHO FINALLY MADE ME STOP SMOKING!"
OR EVEN, "SAY, I HATE TO BOTHER YOU, BUT I'VE GOT THIS PAIN

IN MY ELBOW..."

ON A NUMBER OF OCCASIONS I'VE BEEN RECOGNIZED BY A
STRANGER, AND THEN BOTH PLEASED AND SADDENED BY
SOMEONE SAYING TO ME,

"I WANT TO THANK YOU FOR MAKING ME PROUD, ONCE AGAIN,

TO BE A DOCTOR."
I'M PLEASED, OF COURSE, BECAUSE I'VE GIVEN MY LIFE TO THIS
PROFESSION, AND IT HAS BEEN GOOD TO ME.

BUT I'M SADDENED TO HEAR FROM SO MANY OF MY
COLLEAGUES WHO HAVE LOST THE PRIDE, THE JOY OF BEING A
PHYSICIAN.
MORE THAN SADDENED, I'M ANGRY.

I'VE JUST FINISHED FILMING 5 PRIMETIME SPECIALS ON HEALTH
TO BE AIRED LATER THIS YEAR ON N.B.C. I'VE SPENT 5 MONTHS
GOING BACK AND FORTH ACROSS THIS COUNTRY, FILMING IN 20
CITIES, A FEW TOWNS AND HAMLETS, AND IN REMOTE CORNERS
OF RURAL AMERICA.
THIS EXPERIENCE WITH SO MANY FACETS OF AMERICAN
MEDICINE HAS MADE ME ANGRY.

I AM ANGRY ABOVE ALL BECAUSE OF THE DETERIORATION OF
THE IMAGE OF THE AMERICAN DOCTOR, FOR I BELIEVE THAT
THE DOCTOR-PATIENT RELATIONSHIP LIES AT THE HEART OF ALL
MEDICINE. —
MUCH OF IT IS OUR FAULT. | .
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WHY HAVE WE PERSISTED NOT '®® ROOT OUT TH@ REEESE=FN

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OUR PROFESSION?

WE TOLERATE PEOPLE WHO ARE INCOMPETENT, WHO ARE

GREEDY, WHO ARE ABUSIVE OF PATIENTS, WHO ARE ALCOHOL

AND DRUG ABUSERS.

THESE PEOPLE SHOULD BE REMOVED, AND WHERE POSSIBLE,
REHABILITATED, OW4/ 74éw srtevLo 7hEY RE CESTOEEY
BUS DRIVERS AND AIRLINE PILOTS DO BETTER IN POLICING

THEIR OWN. A MEDICAL SCHOOL DEGREE SHOULD NOT PROVIDE
MORAL IMMUNITY.

10
MEDICINE HAS SUFFERED FROM AN INABILITY TO
SELF-REGULATE ITS MEMBERS, AND THIS FAILING HAS PLAYED
HAVOC WITH THE SYSTEMS AND PROCESSES OF PROFESSIONAL
INSURANCE AND LICENSING AND ACCREDITATION...IN OTHER
WORDS, THE SYSTEMS AND PROCESSES OF PUBLIC TRUST.

11
AS A RESULT, THE CONGRESS HAD TO STEP IN AND ENACT
P GACT TOW ER
LEGISLATION SETTING UP A NATIONAL, DATA BANK ON

PHYSICIANS SO THAT WE COULD FIND THE BAD APPLES --IN THE
SAME WAY WE FIND DRUNK DRIVERS AND BANK ROBBERS AND
ASSORTED OTHER FUGITIVES FROM JUSTICE.

IT'S AN IGNOMINIOUS DEVELOPMENT, TO SAY THE LEAST.

BUT THEREITIS, 7#¢¢& #2€ same UME ACR.

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12
AND IT'S A TRAGEDY BECAUSE IT SHOULD HAVE BEEN AVOIDED.
IT'S A TRAGEDY BECAUSE DAY IN AND DAY OUT MOST

AMERICANS RECEIVE GOOD MEDICAL CARE - AS GOOD AS ANY

PLACE IN THE WORLD - FROM HONEST, COMPETENT PHYSICIANS.

13
UNFORTUNATELY GOOD NEWS IS NOT HEADLINE NEWS - -THE
OCCASIONAL BAD APPLE IS, ....AND DOES GRAB THE HEADLINES,
SAD TO CONTEMPLATE, BUT THE MEDICAL PROFESSION HAS
FOOLISHLY SQUANDERED ITS PUBLIC TRUST AND POSITION OF
LEADERSHIP. |

14
NOW, PHARMACISTS HAVE REPLACED DOCTORS AS THE MOST
TRUSTED PROFESSION IN AMERICA.

THE PUBLIC IS VERY CRITICAL OF DOCTORS.

AND DOCTORS NO LONGER LIKE THEIR PATIENTS.

15
DOCTORS LET THEMSELVES BE CALLED PROVIDERS, AND
PATIENTS BECAME CONSUMERS.
WE NEED TO GET AWAY FROM THE CONSUMER-PROVIDER

MENTALITY.
WE NEED TO RESTORE THE DOCTOR-PATIENT RELATIONSHIP.

EACH OF US.

16
RECENTLY, ONE OF MY FRIENDS, QUITE ACCUSTOMED TO
SPENDING HIS TIME WITH OTHER DOCTORS, FOUND HIMSELF
WITH A GROUP OF LAWYERS INSTEAD ---YES, THE TWO CAN GET
TOGETHER!

THE ATTORNEYS WERE CONGRATULATING THEMSELVES ON
WHAT THEY WERE ABLE TO DO FOR THEIR FELLOW CITIZENS.
IT HAD BEEN A LONG TIME SINCE MY FRIEND HAD HEARD

DOCTORS SPEAK IN THAT VEIN.

17
IF LAWYERS CAN FEEL GOOD ABOUT WRITING A WILL,
CAN'T WE FEEL PROUD ABOUT POSTPONING ITS USE?

WE SHOULD BE PROUD ABOUT WHAT WE HAVE ACCOMPLISHED
FOR THE AMERICAN PEOPLE.
LIFE EXPECTANCY IN THIS COUNTRY HAS GONE FROM 47 YEARS

IN 1900 TO 75 BY 1990.

18
NOW DOCTORS DO MORE AND GET THANKED LESS.

_ INSTEAD OF CELEBRATING, DOCTORS AND PATIENTS ARE
SQUARING OFF AGAINST EACH OTHER.
DOCTOR-BASHING HAS BECOME A POPULAR SPORT.

THERE IS EXASPERATION ON BOTH SIDES OF THE STETHOSCOPE.

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19
AMERICAN MEDICINE IS AT A CROSSROADS.
I HOPE YOU KNOW WHAT THE STAKES ARE.

TEN YEARS FROM NOW YOU COULD BE DOING ONE OF SEVERAL

THINGS:
(AND WHEN I SAY YOU, I AM ADDRESSING THE PHYSICIANS OF
AMERICA. YOU ARE THE LEADERSHIP AMONG SURGEONS)

20
YOU COULD BE WORKING WITH THE PUBLIC TO FREE US ALL
FROM A HASTILY IMPOSED NATIONAL HEALTH SERVICE,

OR,

YOU COULD HAVE SHIFTED FROM PATIENT-ADVOCATE TO AGENT
FOR ALL INSURANCE COMPANIES.

OR,

YOU COULD HAVE LOST YOUR PROFESSIONAL STATUS AND COME
TO BE REGARDED AS A MEMBER OF ANY ONE OF A NUMBER OF
JOURNEYMEN GUILDS.

OR,

21
YOU COULD BE PART OF THE BEST SYSTEM OF MEDICAL CARE IN
THE WORLD, DELIVERING HEALTHCARE TO THE GREAT
SATISFACTION OF YOUR PATIENTS AND YOURSELF.

AND YOU COULD BE PART OF A SYSTEM THAT DELIVERS
REASONABLE HEALTHCARE TO EVERY AMERICAN AT

REASONABLE COST, --URGING PESFEE THEM TO PREVENT
DISEASE AS WELL AS TO TREAT IT.

22
PLEASE FIND SOME WAY TO DISABUSE THE PUBLIC AND THE
PRESS OF THE NOTION THAT YOUR INCOME IS YOUR NUMBER
ONE PRIORITY, AND THAT YOU HAVE CEASED TO BE THE
PROFESSIONALS THAT YOUR FATHERS AND GRANDFATHERS IN

MEDICINE WERE.

IF DOCTORS PAY ATTENTION TO HIGH QUALITY AND HIGH

EFFICIENCY IN THEIR MEDICAL PRACTICE, IN MOST IN STANCES
THE BOTTOM LINE WILL TAKE CARE OF ITSELF.

23
I KNOW ORGANIZED MEDICINE DOES NOT CONSIDER ITSELF A
UNION.

BUT WE DO COMBINE FOR COMMON PURPOSES.

AND WE CAN LEARN FROM WHAT HAS HAPPENED TO UNIONS.

FOR FAR TOO LONG THEIR ONLY CONCERNS WERE INCOME,
WORKING CONDITIONS, AND BENEFITS.

MEANWHILE QUALITY AND EFFICIENCY WERE IGNORED.

24
NOW, BELATEDLY, THEY ARE SCRAMBLING TO ADDRESS QUALITY
AND EFFICIENCY.

THE AMERICAN AUTO INDUSTRY AF FORDS A GOOD EXAMPLE.

I IMAGINE THAT MANY DOCTORS WHO USED TO DRIVE BUICKS
AND CADILLACS NOW SIT BEHIND THE WHEELSOF CAMRYS AND
MAXIMAS.

25