The "why" of what we do

On Sunday, Oct. 15 at the 2017 Annual Meeting of the WSMA House of Delegates, we inaugurated our new president, Donna Smith, MD. For those of you who couldn't be with us, we wanted to be sure you had an opportunity to read her speech, printed here in full.

Thanks to all of you for being here—taking time out from your practices, your families and your weekend. More than that, thank you for your dedication, your passion and your heart for your work. It matters. Take a moment to remind yourself of the words of William James, philosopher and psychologist: “Act as if what you do makes a difference. It does.”

In preparing for this talk, the stories of two people inspired me: one who left us too soon, just two years ago, and another born nearly 100 years ago, who lived a long and full life, well into his 90s.

The first is Dr. Paul Kalanithi, subject of yesterday's keynote, whose legacy is destined to be one of shaping patient care and our end-of-life work for years to come.

The other is Dr. Avedis Donabedian, whose work in the mid-20th century laid the foundation for a health care quality framework that still shapes our work today, many decades later.

The parallels between these two people, born nearly 60 years apart, are stunning.

Both were born to immigrant parents: Kalanithi, an Indian-American born in New York; Donabedian born in Lebanon to Armenian parents who escaped the genocide of the early 20th century. Both were born into, and inspired by, their physician families. At the end of their lives, both experienced the “disorienting” identity transition into a patient’s world, where they experienced first-hand, as Paul wrote, “the hells we put patients through as physicians.”

And both remind us, through their lives and their writing, of the mission of medicine: the “why” of what we do. Think back for a second. Remember when you first realized you wanted to go into medicine. What was your “why”? Was it the call of helping others? The intellectual challenge, a fascination with human physiology? Perhaps it was the variety or technical challenge of the work you would do.

For me, I remember thinking in high school:

  • Doing something that would meaningfully contribute to the lives of others, the greater good, something bigger than myself.
  • I highly value my health and wanted to contribute to something other people highly value rather than selling something that people really did not need and would likely throw away.
  • Intellectual challenge, continuous learning—a role where endless curiosity is a good thing!

Whatever your why, you knew it would require years of study and hard work, incredibly long hours, a hefty financial burden, life-and-death responsibilities, and the emotional strain of tending to the sick and suffering. When you signed up for the profession of medicine, you accepted those challenges that you were aware of and you took a leap of faith that your experience would live up to your ideals, that it would be worth it and that the rewards would outweigh the trials.

Perhaps along the way, the intense daily grind has diminished those idealistic, hopeful, early visions. Perhaps not. No matter how long you have been in practice—whether you’re in the 50-Year-Club like colleagues honored yesterday, or whether you’re in the early stages of your career —it’s likely that much of your time and energy today is not spent as you thought it would be years ago, when you first thought, “I want to practice medicine.”

And I’m sure you weren’t thinking about an alphabet soup of administrative burdens—MACRA…MIPS…ACO…ACA…EHR and the not-so friendly companions of prior authorizations, productivity pressures, increasing regulation, constantly shifting reform, shrinking reimbursements…to name a few.

These are the things that can steal your time, energy and potentially distract you from your “why.” I want to encourage you today, and many times every day, to intentionally remember, to deliberately think about what called you to our work of medicine.

In his 2015 inaugural speech as AMA president, emergency physician Steve Stack spoke to this when he told the story of a patient whose life he saved and who later thanked him—he said, “…that life-changing moment, that defining moment when what’s truly important suddenly draws into focus … the birth of a child, the loss of a loved one, an unexpected diagnosis—the physician’s life is defined not by one, but by hundreds, of these moments. Our profession is literally built around them. To play a part in these moments is a priceless gift. …these are the moments that sustain us.”

We need that sustenance, especially as we face inevitable change that surrounds us. Much has changed in the time I’ve been practicing medicine. From my early days as an independent physician in a small private practice with three trusted colleagues, to today, as a leader in a large organization, I’ve witnessed many advances:

  • Progress with disease diagnosis, treatment and survival rates for illnesses like AMI, asthma, immune diseases, cancer, HIV—meaning we can save more lives.
  • Team approaches to patient care not only yielding improved outcomes, but also more cohesive teams supporting patients, families and those providing care.
  • Innovations borrowed from other industries and emerging technologies supporting the health of our patients.
  • Increasing recognition and understanding of social determinants of health contributing to better patient care.
  • Patient-focused care putting patients back at the center of our “why,” and bringing us back to the importance of caring and compassion.
  • Work aligned around the Quadruple Aim—quality, patient experience, lower costs and clinician experience—yielding healthier doctors and healthier patients.

These have clearly been positive changes.

At the same time, we are currently navigating an unprecedented amount of chaos in our profession. I don’t have to tell you that these are unsettling times! Partisan rigidity—the new normal of health care reform—isn’t helping us see a clear path.

While the debates rage on, our guiding principle is clear: patients first. Period.

We’re here for our patients and their communities. Let’s not forget the long-ago counsel of Dr. Harvey Cushing: “A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world.” Keeping the patient’s life context and their greater community in mind will contribute to our efforts for patients—today and tomorrow—just as it did for him.

We’re here for each other. You’ve heard the old adage, "If you want to go fast, go alone; if you want to go far, go together." Let’s go together! Working together we can amplify what we value for patients; what aligns with our values and purpose and unites our voices. We can speak with one voice to really impact health and health care for all Washingtonians. The physician perspective is powerfully unique, and is grounded in what is best for patients. It’s more important than ever that our voice is heard clearly and that we are influencing the direction of health care and health care decisions.

And yet, despite the changes, challenges and chaos, the silver lining is that “threats” force clarity around what really matters. Threats focus us on core values, making the way forward crystal clear.

It’s not hard to know what that path ought to be: We keep the health of patients at the forefront. We make sure the needs of the people providing care are understood and met. We use our collective power for collective action. And that’s why, the WSMA, your WSMA, provides a glimmer of hope and optimism, a guiding light in our confusing times.

Our new three-year strategic plan reflects that clarity. In short:

  • We will strive to ensure that all Washingtonians have access to medical care and can see a doctor when they need one.
  • We will engage in our community by advocating for strong patient- and physician-focused legislative, regulatory and legal action to drive toward our vision of Washington state being the best place to practice medicine and receive care.
  • We will protect the profession by raising up the unified voice of Washington medicine.
  • We will equip you—our members—with resources and leadership development opportunities that strengthen you as trusted, patient-focused leaders.

The WSMA is a collaborative force. Look around—see who is gathered here, who’s sitting next to you. The WSMA brings people and like-minded organizations together, creates the opportunity for collaboration and amplifies our voice. This is critical right now—that we understand and influence how changes will impact our patients and how those changes will impact those of us providing that care.

We are striving to empower people and remove barriers to doing the right thing for patients. The WSMA works tirelessly so that we, you, can do your best work as a physician.

We know change is inevitable, chaos will continue and challenges will come. When they do, let’s remember the hundreds of moments when we delivered a baby, prevented a disease, made an amazing discovery or diagnosis, guided a patient to full recovery, taught an eager student, collaborated with other caregivers to save a life, or even supported a patient with their end-of-life wishes.

And let’s remember that together we are living our personal mission, that we can be fueled by our “why.” Let’s listen to Dr. Donabedian: “Health care is a sacred mission…a moral enterprise and a scientific enterprise but not fundamentally a commercial one. We are not selling a product. We don’t have a consumer who understands everything and makes rational choices—and I include myself here. Doctors and nurses are stewards of something precious…ultimately, the secret of quality is love. You have to love your patient, you have to love your profession…If you have love, you can then work backward to monitor and improve the system.”

Passion and purpose are force multipliers. Together with each other and our patients, we are more effective in improving the health and care for all Washingtonians.

I’d like to leave you with this story told in Stanford University’s obituary about Paul Kalanithi. A friend and colleague of his recounted this story: “We walked out of the operating room corridor together, toward the intensive care unit and I was complaining of being tired and worn out—and [Paul] looked at me and said, in his very satirical voice, ‘You know I have lung cancer, right?’ I looked at him with great surprise, as if such things shouldn’t be said out loud, and I’ll never forget what he said to me next. ‘Don’t forget what you do, and who you do it for. These are people who you can help, and you shouldn’t forget that.’ ”

Remember your why.

Thank you. It’s an honor and a privilege to serve you as WSMA president.

Donna Smith, MD
WSMA President, 2017-18