Healthcare Address from Dec. 2, 1971

Healthcare Address from Dec. 2, 1971

In the spring of 1970, at the Student American Medical Association – renamed American Medical Student Association in 1975 – I was elected the first chairman of the OSR. The first national meeting of the OSR was held in December 1971. This is the address I delivered at this meeting followed by an addendum that explains the history of my involvement with the AAMC, the OSR and the University of Texas Medical School at San Antonio.

The irony in which American medicine finds itself is aptly described by Rosemary Stevens in her book “American Medicine and the Public Interest.” She said:

“Recent developments in medical education represent a striking success. The average doctor has been transformed in sixty years from an incompetent physician, whose strength lay in the ‘bedside manner’ of his mystique, to a specialist … buttressed by an array of diagnostic and treatment aids and techniques. American doctors are among the best trained technological physicians in the world. Together, however, they are not providing optimal medical care; and it is this factor which has become the educational paradox – the manpower crisis – of the 1970’s.”

Simply stated, the irony is, “Good Doctors but Bad Medicine.”

You and I upon completion of post-graduate training will be among the best qualified physicians in the world today. We will not practice in the anecdotal medicine of herbs and spices as did our great grandfathers; rather we will practice the medicine of EKGs, EEGs, Tidal Volumes, Serum Creatinines and Tissue Biopsies. In short, we will be “good doctors.”

But what of our medicine? That is, the delivery of daily health care to John Doe, Susie Smith and Clarence Jones? In the middle of a crisis, if in the right place, or if financially able, they will receive excellent medical care. However, if in the wrong place, or if financially unable, they may in fact receive no care at all. In addition the facilities for non-crisis or preventive medicine are almost exclusively restricted to infectious disease and even those are inadequate. In short, we have a description of the remaining half of our irony, “bad medicine.”

In 1910, the Flexner report addressed itself “to the task of reconstruction of the American medical school on the lined of the highest modern ideas of efficiency and in accordance with the finest conceptions of public service.” This report facilitated the assurance that our M.D.s would be good doctors. Unfortunately, good medicine, which was expected to follow as a result, did not. In 1970, the Carnegie Commission Report was concerned with the “vital importance of adopting the education of health manpower to the changes needed for an effective system of delivery of health care in the United States.” Here it is implied that academic and scientific excellence alone in the training of a physician will not insure “good medicine.”

What relevance does a discussion of good physician and bad medicine have to do with an organizational meeting of the OSR? A great deal, I think.

“In 1967, Bob Graham, a SAMA officer, first made the suggestion that the AAMC have an organized student input. At the annual meeting in the fall of 1968, the assembly of the association passed a resolution supporting the inclusion of students in the activities of the AAMC. In the fall of 1970, each medical school dean was asked to send a representative of his institution to the annual meeting in Los Angeles. From that group of representatives a steering committee was elected to meet with the president and chairman of the association and devise a plan for student input. In February 1971 in Chicago, the assembly approved the recommendation made by the steering committee for the formation of the Organization of Student Representatives.

It is my hope that the OSR within the AAMC can, while maintaining the academic excellence in medical educations begun by Felxner in 1910, move toward the accomplishment of the concerns of the Carnegie report of 1970; that is, good medicine for the United States.”

Addendum written April 20, 2016, 45 years later

I started medical school at the University of Texas Health Science Center San Antonio School of Medicine in September 1969. In the fall term, the dean of the School of Medicine, Dr. F.C. Pannill, called for a meeting with students to discuss the formation of a Health Careers Program for San Antonio minority and indigent students. When the meeting day arrived, I and a fellow student were walking out of the school late in the afternoon when the dean’s secretary intercepted us and said, “Larry, you have to go down stairs. The dean called a meeting and no one showed.” I told her I had to go home but finally agreed to go.

As a result of this meeting, I led the Health Careers Program at the medical school for the next two years. Every Saturday, we would have a group of minority high school students visiting the medical school, at which time we introduced them to various health careers.

In the spring of 1970, the SAMA meeting was held in Los Angeles. UTMSSA had an official student representative but Dr. Pannill asked me to attend the meeting to represent our Health Careers Program. During the meeting, discussions, formal and informal, were held about the election of the first chairman of the AAMC’s new OSR. As the discussions progressed, I was very interested in the role. I asked UTMSSA’s official representative if he were interested in the position and he said no. I asked him if he would object if I sought the position and again he said no.

After the election and my being named the chairman, a number of students from the north and northeast said that they would never have voted for someone from Texas if we had not had extensive discussions beforehand. Upon my election, I began meeting with the Executive Committee of the AAMC as a voting member. Because 1970 was a formation year, my chairmanship extended into the 1971 academic year. The first formal meeting of the OSR was in December 1971. My first meeting with the AAMC was a strategic planning meet at Airlie House in 1970. Also, that year UTMSSA went through an AAMC Accreditation visit. As a member of the Executive Committee, I received a copy of the Accreditation Site Visit Report and voted on the accreditation of my own school while I was a student. The following year (1971) a one-year follow-up site visit was conducted with a subsequent report upon which I also voted.

Texas healthcare politics were active during these early years. My class (1969-1973) was the first full class to go through all four years at UTMSSA. Our faculty was composed of outstanding clinicians and academicians with strong teaching and research credentials. They also were socially conscience and immediately began to seek ways to expand excellent healthcare into the minority and indigent communities of San Antonio. The chairman of the Department of Medicine, Dr. Leon Cander, led many of those efforts and ran afoul of the TMS and State healthcare leaders.

A number of those leaders pushed for Dr. Cander’s dismissal. Dr. Pannill refused to dismiss him and so in 1972, the chancellor of the UT System fired Dr. Pannill. Unfortunately for the chancellor, he based his action upon the AAMC Accreditation Site visit reports, both of which I had read. Knowing that the chancellor had misrepresented the reports, I wrote a letter to each of the regents, which included Mrs. Lady Bird Johnson. I sent a copy of the letter to the San Antonio Express News which, rather than publishing it as a letter to the editor, published my letter on the front page of the paper above the fold. The title of the article was, “Senior Medical Student Challenges Chancellor’s Truthfulness.” During this time, Bob Dale, the internationally known Editorial Cartoonist for the Express News, did four original sketches on this subject. When I saw his original pen and ink sketches, I asked for them and he gave them to me. Framed, these sketches hang in my son’s office to this day. One sketch shows Drs. Pannill and Cander’s names, and depicts them as victims of the chancellor.

There was some discussion about whether I was going to be allowed to finish school in San Antonio but apparently when the Chancellor’s attorneys pointed out that my assertions about the Accreditation Site Visit Reports were correct, he relented.