ta) Keynote. Speech by C. Everett Koop, MD Deputy Assistant Secretary for Health an Surgeon General U. S. Department of Health and Human Services Awards Banquet, Clinical In-Service Conference National Health Service Corps, Region III Wednesday, March 3, 1982 Philadelphia, Pa ATTN REGION III: Please deliver this copy to Mrs. Betty Smith c/o Surgical Associates 3rd Floor Children's Hospital #1 Children's Center Philadelphia, PA Thank you, Ted Cron, 8-472-5652 YAMA Be -i- (GREETINGS TO HOSTS, GUESTS.) I'M DELIGHTED TO BE HERE THIS EVENING TO BE A PART OF of THIS IMPORTANT CEREMONY. WE ARE LIVING IN A TIME THAT CRIES OUT FOR EXCELLENCE AT ALL LEVELS AND IN ALL ENDEAVORS OF OUR SOCIETY AND WHEN WE DO COME LIPON EXCELLENCE, I BELIEVE IT IS OUR DUTY TO RECOGNIZE IT, AS WE ARE DOING HERE TONIGHT. THE AWARDS FOR “SUPERIOR SERVICE" IN SHORTAGE AREAS ARE REALLY A SMALL RESPONSE BY THE GOVERNMENT TO THE KIND OF PERSONAL EFFORT, PROFESSIONALISM, AND SENSITIVITY THAT EACH AWARD RECIPIENT HAS DEMONSTRATED HERE IN THE REGION. EP IS Ee Mar eP SMALL BY conpenee™ BUT IT IS THE BEST THAT WE CAN DOs, yo WE Péffuam Aacé . KNOWING HOW DIFFICULT IT IS ANYWAY FOR SHEETS OF PAPER OR METAL PLAQUES OR OTHER EPHEMERAL MATERIALS TO CAPTURE THE DEPTH AND THE SINCERITY OF OUR FEELINGS ABOUT EXEMPLARY HUMAN SERVICE. WITH SUCH THOUGHTS IN MIND, DR. RIMPLE, IT THEN OCCURRED TO ME THAT, WITH ALL DUE RESPECT, I WOULD HAVE TO TAKE TSSUE WITH THE THEME OF THIS MEETING..."MORE WITH LESS ~~ MEETING THE NEEDS OF THE 80s." IT IS CLEAR TO ME THAT THE ONLY WAY WE CAN HOPE TO MEET THE NEEDS OF THIS AND COMING DECADES Is NOT BY WORKING WITH LESS. WE NEED TO ACCOMPLISH MORE...WITH MORE™ ONO ERE * MORE PROFESSIONALISM, MORE SKILL, AND MORE KNOWLEDGE ABOUT THE BEST THAT IS AVATLABLE IN HEALTH AND MEDICAL CARE. * MORE PERSONAL COMMITMENT AND DEDICATION TO THE SERVICE OF PEOPLE IN NEED. * MORE UNDERSTANDING OF THE TOTAL CONTEXT OF CARE ~- THE ECONOMIC, SOCIAL, AND PSYCHOLOGICAL IMPACT OF DISEASE AND DISABILITY AND THE IMPACT OF DETECTION AND TREATMENT . * AND MORE ATTENTION TO THE NEED OF OUR SOCIETY TO PREVENT DISEASE AND DISABILITY FROM OCCURRING AND THE NEED TO PROMOTE HEALTH AND WELL-BEING. WE KNOW, OF COURSE, THAT THE "LESS" WE SPEAK OF SO OFTEN IS MONEY. AND I WOULD NOT BE CANDID WITH YOU IF I LET THAT PASS. BUT PRECISELY AT THIS TIME IN OUR HISTORY IT MAY BE VITAL TO THE FUTURE OF AMERICAN MEDICAL PRACTICE THAT WE BEGIN TO PUT MONEY IN PERSPECTIVE, A SINCE, FRANKLY, WE ARE NO LONGER ABLE TO DIP INTO 4 BOTTOMLESS TREASURY/—~ AND FOCUS INSTEAD ON THOSE ATTRIBUTES OF SOCIETY THAT CAN BE IN LIMITLESS ABUNDANCE....NAMELY, THE PROFESSIONALISM, COMMITMENT, AND UNDERSTANDING THAT ~ SPOKE OF A FEW MOMENTS AGO. THOSE, AFTER ALL, ARE THE FUNDAMENTAL ELEMENTS FOR THE "QUALITY ASSURANCE“ WE ALL DESIRE IN HEALTH CARE DELIVERY, WHETHER IN MEDICAL SHORTAGE AREAS OR ELSEWHERE IN OUR SOCIETY. BUT FOR THOSE OF US IN THE FEDERAL HEALTH SERVICES, THE DELIVERY OF QUALITY CARE TO THE UNDERSERVED IS OF PARTICULAR IMPORTANCE. AND, INDEED, THAT IS WHAT THIS EVENING'S CEREMONY IS ALL ABOUT. THEREFORE, I WOWILD LIKE TO SPEND THE NEXT FEW MINUTES SHARING WITH YOU SOME OF MY THOUGHTS ON WHAT OUR WESLTHN IS IN THE CARE OF PEOPLE. WHAT DO WE HAVE A LOT OF? AND WHAT CAN WE USE A LOT MORE OF? IT IS UNFORTUNATE, BUT SOME CONTROVERSY SURROUNDS THE PROPOSITION THAT WE HAVE IN THIS COUNTRY A LOT OF CARING PEOPLE AT @bhL LEVELS OF GOVERNMENT/. «AND T WOULD EMPHASIZE THE WORD ALL. BRINGING THIS UP AT A REGIONAL CONFERENCE IS, I IMAGINE, SOMETHING LIKE "BRINGING COALS TO NEWCASTLE." I AM REFERRING, OF COURSE, TO THE DEVELOPMENT OVER THE PAST DECADE OR MORE OF A LARGE CADRE OF HIGHLY TRAINED, TOTALLY DEDICATED HEALTH PROFESSIONALS IN STATE, COUNTAMY, AND LOCAL GOVERNMENT. WE KNOW THEY ARE THERE BECAUSE STATE AND LOCAL HEALTH OFFICIALS HAVE PROVIDED THE BASIS FOR MOST OF THE CATEGORICAL GRANT-IN-AID PROGRAMS ENACTED IN THE 1960s AND THE 1970s. WE KNOW THEY ARE THERE, YET THERE IS A GREAT DEAL OF UNCERTAINTY ABOUT WHETHER OR NOT THEY CAN HANDLE THE -f- — er RESPONSIBILITIES THE PRESIDENT PROPOSED TO TRANSFER TO THEM UNDER LAST YEAR'S puDgeT/-- WHICH THE CONGRESS ENACTED, FOR THE MOST pary/-- AND THE ADDITIONAL PROGRAM RESPONSIBILITIES PROPOSED FOR TRANSFER IN FISCAL YEAR 1983. LET ME S@Y RIGHT UP FRONT THAT IT BELIEVE THAT PEOPLE OF GOOD WILL CAN DISAGREE ON THE ADVISABILITY OF HAVING THIS OR THAT HEALTH SERVICES PROGRAM AS PART OF GOVERNMENT'S OVERALL HEALTH RESPONSIBILITY. AND I THINK PEOPLE OF GOOD WILL CAN DISAGREE ON THE WAYS TO DELIVER THE PARTICULAR SERVICES PROMISED IN THIS OR THAT PROGRAM. BUT I DON'T THINK PEOPLE OF GOOD WILL CAN ANY LONGER DENY THE ABILITY OF GOVERNMENT PERSONNEL AT STATE AND LOCAL LEVELS TO PROVIDE THE BEST QUALITY CARE THEY CAN TQ THE PEOPLE TO WHOM THEY ARE RESPONSIBILE AS PUBLIC SERVANTS. AND I AM DISMAYED TO READ AND TO SEE THAT MUCH OF THE DIALOGUE ABOUT THE PRESIDENT'S PROPOSALS FOR THE "NEW FEDERALISM" ARE OFTEN REDUCED TO THIS LEVEL OF UNFORTUNATE PREJUDICE AGAINST HEALTH PROFESSIONALS AT LEVELS OF GOVERNMENT OTHER THAN THE FEDERAL LEVEL . AS A NATION AND AS A PEOPLE, WE HAVE COME TEAR IN OUR CONCERNS FOR OUR NEIGHBORS TO DENY THAT IT HAS TAKEN PLACE AT ALL. BECAUSE IT HAS. THIS IS NOT TO SAY THAT EVERY SINGLE AMERICAN HAS COME THE SAME DISTANCE INTO THE TWENTIETH CENTURY EITHER. BUT THE OVERWHELMING MAJORITY OF AMERICANS / -- AND THE PUBLIC OFFICIALS WHO SERVE THEM /-- HAVE NO INTENTION OF TURNING BACK THE CLOCK OF SOCTAL CONSCIOUSNESS, CARING, AND COMPASSION. WE HAVE A LOT OF THOSE FUNDAMENTAL QUALITIES EVIDENT IN DAILY AMERICAN LIFE. AND I FEEL THIS IS THE TIME TO CELEBRATE THAT FACT..-NOT TRY TO HIDE IT OR LIVE IT DOWN. SOMETHING ELSE I THINK WE HAVE IN ABUNDANCE IN THIS COUNTRY IS WHAT I WOULD TERM "HEALTH LITERACY," THAT IS» A FAIRLY WIDESPREAD BODY OF KNOWLEDGE ABOUT THE MECHANISMS OF COMMON DISEASE CONDITIONS, ABOUT THE RUDIMENTS OF NUTRITION AND DENTAL CARE, AND ABOUT OTHER COMMON HEALTH CONCERNS. HAND-IN-HAND WITH THIS GENERAL "HEALTH LITERACY" AMONG OUR PEOPLE IS THE WILLINGNESS AND THE ABILITY -- WHEN STIMULATED BY & REASONABLE APPEAL -- TO TURN THAT LITERACY INTO ACTION, TO DO THINGS FOR OURSELVES AND OUR FAMILIES WHICH WE KNOW WE OUGHT TO DO ANYWAY. DURING AND RIGHT AFTER WORLD WAR II, WHEN THERE WAS AN HISTORIC EXPLOSION OF NEW MEDICAL KNOWLEDGE AND PEOPLE -~- t uy & INCLUDING PRACTICING PHYSICIANS -~- WERE UNDERSTANDABLY -~1O0- CONFUSED ABOUT THINGS LIKE PENICILLIN, THE SUL FAS, NEW SURGICAL PROCEDURES» AND NEW DIAGNOSTICS/~- IN THAT ERA THE PUBLIC NEEDED GUIDANCE OF AN AUTHORITATIVE NATURE. IT WAS» IN FACT, THE RESPONSIBILITY OF PUBLIC HEALTH OFFICIALS TO EXPLAIN THE SIGNIFICANCE OF THIS NEW MEDICAL TECHNOLOGY AND TO PUT PEOPLE AT EASE, AS IT ALL BECAME PART OF COMMON MEDICAL PRACTICE. THEN; AS EXPECTATIONS OF CARE DID EXPAND» SOMETIMES FAR BEYOND AN INDIVIDUALS OR @& FAMILY'S ABILITY TO HANDLE SUCH CAREY IT SEEMED REASONABLE FOR GOVERNMENT TO STEP IN AND PROVIDE HELP. NOW IT APPEARS THAT GOVERNMENT HAS BEEN STRETCHED ALMOST TO THE SREAKING-POINT. RETURNING SOME RESPONSIBILITIES TO THE PEOPLE THEMSELVES SEEMS TO BE FAR MORE REASONABLE THAN PERGISTING IN HAVING GOVERNMENT SHOULDER THE FULL BURDEN. -1i- “nN PEOPLE GENERALLY KNOW MORE, UNDERSTAND MORE, KNOW ORE en ABOUT THE RISKS AND BENEFITS OF MEDICAL CARE} AND KNOW MUCK MORE ABOUT THE TREMENDOUS COSTS OF CARE. TODAY, PROBABLY AS NEVER BEFORE IN THE HISTORY OF MEDICINE, THERE IS A CLOSE PARTNERSHIP POSSIBLE BETWEEN THE PHYSICIAN AND THE PATIENT. IT IS A PHENOMENON RICH WITH POTENTIAL FOR IMPROVED HEALTH STATUS FOR INDIVIDUALS, FAMILIES, AND COMMUNITIES . THIS IS WEALTH TO BUILD ON THIS IS THE a OF ANY PROGRAM TO PREVENT DISEASE AND TO PROMOTE HEALTH AND GENERAL WELL-BEING. AND, TO BE PERFECTLY HONEST, THERE CAN BE NO BELIEVABLE PROGRAM OF "QUALITY ASSURANCE" WITHOUT AN APPRECIATION OF THE ROLE OF THE PUBLIC. PHYSICIANS » DENTISTS, NURSES, AND OTHER HEALTH PROFESSIONALS SIMPLY CANNOT BRING IT OFF BY THEMSELVES. NOT ANY LONGER. AND THAT IS THE GREAT STRENGTH OF OUR TIMES, THE STRENGTH WITH WHICH WE 4 RENAE OTOL, ~ta- CAN INDEED MEET THE CHALLENGES AND THE NEEDS OF THE 1980s. TT HAS TO BE A SOURCE OF EXHILIRATION TO EACH OF US IN THE HEALTH PROFESSIONS TO KNOW THAT PRIMARY CARE IS NOT ONLY ADMINISTERED. IT IS SOMETIMES SHORED . IN THE YEARS AHEAD, I BELIEVE THAT NOTION WILL BECOME THE NORM IN PRIMARY CARE . DEAL NOW. ..WHAT DO WE NEED MORE OF? I SATO I WOULD TReeT WITH THAT GUESTION, ALSO. I WON'T PUT MONEY AT THE TOP OF THE LIST.FIRST OF ALL, I t DON'T BELIEVE THAT'S WHERE IT BELONGS. AND IN ANY CASE, EVEN I DID BELIEVE IT, THE MONEY JUST ISN'T “oo THERE ANY MORE THE WAY IT WAS IN OUR HEADSTRONG DAYS OF 4 DECADE OR TWO AGO. NO, I WOULD RATHER OFFER THIS LITTLE LIST OF WHAT WE NEED MORE OF...MY OWN LITTLE PERSONAL "WISH LIST" * -13- + MORE BASIC RESEARCH ABOUT LIFE PROCESSES TO FURTHER EXPAND OUR KNOWLEDGE BASE FOR THE FUTURE. THE PRESIDENT'S BUDGET PROPOSALS FOR FISCAL 1983 DO, IN FACT, ASK FOR INCREASES IN OUR RESEARCH FUNDS . * MORE ATTENTION TO THE TRANSFER OF KNOWLEDGE FROM THE LABORATORY TO THE BEDSIDE AND MORE INFORMATION NOT ONLY TO THE PROFESSION BUT TO THE GENERAL PUBLIC ABOUT THE FRUITS OF BASIC AND APPLIED RESEARCH IN HEALTH AND MEDICAL CARE. % MORE CONCENTRATION ON WAYS TO PREVENT DISEASE AND DISABILITY, BRINGING OTHER PROFESSIONS; SUCH AS LAW AND BUILDING DESIGN AND NUTRITION, INTO A PARTNERSHIP WITH MEDICINE AND THE PUBLIC. -i4~- * AND MORE DEEPLY FELT CONCERN ABOLIT THE QUALITY OF CARE AND THE COMMITMENT OF HUMAN SERVICE. THIS IS THE KIND OF THING THAT CANNOT BE BOLIGHTs CANNOT BE ENACTED INTO LAW, CANNOT BE PUT INTO EFFECT BY ANY REGULATION OR ORDINANCE OR DECREE AND CANNOT BE WISHED INTO BEING. IT HAS TO BE GENERATED FROM WITHIN EACH OF US. IT HAS TO BE WORKED AT THROUGHOUT QUR PROFESSIONAL LIVES. IF YOU WERE EXPECTING A VERY ESOTERIC "WISH LIST," I'M SORRY TO DISAPPOINT YOU. BUT THE THINGS THAT REALLY MATTER IN QUALITY PROFESSIONAL HEALTH AND MEDICAL CARE ARE NOT VERY ESOFRIC AT ALL. WE MAY OVERLOOK THEM BECAUSE THEY HAVE BECOME SO FAMILIAR. WE MAY TAKE THEM FOR GRANTED, OR WE MIGHT EVEN CONSIDER THEM SO ACCEPTED AS TO BE BEYOND OISCUSSION,* MUCH LESS BEYOND QUESTION. -15- BUT THIS IS HARDLY THE TIME TQ IGNORE OUR OBVIOUS STRENGTHS. AND THIS AWARDS CEREMONY THIS EVENING I LOOK UPON AS A CLEAR INDICATION THAT WE WILL NOT IGNORE OUR STRENGTHS. RATHER, WE WILL REMAIN AWARE OF THEM AND REWARD THOSE WHO GIVE WITNESS TO THEM. IN THAT SPIRIT I HAVE COME HERE THIS EVENING AND IN THAT SPIRIT I WANT TO WISH EVERYONE HERE A MOST FRUITFUL CAREER IN THE HEALTH PROFESSIONS. THANK YOU.