Past Presidents

Past Presidents | ASCRS

1999 to 2000

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.

1998 to 1999

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.

1997 to 1998

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.

1996 to 1997

Do more, do it better, do it with less, and do it for less. Is this Mission Impossible? How should we respond to this new mission?

Today, I want to talk with you, physician to physician and friend to friend, about the stressful changes we all have experienced in recent years and suggest ways to RESPOND to our current medical environment.

• Reality Check
• Emotional Check
• Self-Assessment
• Patients, Partners, Professionalism
• Open Mind
• Negotiate
• Daily Delights

1995 to 1996

To have been accorded the privilege of serving as your President for this past year has been a singular honor. My deep gratitude goes out to all who made that possible... my colleagues, my friends, and especially my family. Because this is, by tradition, a time when the speaker has a lot of latitude with his allotted time, I will take the time to single out a few colleagues and mentors for special mention. To my fellow Council members I give thanks for their advice and support during a year of change that has seen many events unfold. One of these, an historic event, will lead to a unification of The American Society of Colon and Rectal Surgeons and the Research Foundation to which I will refer later. My thanks are due to my mentors and fellow Australians Mark Killingback and Neville Davis for the encouragement they gave in my early years, especially for their acting as role models for me and so many other surgeons. Thanks also are due to my teacher, the late Rupert Turnbull, who taught--rather, who revealed--the added dimension to which advanced colorectal surgery could be taken. To my other late mentor, Noel Newton, the best surgeon I have ever seen, I acknowledge not just his guidance, but also his unflagging commitment to teaching the art and craft of surgery during a quarter century to anyone and everyone who wanted to attend his Sunday morning teaching rounds. It was he who steered me to Dr. E. S. R. Hughes, who in turn fired my enthusiasm to seek specialized training in colon and rectal surgery. More than any others, these men have that marvelous ability to instill enthusiasm in their students.

1994 to 1995

This annual meeting of the Society, the 94th in our esteemed history, is the first to be held under the Presidency of a Canadian. By coincidence, our meeting is being held in my own town, so I would like to extend to you a warm welcome to Montreal. (Bienvenu a Montreal. J'espere et reste d'ailleurs persuade que votre sejour a Montreal vous sera benefique tant de point de vue scientifique que sociale). Our Chamber of Commerce proclaims Montreal to be the largest French-speaking city in the world, next to Paris, It is also 1,000 miles from the mouth of the St. Lawrence River, making us the world's most inland seaport.


What the Chamber of Commerce does not tell prospective visitors from the South is that when the British fought to claim the territory, King Louis of France shrugged off his loss by saying it was not worth his while to fight over a few million acres of snow and ice. We Canadians are still trying to live down the image of a glacial domain, which generates the Arctic blasts that from time to time invade the temperate climate normally enjoyed by the citizens of the United States. I hope that your presence here in the month of May will help dispel the still lingering notion that we are permanently ice and snow bound and that prompts the occasional visitor to arrive here on a hot summer day with skis atop his four-wheel drive recreational vehicle. And, may I add my wish that the warmth of our welcome with which you have been received will further cement the bonds that exist between our countries.

1993 to 1994

I would like to thank the Society and its members for the privilege of addressing you. For me, giving the presidential address is probably the most difficult task of this year. For inspiration, I reviewed the presidential addresses of recent years. After this review, I realized that the great issues pertaining to our Society have already been presented in a most eloquent manner. In fact, there is truly nothing presidential left to be said at this time. However, I also realized that I was completely unwilling to allow you an extra 15 minutes for lunch break. Therefore, I decided that, instead of giving you a presidential address, I would give us all a pep talk. If any of you would question the need for a pep talk, I would suggest that you spend a day or two visiting the surgical lounge of your local hospital. The detailed descriptions of the missed three-foot putt for the club championship, the Monday morning commentary on every football, basketball, or baseball game, the debate of the relative merits of a BMW vs. a Mercedes have all been replaced by endless discussions of the problems affecting physicians in general and more specifically surgeons. What has brought about this change? The reasons are many. We have a federal government that tells us that surgeons have little cognitive function in patient care and that our surgical skills are grossly overvalued. We have third-party payers who tell us on whom, when, and where we can operate and then demand to know why the patient was not discharged immediately after surgery.

1992 to 1993

Twenty-three years ago, Dr. James Ferguson stood where I stand now and spoke to you as your president. He had a message for us when we called ourselves the American Proctologic Society. I was a part of the audience then, young, and full of ambition. I listened carefully; I was proud of our President, "my boss," and I was proud to be a "proctologist." In 1973 we had a name change; we became the "American Society of Colon and Rectal Surgeons." I felt a sense of increasing pride then as I do now. Today, I stand here as your president, a dream come true; proud to be here and very thankful to you and to many others for this, all of this. I am especially grateful and hopeful that this will be my chance, my opportunity, to bring you a message and to ask for your help. I will ask you to do something for me and for your society, and ultimately for yourself. I will not speak for long, I will tell you a few stories, give you some examples, tweak your imagination a little, and maybe, just maybe, make you feel a little bit guilty.


Please regard the title of this address carefully, and take it very seriously, because this is my message and my heartfelt wish that "together we will do it."


The obvious first question one might ask is "how?" Let me tell you about a man I knew as a child. I was four or five years old. His shop was next to my father's store; we were separated by an empty lot through which a little stream ran. In the mornings I would sit on our back porch watching for the smoke from his chimney. As soon as I would see it I would go running across the lot, jump the stream, and invariably soil my pajama bottoms in the mud. I spent most of the first hour of the day marveling at Mr. Walker.

1991 to 1992

In 1967, John Forsythe wrote a book about Bill Bradley. The title of this book was "A Sense of Where You Are" and its thesis was that Bill Bradley was an outstanding basketball player, in large part, because of his ability on the basketball court to know where he was. Supposedly his peripheral vision exceeded that of most people and he had an uncanny sense to know where he was and where other players were on the court. This phrase has always stuck in my mind and it has always seemed an important concept to me to know where you are. It is impractical to think that you have an outstanding sub-specialty practice in a rural farm community. Similarly, the ability to do research on a disease process which you rarely see in your practice is unrealistic. If one is interested in having a fulfilling life and achieving the goals which help one to realize that fulfillment, then it is important to recognize the implications of where we are and how we will get to the point where we want to be.


Well, where are we? Specifically, you are in lovely city today, enjoying what I hope will be an outstanding meeting. The Hilton Hotel venue is outstanding and provides each of us the opportunity for a stimulating intellectual environment, as well as an opportunity for camaraderie and fellowship, which has become so meaningful to those of us in this sub-specialty. More specifically, we are involved in the game of medicine on a team called colon and rectal surgery.

1990 to 1991

To serve as President of the American Society of Colon and Rectal Surgeons has been a great challenge, an honor that exceeds any other in my career, and a privilege that will be remembered forever. I appreciate your trust, and I'll cherish the memories.


I decided to give this talk with this title two years ago, after listening to Herand Abcarian's address at the Toronto meeting.


Dr. Abcarian discussed the issue of giving something back for all that we take. He referred to Gene Salvati's principle that we each have a "G.O.H.," or goodness of heart, column in our books and our thoughts. Individually, to greater or lesser degrees, this is done by all of you here, in your clinic coverage, your free or discounted care, in the extra time you put forth for patient and family education, in donations, and in many other ways. Much of this comes from time you might take more comfortably with your spouse or your children or your friends. The satisfaction of charitable or benevolent care is rewarding; you can be proud of that.


Does the ASCRS have a goodness of heart column? I didn't see one on the Council's list of work. I haven't heard one discussed.


I will describe for you briefly the current overall agenda of this Society, professionalism and what true professionalism for this Society might imply, and, lastly, how we might get there.

This Society has five major agenda items, which have been present since the first meeting in 1899 in Columbus, Ohio. They have been greatly expanded and will continue to grow.

1989 to 1990

St. Mark said "for you have the poor with you always." Alas, for you poor people today, the Presidential Address appears equally as permanent a fixture. In this, the 91st year of our organization, it appears that only one man has spared his audience. I shall not be the second.


Presidential addresses have run the gamut from scholarly scientific papers, attempts to foretell the future, predictions about the fate of our specialty, both gloomy and bright, exhortations as to what we could and should do for the specialty, philosophic looks at the past and our debt to our predecessors, to last year's eloquent plea for unity around the globe for those practicing our discipline. These addresses were sources of inspiration and consternation for me. What would hold the interest of this diverse group? Perhaps a summation of the current status of the one central interest that binds all of us together. The specialty of colon and rectal surgery.


Vital signs: vital from the latin wita alis, of life. Defined as existing as a manifestation of life. Thus, the signs of life. I should like, as a good chief resident might, to recite for you, the vital signs of the specialty of colon and rectal surgery.

1988 to 1989

The opportunity of serving The American Society of Colon and Rectal Surgeons as its President is a unique and singular privilege. I am grateful to have had this opportunity and I consider this the pinnacle of my professional career.


Most of you who know me well also know that I am rarely at a loss for words, but I must admit that I found preparing and delivering a Presidential Address to this body a most intimidating task. After all, having heard the last 18 such addresses and having read the text of many recent ones in the last few weeks leaves one with a strong feeling of not only what is there left to say, but also how can one even come close to the eloquence of the giants who seemingly have said it all before. Moreover, I had to look hard to see whether there is any good news to bring to the Society, as I was reluctant to be the prophet of doom and gloom.


Having had a year to reflect on these matters, I thought I would share with you today my beliefs of the specialty of Colon and Rectal Surgery, what it does for each one of us individually, what we can do for it collectively, and where the future of the specialty lies in relationship to other disciplines in medicine.


To many, if not all, it is abundantly obvious that the golden era of the practice of medicine is behind us. We have, to a great extent, been burdened with governmental bureaucracy, an increasingly difficult medico-legal climate, and dwindling public confidence. Some days it is hard to figure out whether we are the good guys or the ones wearing the black hats in the old cowboy movies.

1987 to 1988

Over the past several years we have seen more gloom for the practice of medicine than ever before. Things seem to be going completely to pot. Malpractice litigation is rampant, the government is trying to regulate how we practice, our fees are being challenged, we "don't get no respect" from the public. The media, legal profession, and even Uncle Sam are all hostile toward us, we are competing more and more for patients, even by advertising (which used to be unethical), and more of us are retiring younger than ever before.


In view of all this, it seemed to me that it might be interesting to pull out the old crystal ball and predict what the future has in store for us. Because it is the old crystal ball that is doing the reflective speaking, no one can blame me if it is wrong or controversial, but at least it will give us something to think about. Will it be good? Will be be bad? Let's see!


It has been reported that there is a reduction in the quality of medical school applicants as compared with the past. Is that bad? Is a 4.0 average an indication of the ability of the student, once he graduates, to evaluate a patient by combining cognitive knowledge with the skill and intuitive sense required to make a good judgment? Of course not! Most of the doctors in my age category would never have been accepted by medical schools today (many of us had only B+ averages in college), yet medicine has not suffered as a result. And it will not suffer in the future! We will see an entirely new breed of physician in the future, one with less concern for monetary gain and with more compassion and regard for the total welfare of the patient than ever before, I think we will like the new breed, maybe because it will remind us of the old breed.

1986 to 1987

As the American Society of Colon and Rectal Surgeons enters its 87th year of service of our profession, I am proud to have been the 81st person to serve as your President. Indeed, I have had the unique opportunity to serve our specialty as a member of our specialty board or as an officer of this Society for more than half of my professional life. For this, I shall always be grateful, and I offer each of you my sincere thanks.


My predecessor advised me to prepare this address during the early days of my presidential year. I immediately began preparing a presidential address that I believed would have just the right blend of the historical and the philosophic. As events began to unfold, however, I realized that it was time to turn attention to the practical side of our Society's affairs, time to discuss some of the problems that we, as a Society, must face, and some of the problems over which we, together, have control. Thus, I called this presidential address, "But There is a Practical Side." When I told Harriette Gibson my title, her response was swift! She said, "How do you want me to spell but--with one T or two?"


I do not have the solutions to the vast number of complex problems confronting the medical profession today. Suffice it to say that ever-increasing manhours and money will be required of this membership just to keep informed and to try to prevent from being swept away by the political and economic tides now controlling the ebb and flow of our professional lives.

1985 to 1986

In preparing for this presidential address of the 87th year of our Society I read every prior address that was available for the past twenty-five years and this in itself was an interesting exercise. It was fascinating to see how our Society has grown and matured. So many men much wiser and erudite than I, had preceded me. All of the golden words of wisdom seem to have been spoken. What was left for me to say? What could I possibly add that would be of interest? All of the past Presidents had very ably covered the progress of our Society and specialty, historically. All of the great men had been properly credited. Twenty-five years from now, would some future President read my address and what would he think of it? These thoughts kept going through my mind as I searched for some common theme that I might dwell on; something that perhaps would stimulate and not bore. I realized that I must not attach too much importance to my words since it was highly unlikely that they would be remembered as most words are written in the sands of time, disappearing quickly with the vagaries of the wind.


The more I thought about it, the more I realized that I had lived my professional life through the developmental years of our specialty. From 1899, when the American Proctologic Society was established in this country with Joseph Matthews as its first President to the mid 1950's our specialty, and that is synonymous with our Society, remained small and
rather obscure. Our interest was primarily proctologic.

1984 to 1985

Welcome to the 84th Annual Meeting of the American Society of Colon and Rectal Surgeons. I am honored, indeed, that you have permitted me to serve as your president during the past year. This marks my 28th meeting as a member, but the first time I remember attending was in 1933 in Chicago. I got a strong early impression that this was a very special organization, possibly because there was an international exposition: a magnificant World's Fair in Chicago that year. I must confess that the meeting and the grandeur of the Fair were completely interwoven in an 8-year-old's memory.


I still feel that this is a very special organization even today, and I must confess that the past year has increased my admiration for it and the wise leaders who founded, forged, guided and established the Society and the specialty of Colon and Rectal Surgery. As physicians and specialists in 1985, we can only benefit from their efforts because what they built for us is sound and solid. Because of this, I am certain that we can survive the turmoil of change that now threatens to engulf the profession of medicine.


In June of 1899, 15 proctologists met at the Chittenden Hotel in Columbus, Ohio, and founded the American Proctologic Society. The only purpose of their meeting was the dissemination of specialized knowledge; 13 of the 15 presented scientific papers. The rest is history. From this modest beginning, there has evolved a specialty organization that has produced an annual meeting with over 1300 registrants; a world-class journal, Diseases of the Colon & Rectum, and 27 approved residency training programs, producing 50 graduates each year. It is only after passing the Qualifying Examination of the American Board of Surgery that these candidates become eligible to sit for the examination oi the American Board of Colon and Rectal Surgery.

1983 to 1984

In the year 1949, George Orwell wrote a book entitled 1984. His book predicted how life would be 35 years later. Nineteen eighty-four is here and, if we look back over 35 years of colon and rectal surgery, we can see how far we have come. A review of the past, stimulated by Orwell's predictions, compels us also to forecast the future and to predict what the next 35 years will hold. Where will the specialty of colon and rectal surgery be in the year 2019 and what will make it strong?


Before we attempt predictions of the future, let us look first at some of the key factors in the progress of colon and rectal surgery during the last 35 years. AI though Orwell's predictions for the years spanning 1949 to 1984 were ones of gloom, those years contained many positive developments for colon and rectal surgery.


In 1949, the year Orwell wrote his book, the first examination by the American Board of Proctology was given. Twenty-two applicants were certified; these applicants had been trained in a variety of situations. There were only eight residencies. The majority received their training in an approved preceptorship. In contrast, today there are 27 approved training programs producing 50 candidates per year who are eligible to write the examination of the American Board of Colon and Rectal Surgery. All of these candidates have passed the qualifying examination of the American Board of Surgery.

1982 to 1983

For me, the greatest award from my close involvement with this Society has been the opportunity to associate with leaders in colon and rectal surgery; men and women of vision, dedication, and action, who have been, and are, a source of challenge, insight, and inspiration. Under their influence I presume, this morning, to suggest a goal for the future of our specialty. First, I wish to review some aspects of our past, with particular attention to the relationship with the academic community.


When this Society was founded at the beginning of this century, surgical training in this country was unstandardized, frequently self-taught, obtained through visiting a clinical center here or abroad, or by attending a series of lectures. With good fortune, one might be a preceptee to one of the eminent practitioners of the time. In our specialty, a tour to St. Mark's Hospital in London, soon to be celebrating its 150th anniversary, was the way chosen by Joseph Matthews, first president of this Society, and many of his, and our, colleagues who followed.


Formalized training of surgeons by the residency system in the United States, set forth by William Halstead in 1904 and shown effective at the Johns Hopkins Hospital, was gradually adopted by private and academic surgical training centers, and standardized, initially by the American Medical Association, and later joined by other interested accrediting agencies. Thus, Halstead's vision shaped the form of the residency system and has become the general pattern of training for most medical specialties.

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