September 18, 2015

This BOG Update is brought to you by Barry F. Rose, MD, FACC, Governor of the Atlantic Provinces of Canada.

"Change is the law of life. And those who look only to
the past or to the present are certain to miss the future."

President John F. Kennedy

What keeps me up at night? As it relates to our profession?

I am honored to have been elected as Governor of the Atlantic Provinces of Canada, of which there are four comprising about 2.5 million residents in the easternmost part of North America. My time zone is actually 1.5 hours ahead of Eastern Time, which means that I can fly to London in less time than it takes me to get to Chicago.

I have read with great interest comments from other Governors on the same question and it is clear to me how alike we are despite cultural or geographic differences. I could easily conclude by stating that I concur. So, in an attempt to contribute to the ongoing conversation, I will add a few thoughts, musings and philosophical quotations on what keeps me up, but more importantly what then helps me sleep.

My comments are not to undermine the well-intentioned initiatives and efforts designed to ultimately improve patient care; however, some liken such change to the proverbial pendulum and how sometimes with the good, comes the bad.

What are the issues that potentially affect sleep? I am as a cardiologist who is starting his 30th year of practice, and noted myself or heard colleagues commenting on many changes in medicine. We are in an era of increased scrutiny and transparency. We have increased and sometimes unrealistic expectations placed upon us .We have increased demands on our time. We sometimes seem to have less autonomy and less say over what some perceive as overly restrictive conflict of interest guidelines. The plethora of new data can make some less confident about maintaining competency or are challenged by measurement of such. Some view a potential weakening of the previously revered patient-physician relationship.

Many books examine our profession. Some do not depict the physician in as positive a light as in previous generations. One such new example — Trusting Doctors: The Decline of Moral Authority in American Medicine — exemplifies the change in how potentially we perceive ourselves or are viewed by society. Contrary to this are many polls listing physicians as the most respected, honored and admired professionals.

So, how might chance events in one's life (one of my medical resident's recent rounds presentations), quotes by a president, a 19th century French author/journalist and famous Canadian born physician, and the ACC help me sleep?

Sometimes I reflect on how our practice environment has been changed. I attended a noontime rounds recently. It was presented by a second year resident and focused on medicine in earthquake stricken Nepal where he spent the previous month volunteering. His experience and photos of flattened villages, lack of medical supplies and personnel, reminded me how lucky we were. Shortly after rounds, I returned to one of our many state of the art cath labs, performing radial procedures with OCT, FFR, IVUS devices available, using DES for lesions I wouldn't have imagined tackling only 10 or 15 years ago.

So times change, our profession is changing, and we as individuals change. Quotes from completely unrelated sources remind me not to be too concerned:

Jean-Baptiste Alphonse Karr, a 19th century French journalist, and novelist reportedly stated "the more things change, the more they stay the same." Initially the statement appears contradictory to itself, yet philosophical analysis suggests otherwise. Although technology, procedures, diagnostic tools, education, documentation, therapies, and funding are all changing, I am most comfortable with the unchanged, respectful, valued, individual patient-physician interaction.

That famed physician reminded me that although change is here, not to worry. Sir William Osler stated, "The search for static security is misguided. The fact is that security can only be achieved through constant change, adapting old ideas that have outlived their usefulness to current facts."

As for the ACC, I reiterate the comments of others as to how this stellar organization addresses the needs of the membership and the opportunities it provides. The benefits of membership within this professional organization go well beyond the 50 states. Advocacy, help in regard to the MOC demands, education, JACC journals, conferences, courses, assistance with guidelines and quality initiatives need to be used by the membership so as to enhance patient care, as well enhancing the skills, knowledge, and lives of the care givers. One of my early goals is to highlight to colleagues in the northeast the value and opportunities afforded us within the organization. An organization with vision will not miss the future and will have input into changes for the betterment and security for all.