Past Presidents | ASCRS
Friends and Colleagues,
As I stand before you this morning to present the 114th Presidential Address to the American Society of Colon Rectal Surgery, I find myself both humbled and honored.
I am honored and humbled to be here today, as a representative of the society with which I have identified myself for the past 24 years. The honor of serving as President for the past 13 months has been one that I have taken seriously, because it reflects a trust that each of you have bestowed upon me. In the words of former American Society of Colon and Rectal Surgeons (ASCRS) President Harry Bacon during his 1949 presidential talk, “It is good to lose oneself in contemplation of the past and in reflection upon the achievements of those who have gone before us.” I actually have the distinct pleasure of introducing the Bacon Lecturer tomorrow and am doubly honored in that Harry Bacon was a prime mentor in the 1940's for my father-in-law Dr. Richard Thompson during his surgical training at Temple, and the speaker chosen to give the Bacon Lecture is Dr David Hoyt, one of my mentors. Who would believe that this young lad from Ohio would go on to graduate from medical school at Case Western Reserve University and then to complete surgical training as a young man in California, much less become the executive Director of the American College of Surgeons! But that’s the point…things change.
It has been a busy but very rewarding year, culminated by this meeting, but also highlighted by the Strategic Planning session we held right up the coast in Fort Lauderdale in conjunction with the 25th annual Cleveland Clinic Symposia in February, the results of which are being disseminated broadly this week and which will guide our society over the next 3 to 4 years.
Members of the The American Society of Colon and Rectal Surgeons (Society), friends, and guests, it has been my distinct pleasure and honor to have served as your president for the past year. Shortly after being elected to this distinguished office, my predecessor gladly sent me a notebook that contains all the previous presidential lectures, many of which have been published in Diseases of the Colon & Rectum. One of my goals as a past president will be to convert these talks into a digital format for future presidents.
In reviewing the binder, I learned that during the previous 111 years, there have been 101 presidents, with 6 of them serving 2 terms, an event unlikely to occur again. The presidential talks have run the gamut from scholarly scientific papers, attempts to foretell the future, predictions about the future fate of our specialty, both gloomy and bright, philosophic looks at our predecessors, and exhortations on what we could and should do for our specialty. Only one president did not give a presidential oration and to quote a previous president, J. Byron Gathright, “I won’t be the second.”
What would be a suitable topic for this presentation? I sought advice from my wife Sharon, who wisely advised me to speak slowly, make it interesting, and keep it short. After significant deliberation, I have chosen to speak on Choosing your Goals and how this skill has advanced our specialty and can enhance your professional career.
Goals are defined in Webster’s Dictionary as a boundary or an end that one strives to attain.
Honor is a perception that is bestowed and received. Serving as your president this year has been an honor, which I humbly receive, knowing the stature of the individuals who have preceded me. I thank God daily for safe passage through this year, as I look forward to achieving that most desired status of Past President. I cannot take sole credit for this honor and, in fact, never imagined this to be possible in my youth. I have served with many of you in many areas of our society and it has been through those combined efforts that I have come to serve you as your president. Thank all of you for your friendship and hard work and thank you for this honor.
As I read through the speeches of 100 Past Presidents, I too became aware of the fact that everything that really needs to be said has previously been said. I refer you to this extremely interesting living history of our society which, thanks to Stella Zedalis, will soon be available through a link on our website. The struggle to identify a meaningful topic and a title for this speech has plagued every past president since A. B. Cooke first published his talk in 1910. As you can see from this table, I also struggled, until I settled on the “Impact of Professionalism.” Looking into the past has helped me understand our responsibility for today and given me hope for the future of our society. Our expressed goals will become the future (hopefully) and our actions will be seen as the past in a few short years. One can only hope that our “past” reflects our purity of heart, our soundness of mind, and our selfless pursuit of what is right today. Even though the issues in our 1st century of societal life are different from those in 2010, the methods by which we overcome those hurdles have not changed.
In the book The Black Swan by Nassim Taleb, the author introduces the concept of an ovine miracle that had previously been deemed an unassailable European belief, the existence of a living “black swan.” The living evidence of these Australian phenomena was a concept whose very existence was thought to be not only improbable but also completely impossible, an unknown unknown. This finding caused great excitement within ornithological circles. These fantastic occurrences are very different from the known unknowns, which represent phenomena that occur with a predictable frequency, whose mechanism is understood, and are recognizable and quantifiable. The response is easy to craft and the downstream impact is rarely dramatic and unique. We understand these phenomena: a patient with a fever on postoperative day 5 may have atelectasis, a urinary tract infection, pneumonia, an intra-abdominal abscess, or an anastomotic leak. We can sort these dilemmas out.
To qualify as a true black swan, the event must be dramatic in and of itself. The magnitude of the event, however, is defined not by the occurrence itself but predominantly by the response and sequelae of the phenomena. Although it would be presumptuous to claim clairvoyance in selection of a theme for this talk, my term as president of the American Society of Colon and Rectal Surgeons (ASCRS) has been bracketed by 2 dramatic and unexpected events: the international monetary crisis last Fall and now the potential impact of influenza A(the politically correct term to avoid offending the porcine contingent). As a result, I would like to put this metaphor of the black swan in context for the things I have experienced thus far in my career and what this may mean to our specialty and professional medical association, the ASCRS.
It has truly been a privilege and a wonderful honor to serve as president of the American Society of Colon and Rectal Surgeons this past year. I want to extend my heartfelt gratitude to all of you here in attendance today, and to everyone who supported my presidency year. I am sincerely grateful to our three past presidents on the nominating committee: Dr. Rick Billingham, Dr. David Schoetz, and Dr. Bruce Wolff, as well as to all of you who endorsed my nomination. This is the pinnacle of my career.
I also appreciate the hard work and outstanding effort of the Executive Council in helping me through this year; and the Society’s administrative staff which, for many years, has efficiently organized and maintained our society at such a high level. And I am extremely grateful to my colleagues at Memorial Sloan-Kettering for their enduring support. They are an outstanding group of surgeons, and it is an honor for me to work with them. I would also like to thank my former colleagues from Minnesota who initially trained and mentored me, and set my career on the right path- as opposed to the ‘‘Wong path’’ to which I am accustomed!
Finally, there are two ladies I have relied on most during this past year. Stella Zedalis, Associate Executive Director of our Society, is a remarkable individual: extraordinarily efficient, well-organized, and personable; I know that all of our presidents have relied on her for support. And of course, my dear wife Sola; she has been my guiding light throughout our married life and throughout my entire career. She did a marvelous job of raising our three wonderful children while I worked long hours.
The American Society of Colon and Rectal Surgeons (ASCRS) is an association of individuals who have shared interests, experiences, and traditions since 1899. In the tradition of appreciation, I would like to thank the Society for more than a quarter of a century of personal experiences, led by 26 presidents, who have served as mentors to us all.
In 2007, the ASCRS membership totals 2,674—26 percent of whom are international. Currently, 9 percent are women, and I would like to thank Dr. Ann Lowry, our Immediate-Past President for her support this year. I wish her well as she enters the realm of Past Presidency. I also thank the 12 council members, 37 ASCRS advisors and representatives, 24 committee chairs, 428 committee members, 44 members of the Diseases of the Colon & Rectum editorial board, and our 19-member administrative staff at Executive Administration Inc. (EAI). In addition, I would like to recognize the 19 members serving the American Board of Colon and Rectal Surgery (ABCRS), the President, Dr. Herand Abcarian, the Executive Director, Dr. David Schoetz, as well as the 49 members of the Research Foundation, and the President, Dr. Walter Koltun. Finally, we recognize Dr. David Cherry, President of the Association of Program Directors for Colon and Rectal Surgery, for the 47 colon and rectal residency programs in this country.
In total, we have a 660-member workforce in our specialty, which is the engine that drives us forward. I thank members of the U.S. Armed Forces, in particular those ASCRS members who serve and allow us to live in peace in the United States while we perform our clinical duties.
In a Presidential Address notable for its frankness, outgoing ASCRS President Dr. Ann C. Lowry, Minneapolis, MN, proposed strategies to squarely confront three major challenges:
• Continuing medical education,
• Quality of care, and
• Relationship with industry.
Dr. Lowry introduced a six-point approach to meeting these challenges:
• Acknowledge the problem (even when it's difficult to admit something may be wrong);
• Learn from others;
• Brainstorm possible solutions;
• Prioritize the options;
• Collaborate when appropriate ("You can accomplish more if you do not worry about who gets the credit");
• Do something ("Even if you're on the right track, you'll get run over if you just sit there," said Will Rogers).
It has been a privilege and an honor to work this past year with a superb Executive Council and to be an advocate and caretaker of a most sacred trust, The American Society of Colon and Rectal Surgeons (ASCRS). As many of my predecessors have affirmed in their own cases, I have been able to do this only with the help and understanding of my colleagues at Mayo, my children, and most of all, my wife, Vikki. Please also permit me to acknowledge the influence and example of my father and mother, who started what are now three generations of Mayo-trained surgeons.
For two years, I have been considering what I would say to you at this moment, as the presidential address is the bane of all presidents. Although I am comfortable discussing with you, as colleagues, such things as diverticulitis or Crohn’s disease, where I can hide behind data and clinical experience, this address requires something more for which I am somewhat ill-equipped—the sharing of pertinent philosophic beliefs, global perspective on our sub-specialty, and recommendations for positive action. These inner revelations have been bound in conceptual constipation and have not come easily, and I am exhausted with the effort.
I wish to extend my humble gratitude to the membership for the privilege of having served as your 97th president (5 have served twice); this represents a singular professional and personal honor. Particular thanks to the Executive Council for their sage advice during the year; they, in conjunction with our management team at EAI, have helped steer the organization through exciting and potentially difficult decisions and developments. I cannot omit my partners at the Lahey Clinic, who have allowed and endured my absences to perform Society business. Similarly, I am grateful to my friends and colleagues both inside the specialty and out, who have been more than willing to impart wise counsel and personal opinions regarding all manner of Society and specialty business. Finally, and first, I must thank my family and particularly my “appreciably better half” for encouraging and supporting my professional career over the years; without them, none of this would have been even remotely possible.
When one assumes the presidency, most of the past presidents assure you that your presidential address is the single most daunting task of the year; I agree. As one seeks inspiration for a topic of sufficient importance to be worthy of presentation, it occurs to you that this represents one of the few opportunities in your life (particularly if you have children) to present your personal passion for up to 25 uninterrupted minutes without any argument.
It has been my honor to serve as your President during this past year. The American Society of Colon and Rectal Surgeons celebrates its 104th year with this meeting and is a unique group, numbering more than 2,300 members worldwide. It is a very different group from others with which I have been associated, likely because of the warm and affable personalities of those who have chosen a career in colon and rectal surgery. Newcomers to our meetings are immediately made to feel welcome, and long-term friendships are easily formed. Most of my best friends have been made within the context of this Society, as well as its sister organizations, the American Board of Colon and Rectal Surgery, the Research Foundation of the ASCRS, and the Association of Program Directors in Colon and Rectal Surgery.
A feature that is perhaps unique in our Society is not the number of people whom we know on a first-name basis, but those who are universally known by their first names alone.
Ira (Ira Kodner)
Stanley (Stanley Goldberg)
Johnny (John Mackeigan)
Vic (Victor Fazio)
Byron (Byron Gathright)
Sam (Sam Labow)
Heidi (Heidi Nelson)
Randy (Randy Bailey)
Graham (Graham Newstead)
Yanek (Yanek Chiu)
Sergio (Sergio Larach)
Ann (Ann Lowry)
Stella (Stella Zedalis)
I would like to express my humble and most profound gratitude for the honor of serving this Society as president for the past year. I’ve approached this presidential address with some trepidation. What can I say that will be of interest that hasn’t already been said? I’ve sat through 22 previous presidential addresses, and reviewed several more in preparation for my own talk. I’m sad to say that I had forgotten the pertinent message of many of these speeches, a fact that I am prepared to accept that most of you will accord to mine today. A couple of addresses I distinctly remember because of their length; sitting through these talks I passed through all of the classic stages described by Elisabeth Kubler-Ross—denial, anger, bargaining with God, depression, and finally reluctant acceptance. I hope not to follow in this mold, and I’m going to attempt to finish at about the anger stage, or at least before the stage of depression that seems to characterize so many of today’s surgical meetings.
The title of my talk is “A Picture from Philadelphia,” and the picture I would like to use as a starting reference is the Thomas Eakins’ painting, The Gross Clinic. This work was completed in 1875, in anticipation of the American Centennial Celebration held in Philadelphia the following year.
I wish to thank the Society for the privilege of standing before you today, and for the wisdom to place this presentation before lunch. It gives me reassurance that if the hall should empty during this presentation, it has nothing to do with the quality of the talk, but more to do with the quality of the lunch.
Today, I would like to talk to you about longitude- finding longitude. We are all navigators; we are pilots sailing our own vessels--explorers launched into uncertain realms in uncertain times--at a time when our profession and the value of our professionalism is constantly being questioned. But let us not give up hope. Francis Bacon wrote in the Advancement of Learning: "They are all discoverers that think there is no land, when they can see nothing but sea." During the early 1700s, the age of exploration, navigation was treacherous. Ships went aground frequently, and ships were literally lost at sea as soon as they lost sight of land.
Dava Sobel in her book Longitude tells the stow of navigation, of scientific discovery and independence, of politics and its influence on independent thought, discovery, and the seeking of new worlds. As you know, the latitudes are the parallel lines encircling the globe, fixed, for the most part, by the laws of nature. The longitudes, in contrast, were set by politics as well as by science. The placement of the 0 ° longitude, the Prime Meridian--where east meets west--was purely a political decision.
Twenty-five years ago, when I finished my surgical training and obtained certification by the American Board of Surgery and the American Board of Colon and Rectal Surgery, I felt relief and told myself that my education was finally finished. How wrong I was! I do know surgeons who, although my contemporaries, quite literally "finished" their education after residency, and I can see how dramatically their practice of colon and rectal surgery differs from mine. Thus, I feel it is truly necessary that we continue to broaden our horizons through a lifetime of learning.
The American Board of Medical Specialties has only recently approved significant changes in the way its member boards provide certification and re-certification for physicians. One of the new concepts involves moving from re-certification to maintenance of certification. One of the four basic components of maintenance of certification or continuing competence is "evidence of commitment to lifelong learning and involvement in a periodic self-assessment process." It is ironic that so many years earlier, in 1982, Bert Portin I entitled his presidential address to this society" "self-assessment and self-education." It is also no accident that most institutions of higher learning refer to their graduation exercises not as completions but as "commencements," thus reflecting the beginning of a lifetime of learning.
The need for lifelong learning is particularly evident in medicine. During the past 25 years the changes in colon and rectal surgery have been quite dramatic. I will mention but a few of the innovations that I have had to adopt to stay current in the practice of our specialty.
I am honored to have been your president for the past year. I now go back to being what I like best, a colon and rectal surgeon. As colon and rectal surgeons, we enjoy being able to diagnose and treat the many diseases and disorders that our patients experience. Even better, we are proud that we can successfully treat most patients. However, we owe a debt of gratitude to our predecessors, the colon and rectal surgeons who have guided this society during the past century.
As you know, we meet in a very special year, the 100th anniversary of The American Society of Colon and Rectal Surgeons. During this century more improvements in health care have been made than in all recorded time. It has been marvelous to be a physician in the 20th century. My message today is to point out where The American Society of Colon and Rectal Surgeons has been in the 20th century, point out where we are regarding colorectal cancer screening at the end of the century, and make a strong recommendation about how we must tread boldly into the new millennium.
THE PAST CENTURY
Less than two centuries ago, one of my heroes, Thomas Jefferson, occupied the White House, just down the street. His foresight lead to the Louisiana Purchase, the New Frontier.
At a recent meeting of one of our most prestigious surgical societies, the presidential address was delivered by a prominent surgeon and directed toward young surgeons who might be interested in becoming academic surgical scientists. During the speech, he explained to the audience the importance of focusing on the advancement of the individual academic career, without allowing such intrusions as administrative responsibility, teaching, intense clinical load, and even time spent with community and family. He cited an article by Carl Dragstedt, the brother of renowned surgeon, Lester Dragstedt, written in 1964. The article entitled "Who Killed Cock Robin?" was a parody on the famous children's rhyme dealing with the ultimate death of Cock Robin for which no one would take the blame. The article by Dragstedt was interpreted as illustrating the failure of a young scientist who made a potentially important discovery in the laboratory, but never progressed to acquire his fame as a scientist because his early work was recognized, and his fame quickly diverted him to community, family, humanitarian, and educational issues. The point of the article is that no one who lured him into all of these activities took blame for his demise; but in fact, he was looked on as a failure for never developing his initial potential.
The question I ask today is "Was he a failure?" I believe it is a flaw to counsel a young surgeon to look only at the benefit to his or her own personal career and accomplishment.