September 30, 2021

What Makes Us Physicians

Dr. Mika Sinanan celebrates the art of medicine in his inaugural address as WSMA president on Saturday, Sept. 25, 2021.

It is a pleasure and honor to address you as your president. I fully acknowledge that you and the WSMA membership at large have taken on a bit of risk, putting a surgeon again in this role that has been discharged with so much skill and grace by my immediate predecessors, Nathan Schlicher, Bill Hirota, Tom Schaaf, and Donna Smith. I did note while working with them that they all have something of a "surgical" demeanor, and I mean this in the kindest possible way. Alas, they do hail from different, nonsurgical specialties. That said, the WSMA has had surgeons serve previously as president with distinction. I recall introducing Nick Rajacich, a pediatric orthopedic surgeon from Tacoma, to present to the UW Physicians board of trustees, serving as a great advocate for our organization. These are all very big footprints to fill … I hope to justify the risk you've all taken.

A little about me: I was born in Finland and grew up in the West Indies, the US, and Vancouver, BC. My father was an ear, nose, and throat surgeon; my mother a former nurse and homemaker, and a great cook! I completed medical school at Johns Hopkins in Baltimore, and my general surgical residency at the University of Washington. I completed a PhD in physiology at the University of British Columbia and have spent the last 33 years on faculty at the UW with a practice focused on gastrointestinal and complex abdominal surgical disorders. My research interests have been in the areas of surgical robotics and simulation training, and the objective measurement of surgical performance, working with the WISH Surgical Simulation Division and engineers in the biorobotics lab at the UW Department of Electrical Engineering.

I am grateful for a wonderful set of clinical and research partners at the University of Washington, as well as an inspiring and dedicated cadre of residents in our department who I am helping to train to take great care of me-and you-and our community, when we need it! After all, everyone should have at least one major operation in their lifetime! All of this is built on the foundation of an incredibly supportive family: two sons, Josh and Reilly, who are carving their own paths outside of health care, three great Brittany spaniels, and my wonderfully supportive and patient spouse of 41 years, Jenny. I have also been blessed with great mentors through my career. It is only by standing on their shoulders that I am before you today.

The duties of the president are outlined in the WSMA bylaws: to preside at all general meetings of the association, to serve as a member of the executive committee, chair the board of trustees, and ex officio on all other WSMA committees except the nominating committee and judicial council. Most importantly, the president serves as the spokesperson for our profession to our state and to all component county societies. That means I serve you all, and I ask and expect you to call on me for help and support in any way that I and our great executive team can be of assistance.

I want you to know that I have been preparing for this role. I've instructed my family that calling me "Mr. President" around the house is not necessary, at least not more than a half dozen times a day. The welts on my head and back that followed this suggestion are a testament to their measured response, but also probably the best preparation for the coming year. Clearly the titles of "Excellency" or "Chosen One," as Nathan and Bill were rumored to have tried out at home, won't be sustainable.

In all seriousness, we all-all of the nearly 12,000 physician and physician assistant members of the WSMA, representing over half of the practicing physicians in Washington state-are challenged as we "live in interesting times." This saying is thought to be a loose translation of the Chinese proverb: "Better to be a dog in times of tranquility than a human in times of chaos." I'm not sure that my dogs would agree! But our times do seem chaotic with challenges that assail us all as we strive to meet our WSMA mission: to "Provide strong physician leadership and advocacy to shape the future of medicine. To advance quality care for all Washingtonians."

Access to safe, effective, available, and affordable health care remains out of reach for too many in our community. We have not yet developed the tools to effectively address those social determinants of health that drive, to such a high degree, the health and health care needs of our patients. We face great disparities in income AND structural inequity across races and ethnicities in our communities and even within our own health care workforce. As Walter Cronkite, the journalist, noted, our health care system is too often not "healthy, caring, nor a system," fragmented and sometimes incomprehensibly complex.

Coming into yet another wave of the COVID epidemic we face capacity and safety challenges with a stressed and stretched workforce who are, themselves, at risk of the illness that we are treating. Dr. Schlicher eloquently reviewed this in his presidential address last year. The ravages of climate change evident through reports of drought, previously "100 year" weather events that are now annual, heatwaves, and wildfires-are all a constant reminder of an even more complex future. New climate-related illnesses, population shifts due to rising sea water levels, and changes in the food supply will undoubtedly have a profound effect on our society, health care needs, and our resources to deliver that care.

Any one of these topics could be a focus of an entire talk. Fortunately, they are well represented in the WSMA strategic plan and have been the subject of careful review by our board of trustees and select WSMA committees. They also undergird many of the resolutions brought forward for consideration through the House of Delegates as well as in our advocacy and regulatory agendas. We have much more work to do, but we should pause briefly and reflect on this past, enormously successful year.

Our WSMA leadership team-led by CEO Jennifer Hanscom-has worked tirelessly to retain and expand our membership and maintain strong relationships with both smaller practice groups and larger organizations, all while holding the line on expenses. The thoughtful, constructive governance changes proposed by our Executive Committee and board of trustees-if approved by the House-will certainly make the WSMA more nimble, representative, and stronger. [See update at bottom.] And just as we achieved our own clinical pivot to telemedicine, the WSMA made a graceful move to virtual meetings and training without missing a step.

The 2021 legislative session focused on the COVID pandemic. Despite a virtual format, the WSMA brought forward an ambitious agenda and achieved a 100% success rate in passing our priority bills and funding requests, truly remarkable work by Sean Graham, Jeb Shepard, and the entire advocacy team with help from many of you!

• We secured the first Medicaid reimbursement rate increase in memory, $140 million more for primary care, behavioral health, and pediatric services.
• Foundational Public Health Services were funded at $147 million over the next two years with a promise for twice that amount in the next biennial budget.
• Audio-only telemedicine is now a covered service, supporting our ability to reach rural, lower income, and older patients.
• Liability protections for care delivered or delayed due to COVID were instituted.
• Health equity CME for all state health care professionals, based on recent House of Delegates resolutions, will be starting in 2024.
• We also avoided any new taxes targeted at physicians or inappropriate expansion of scope of practice, holding a safe line on expanded prescriptive authority for naturopathic physicians and parity in reimbursement for ARNPs while embracing modernization of practice agreements for our PA partners.

As I have pointed out, our profession and our society are being forced to adapt to a rapidly changing environment. In the next legislative session, I urge you to help us maintain this tremendous momentum. Topline issues include:

• Improved Medicaid funding for ALL physician specialty services.
• Support and replenishment of our COVID-ravaged workforce guided by principles of inclusion and diversity that, with physician leadership, will deliver a more robust delivery system and better patient experience.
• Promoting development of public health infrastructure and the efficacy of vaccines.
• Starting to meaningfully address the social determinants of health: income inequity, pollution, racism, and poor access to nutritious foods, these and other structural issues that determine overall health and chronic illness.
• Supporting our community response to climate change.

We should all be proud of our present success while looking forward to next year's priorities. But I believe that preserving a historical perspective is also important in guiding our path to the future.

The roots of the WSMA run deep and long in our state. In the historical compilation "Saddlebags to Scanners," which documented the first 100 years of medicine in Washington state, providing for the health of our community was a key consideration when the state of Washington was first established. The WSMA was formed in some of the first articles of state incorporation. The Washington Territorial Medical Society was founded in 1874, and renamed the Washington State Medical Association in 1894, to "represent the interest of physicians in matters of public policy and professional practice." Indeed, WSMA had a key role in developing some of the first capitated health model plans in the US and helping establish the UW School of Medicine in 1945. We, the WSMA, have been woven into the fabric of our community from its early days. We should be proud of our accomplishments and poised to build on them!

In the past year, we have quite appropriately focused on the science, on public health measures, on team practice, on deploying electronic tools in support of coordinated care and excellent communication. It was clearly the right approach, but as we continue pursuing the science, we must not lose sight of those essential attributes of our art that brought so many of us into medicine.

I would like to close with my own very personal observation and request to us all. Donna Smith, in her presidential address to the WSMA, noted, "We cannot lose sight of the why, why we came to medicine, why we remain, why we are effective as we touch lives around us."

I, like so many of you, find my inspiration in the wisdom, courage, and calm endurance of our patients. Every patient I take to the operating room is putting their faith in me and my team while they surrender their autonomy under anesthesia. That is a sacred trust. It is a simple thing, but I acknowledge this trust by holding the hand of each patient as they're going under anesthesia and then being present when they wake up so that they know that I was there with them from beginning to end as I had promised. Many of my patients have mentioned that this simple gesture was memorable and comforting at a time of fear and uncertainty.

Today, we continue to use the tools, data, and technology of public health in pursuit of the best health for all. But that is only part of the solution. William Osler, in his 1904 collection of addresses, "Aequanimitas," described the critical ability to listen and hear the experience and suffering of the soul before us, that these human skills are essential to good diagnosis but also to healing. President Theodore Roosevelt observed, "No one cares what you know until they know you care." Our knowledge and training equip us for the technical aspects of our profession. However, it is our caring and compassion, our ability to touch with empathy and skill that sustains a common bond of humanity with our patients, that makes us physicians-and pretty good surgeons-instead of technicians, and that sustains all of us in the WSMA as a community. I relish the challenges before us-so much opportunity!-and look forward to working in the coming year with you all as your president.

Thank you.

In a postscript to my speech on Sunday, your leadership's attempt to bring more voices into our policymaking and to create a more diverse and inclusive organization - whether based on race, geography, or practice setting - had strong support but did not quite make the 2/3 threshold to pass the House of Delegates. However, this is just one of many steps we are taking on this important topic. Please stay tuned!