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W2022146640 abstract "As political, sociologic, and technical advances accelerate, we as teachers and clinicians are obligated to stay abreast of current forces, develop our own strategies of practice and education, and above all maintain our role as primary advocates for women. In the face of the raging changes in our stormy society let us ”adjust our sails” to maximize our resources in the pursuit of continued excellence in technology and societal leadership.There is a “wind direction,” or a combination of powerful forces that ultimately cannot be changed. This involves our ability to teach and to practice medicine. Our task is to “adjust our sails” to take advantage of these forces. For example, communications disseminate medical and technologic advances at rapidly increasing speeds. Societal, economic, and political demands are increasingly challenging our reliance on the truths that have been our pilots. The shifting of income from the physicians to the managers is drastically interfering with our ability to practice the “art” of medicine. Logistically, our unique interpersonal interface with our patients is being replaced by various types of “extenders,” that is, people and technology. Our challenge is to effectively use these people and technologies in our constant goal of continuing to lead the way in promoting excellence in medical care.This theme was borrowed from Dr. Robert Cefalo: “We may not be able to direct the wind, but we can adjust the sails.”1Cefalo RC. Comment.Obstet Gynecol Surv. 1994; 49: 248Google Scholar This seems particularly appropriate for our society. As recognized leaders in our speciality and in our communities, we must “adjust our sails.” We must learn to adapt new approaches and techniques in developing and dispensing our skills. Unlike many societies, the Pacific Coast Obstetrical and Gynecological Society can boast of the quality of its membership and the wholesome and warm camaraderie between clinicians and academicians. These traits give us a head start in developing and sharing information and skills. Thus we can “use the wind” instead of letting the wind direct us.As I look back on the relatively tiny spectrum of time during which I have been privileged to practice medicine, I find the road facing the current practitioners of our art truly mind boggling. Growing up in a family of an outstanding and dedicated general practitioner and two decades in solo practice followed by two more decades in a health maintenance organization ill prepared me for the exploding complexities of today's “form over function” climate. The incredible speed of information dissemination not only demands an accelerated learning curve but also the development of communications skills undreamed of even today. While adapting and assimilating all of these new advances, forthcoming generations must diligently adhere to basic truths. These truths, inherent in the human animal, are expected from the word “doctor,” from the Latin ”docere,” to teach.2Doctor Random House dictionary of the English Language, unabridged.in: 1st ed. Random House, New York (NY)1966: 421Google ScholarAlthough we may not be able to change the wind of politics and economics, our society is in a position to adjust our sails. As the Task Force on Status Evaluation reports on the direction and goals of the Pacific Coast Obstetrical and Gynecological Society, we can individually ponder and advise as we present and discuss the papers at our meetings. Virtues still remain as excellent “lanyards and stays.” Although the ancient cardinal virtues - prudence, justice, temperance, and courage — do not change3Byron MD Charles S. What is the oslerian tradition?.Ann Intern Med. 1994; 120: 682-687Crossref PubMed Scopus (18) Google Scholar as truths, I propose to nominate with enthusiasm honesty, perseverance, and humor.Honesty from the physician and his or her representatives is mandatory for a confidential relationship. Deviation from honesty on the part of the physician can produce irreparable emotional and physical harm. Attempting to hide the truth is infinitely worse than an honest, “I don't know.” Four decades ago one of my patients died of a massive amniotic fluid embolism in spite of desperate efforts to save her. Because she was a close personal friend, the daughter of a physician and the wife of an attorney, it was personally truly devastating. At the time all parties were kept informed of subsequent investigative results. Although the openness of our efforts did not mitigate the terrible loss, all parties knew that honesty was complete. In today's climate we are all aware of the media and legal consequences that would follow such an episode. Additionally, today honesty is to be hoped for, but not always received, from the patient. Nevertheless, honesty must be imprinted on those who are extensions of ourselves: nurses, physician assistants, house staff, students, social and home health workers, and all personnel interfacing with our patients. Because technology tends to isolate the health managers from ourselves, we must see that honesty is present in them as well. This can be a challenge for the physician. As the complexities of an educational system give way to form over function, how do we instill virtues through the video terminal, audio-video telephone, CD ROM disks, or satellites? We must be ever alert for the deplorable results from the occasional dishonest research, teaching, or managerial business practice. These are the true fodder for media frenzies, political capriciousness, and litigious retributions. Of course, the “splatter” covers the dedicated innocent as well.Perseverance is a factor contributing to maximum achievement, empathy, and efficiency. Perseverance drags us out of bed after too little sleep, enforcing optimism and cheerfulness when the opposite is present. It makes us remove that last little lymph node in a dissection, verify an off-line laboratory report, and pursue a subtle innuendo from an unhappy patient at the end of an overworked day. It keeps us going back after being chewed out by whomever, in front of whatever, and in spite of however. Perseverance keeps us listening to the patient's diatribe and patiently and calmly getting the patient to understand her real problem and solution. Perseverance enables us to sense, discover, and temper the patient's unspoken fears and concerns. Perseverance drives us to that extra concentration and effort with a house officer who needs uplifting and reassurance at 4 AM. Perseverance means that the professors must use technologies such as voice mail, voice typing, television conferences, audiovisual techniques, to get from behind their desks, be exposed to the patients, and to transmit their hard-won skills at the bedside to the coming generations of physicians. (Perseverance makes us read and revise this speech too many times!)Humor is a trait seemingly unique to man. Although it is possible that many other species are not only laughing within themselves but also at us, this could be another topic entirely. The popularity of using humor is well known. Many hospitals have humor programs and services.4Fry Jr., WF The physiologic effects of humor, mirth and laughter.JAMA. 1992; 267: 1857-1858Crossref PubMed Scopus (128) Google Scholar There are numerous magazines, books, seminars, and shows on developing the skills of using humor. “The appreciation of humor can be learned; it is an intuitive intelligence that can be nourished.”5Sullivan D. Humor and health.J Gerontol Nurs. 1988; 14: 20-24PubMed Google Scholar Physiologically laughter is motor reflex, present by 16 weeks of age. It requires the coordinated movement of 15 facial muscles. The bellows action of the chest cavity plus the increased venous return reduces vascular stasis and diminishes thrombus formation and aids in clearing mucus. Laughter affects facial muscles, spasmodic skeletal muscle contractions, tachycardia, and changes in breathing and releases endorphins and increases catacholamine production. Boisterous laughter involves large muscle tissue participation and total body response; thereby it is an excellent conditioning exercise for the immobilized. Solid laughter 100 times per day is said to equal 10 minutes of rowing.6Erdman L. Laughter therapy for patients with cancer.Oncol Nurs Forum. 1991; 18: 1359-1363PubMed Google Scholar The value of laughter as promoted by Cousins7Cousins N. Anatomy of an illness.N Engl J Med. 1976; 295: 1458-1463Crossref PubMed Scopus (183) Google Scholar and others is known to all of us. Speakers often open with a joke to get attention, relaxation, and a common wavelength and to get themselves organized. Humor tends to unite people with common weaknesses such as smoking, eating inappropriately, and excessive worrying. Laughing with others builds confidence, brings people together, and pokes fun at common problems dealing with current issues. Laughing at others, so common in today's media, destroys confidence and teamwork, could be injurious to those with certain seizure disorders and elevated blood pressure, and should be used with discretion in certain postoperative and respiratory patients. Is it possible that those with a humorous outlook tend to live longer and happier and overcome obstacles with more alacrity? My father used to say, “Whenever possible, leave them laughing, either with you or at you!”To quote Lippman,8Lippman W. The essential Lippman. Random House, New York (NY)1963Google Scholar ”Our civilization can be maintained and restored only by remembering and rediscovering the truth, and re-establishing the virtuous habits on which it was founded. There is no use looking to the blank future for some new and fancy revelation for what man needs in order to live. The revelation has been made . . . .”How can we use these truths of honesty, persistence, and humor in the future? We “adjust our sails” by persisting in reaching out and adapting to the exciting and exploding technologic advances in our offices and clinics. Voice transcribing and translating equipment, packet transmission of data, the use of digital imaging and remote manipulation through three-dimensional video display, stereophonic audio input, and hand controllers with multisensory input and dexterous manipulation are making possible heretofore never imagined possibilities. Already there are many medical institutions routinely using satellite transmission to perform telemedicine in smaller affiliated clinics.9Satava RM. Surgery 2001: a technologic framework for the future.Surg Endosc. 1993; 7: 111-113Crossref PubMed Scopus (53) Google Scholar Teaching anatomy, surgery, and medicine will probably be done by virtual reality models without protoplasmic participation. Miniature robotic research promises incredible capabilities in therapeutics.10Satava RM. Endoscopy for the year 2000.Exp Invest Endosc. 1994; 4: 397-406Google Scholar It is essential that we persist in maintaining our learning curve and apply techniques and data honestly. We must extend our reach so we can expand our ability to teach.How do we maintain the patient-physician relationship in this environment? In spite of governmental “governing,” the arena of communication technology must increase its contribution to us. As we have adjusted to the omnipresent television screen and its one-way communication mode, we will become comfortable with two-way audiovideo communication. With increasing encouragement by management, people are already more comfortable working at home, that is, home offices, than in braving the rigors of travel and physically being there. But what about the warmth of a handshake, a pat on the back, a hug, or a mutual tear, all so significant in my solo practice years? The time released from paper work in my group practice years allowed some continuance of personal interactions. Today in our offices or clinics our physician assistants, licensed vocational nurses, and others could have in-depth patient discussions, elicit physical and emotional problems, explain procedures and techniques, and accompany and prepare the patient physically and emotionally. The physician's time can be used to reinforce the extenders' points and empathetically allaying the patient's real fears and concerns while performing the procedure, then progressing to the next patient, who has been similarly prepared. Follow-up questions could be handled by the extenders or rarely by audiovisual telephone. In most cases this approach would allow the physician to at least double his or her patient volume when eyeballing the patient while doing the procedure. In the face of budgetary tyranny, repetitive and frequent communication with home care providers and organizations can maintain patient quality management and tender loving care.How can we instill our personalities and energies that have served us for so long and so well into our extenders and upcoming physicians? We must effectively organize our profession so that we will be available to pass on our baton to the still idealistic, exhausted, and discouraged house officer in the nocturnal abyss of lonely struggles with traumatic emergencies. By continuing to lead in the social and technologic adjustments of our society, we can truly direct our course. Although tomorrow's patient will expect - nay, demand - more of our personal interface, let each of us explore our American ingenuity and industry in the use of the new and exciting technologies. Those in this room have seen the pendulum swing from an era of relatively minimal therapeutic capabilities, limited mainly to “bedside manner and tender loving care,” unquestioned patient compliance, and loyalty to one of almost incomprehensible therapeutic options and unremitting patient demands for perfection. As the pendulum starts to swing back, we can use these therapeutic options in satisfying patient needs in spite of the unrealistic expectations engendered by both the media and the legal system. I am confident that this society will continue to lead the way by relaying through extenders, both human and electronic, the “art” of medicine by the truths of honesty, perseverance, and humor. Although we may not be able to “direct the wind,” we can certainly “adjust the sails.”Insistence on Perseverance leads to endurance,which has brought us to this place;And Honesty has verified our existence,In spite of society's crazy pace.So add some HumorAnd dispel the rumorThat we in medicine have no face. As political, sociologic, and technical advances accelerate, we as teachers and clinicians are obligated to stay abreast of current forces, develop our own strategies of practice and education, and above all maintain our role as primary advocates for women. In the face of the raging changes in our stormy society let us ”adjust our sails” to maximize our resources in the pursuit of continued excellence in technology and societal leadership. There is a “wind direction,” or a combination of powerful forces that ultimately cannot be changed. This involves our ability to teach and to practice medicine. Our task is to “adjust our sails” to take advantage of these forces. For example, communications disseminate medical and technologic advances at rapidly increasing speeds. Societal, economic, and political demands are increasingly challenging our reliance on the truths that have been our pilots. The shifting of income from the physicians to the managers is drastically interfering with our ability to practice the “art” of medicine. Logistically, our unique interpersonal interface with our patients is being replaced by various types of “extenders,” that is, people and technology. Our challenge is to effectively use these people and technologies in our constant goal of continuing to lead the way in promoting excellence in medical care. This theme was borrowed from Dr. Robert Cefalo: “We may not be able to direct the wind, but we can adjust the sails.”1Cefalo RC. Comment.Obstet Gynecol Surv. 1994; 49: 248Google Scholar This seems particularly appropriate for our society. As recognized leaders in our speciality and in our communities, we must “adjust our sails.” We must learn to adapt new approaches and techniques in developing and dispensing our skills. Unlike many societies, the Pacific Coast Obstetrical and Gynecological Society can boast of the quality of its membership and the wholesome and warm camaraderie between clinicians and academicians. These traits give us a head start in developing and sharing information and skills. Thus we can “use the wind” instead of letting the wind direct us. As I look back on the relatively tiny spectrum of time during which I have been privileged to practice medicine, I find the road facing the current practitioners of our art truly mind boggling. Growing up in a family of an outstanding and dedicated general practitioner and two decades in solo practice followed by two more decades in a health maintenance organization ill prepared me for the exploding complexities of today's “form over function” climate. The incredible speed of information dissemination not only demands an accelerated learning curve but also the development of communications skills undreamed of even today. While adapting and assimilating all of these new advances, forthcoming generations must diligently adhere to basic truths. These truths, inherent in the human animal, are expected from the word “doctor,” from the Latin ”docere,” to teach.2Doctor Random House dictionary of the English Language, unabridged.in: 1st ed. Random House, New York (NY)1966: 421Google Scholar Although we may not be able to change the wind of politics and economics, our society is in a position to adjust our sails. As the Task Force on Status Evaluation reports on the direction and goals of the Pacific Coast Obstetrical and Gynecological Society, we can individually ponder and advise as we present and discuss the papers at our meetings. Virtues still remain as excellent “lanyards and stays.” Although the ancient cardinal virtues - prudence, justice, temperance, and courage — do not change3Byron MD Charles S. What is the oslerian tradition?.Ann Intern Med. 1994; 120: 682-687Crossref PubMed Scopus (18) Google Scholar as truths, I propose to nominate with enthusiasm honesty, perseverance, and humor. Honesty from the physician and his or her representatives is mandatory for a confidential relationship. Deviation from honesty on the part of the physician can produce irreparable emotional and physical harm. Attempting to hide the truth is infinitely worse than an honest, “I don't know.” Four decades ago one of my patients died of a massive amniotic fluid embolism in spite of desperate efforts to save her. Because she was a close personal friend, the daughter of a physician and the wife of an attorney, it was personally truly devastating. At the time all parties were kept informed of subsequent investigative results. Although the openness of our efforts did not mitigate the terrible loss, all parties knew that honesty was complete. In today's climate we are all aware of the media and legal consequences that would follow such an episode. Additionally, today honesty is to be hoped for, but not always received, from the patient. Nevertheless, honesty must be imprinted on those who are extensions of ourselves: nurses, physician assistants, house staff, students, social and home health workers, and all personnel interfacing with our patients. Because technology tends to isolate the health managers from ourselves, we must see that honesty is present in them as well. This can be a challenge for the physician. As the complexities of an educational system give way to form over function, how do we instill virtues through the video terminal, audio-video telephone, CD ROM disks, or satellites? We must be ever alert for the deplorable results from the occasional dishonest research, teaching, or managerial business practice. These are the true fodder for media frenzies, political capriciousness, and litigious retributions. Of course, the “splatter” covers the dedicated innocent as well. Perseverance is a factor contributing to maximum achievement, empathy, and efficiency. Perseverance drags us out of bed after too little sleep, enforcing optimism and cheerfulness when the opposite is present. It makes us remove that last little lymph node in a dissection, verify an off-line laboratory report, and pursue a subtle innuendo from an unhappy patient at the end of an overworked day. It keeps us going back after being chewed out by whomever, in front of whatever, and in spite of however. Perseverance keeps us listening to the patient's diatribe and patiently and calmly getting the patient to understand her real problem and solution. Perseverance enables us to sense, discover, and temper the patient's unspoken fears and concerns. Perseverance drives us to that extra concentration and effort with a house officer who needs uplifting and reassurance at 4 AM. Perseverance means that the professors must use technologies such as voice mail, voice typing, television conferences, audiovisual techniques, to get from behind their desks, be exposed to the patients, and to transmit their hard-won skills at the bedside to the coming generations of physicians. (Perseverance makes us read and revise this speech too many times!) Humor is a trait seemingly unique to man. Although it is possible that many other species are not only laughing within themselves but also at us, this could be another topic entirely. The popularity of using humor is well known. Many hospitals have humor programs and services.4Fry Jr., WF The physiologic effects of humor, mirth and laughter.JAMA. 1992; 267: 1857-1858Crossref PubMed Scopus (128) Google Scholar There are numerous magazines, books, seminars, and shows on developing the skills of using humor. “The appreciation of humor can be learned; it is an intuitive intelligence that can be nourished.”5Sullivan D. Humor and health.J Gerontol Nurs. 1988; 14: 20-24PubMed Google Scholar Physiologically laughter is motor reflex, present by 16 weeks of age. It requires the coordinated movement of 15 facial muscles. The bellows action of the chest cavity plus the increased venous return reduces vascular stasis and diminishes thrombus formation and aids in clearing mucus. Laughter affects facial muscles, spasmodic skeletal muscle contractions, tachycardia, and changes in breathing and releases endorphins and increases catacholamine production. Boisterous laughter involves large muscle tissue participation and total body response; thereby it is an excellent conditioning exercise for the immobilized. Solid laughter 100 times per day is said to equal 10 minutes of rowing.6Erdman L. Laughter therapy for patients with cancer.Oncol Nurs Forum. 1991; 18: 1359-1363PubMed Google Scholar The value of laughter as promoted by Cousins7Cousins N. Anatomy of an illness.N Engl J Med. 1976; 295: 1458-1463Crossref PubMed Scopus (183) Google Scholar and others is known to all of us. Speakers often open with a joke to get attention, relaxation, and a common wavelength and to get themselves organized. Humor tends to unite people with common weaknesses such as smoking, eating inappropriately, and excessive worrying. Laughing with others builds confidence, brings people together, and pokes fun at common problems dealing with current issues. Laughing at others, so common in today's media, destroys confidence and teamwork, could be injurious to those with certain seizure disorders and elevated blood pressure, and should be used with discretion in certain postoperative and respiratory patients. Is it possible that those with a humorous outlook tend to live longer and happier and overcome obstacles with more alacrity? My father used to say, “Whenever possible, leave them laughing, either with you or at you!” To quote Lippman,8Lippman W. The essential Lippman. Random House, New York (NY)1963Google Scholar ”Our civilization can be maintained and restored only by remembering and rediscovering the truth, and re-establishing the virtuous habits on which it was founded. There is no use looking to the blank future for some new and fancy revelation for what man needs in order to live. The revelation has been made . . . .” How can we use these truths of honesty, persistence, and humor in the future? We “adjust our sails” by persisting in reaching out and adapting to the exciting and exploding technologic advances in our offices and clinics. Voice transcribing and translating equipment, packet transmission of data, the use of digital imaging and remote manipulation through three-dimensional video display, stereophonic audio input, and hand controllers with multisensory input and dexterous manipulation are making possible heretofore never imagined possibilities. Already there are many medical institutions routinely using satellite transmission to perform telemedicine in smaller affiliated clinics.9Satava RM. Surgery 2001: a technologic framework for the future.Surg Endosc. 1993; 7: 111-113Crossref PubMed Scopus (53) Google Scholar Teaching anatomy, surgery, and medicine will probably be done by virtual reality models without protoplasmic participation. Miniature robotic research promises incredible capabilities in therapeutics.10Satava RM. Endoscopy for the year 2000.Exp Invest Endosc. 1994; 4: 397-406Google Scholar It is essential that we persist in maintaining our learning curve and apply techniques and data honestly. We must extend our reach so we can expand our ability to teach. How do we maintain the patient-physician relationship in this environment? In spite of governmental “governing,” the arena of communication technology must increase its contribution to us. As we have adjusted to the omnipresent television screen and its one-way communication mode, we will become comfortable with two-way audiovideo communication. With increasing encouragement by management, people are already more comfortable working at home, that is, home offices, than in braving the rigors of travel and physically being there. But what about the warmth of a handshake, a pat on the back, a hug, or a mutual tear, all so significant in my solo practice years? The time released from paper work in my group practice years allowed some continuance of personal interactions. Today in our offices or clinics our physician assistants, licensed vocational nurses, and others could have in-depth patient discussions, elicit physical and emotional problems, explain procedures and techniques, and accompany and prepare the patient physically and emotionally. The physician's time can be used to reinforce the extenders' points and empathetically allaying the patient's real fears and concerns while performing the procedure, then progressing to the next patient, who has been similarly prepared. Follow-up questions could be handled by the extenders or rarely by audiovisual telephone. In most cases this approach would allow the physician to at least double his or her patient volume when eyeballing the patient while doing the procedure. In the face of budgetary tyranny, repetitive and frequent communication with home care providers and organizations can maintain patient quality management and tender loving care. How can we instill our personalities and energies that have served us for so long and so well into our extenders and upcoming physicians? We must effectively organize our profession so that we will be available to pass on our baton to the still idealistic, exhausted, and discouraged house officer in the nocturnal abyss of lonely struggles with traumatic emergencies. By continuing to lead in the social and technologic adjustments of our society, we can truly direct our course. Although tomorrow's patient will expect - nay, demand - more of our personal interface, let each of us explore our American ingenuity and industry in the use of the new and exciting technologies. Those in this room have seen the pendulum swing from an era of relatively minimal therapeutic capabilities, limited mainly to “bedside manner and tender loving care,” unquestioned patient compliance, and loyalty to one of almost incomprehensible therapeutic options and unremitting patient demands for perfection. As the pendulum starts to swing back, we can use these therapeutic options in satisfying patient needs in spite of the unrealistic expectations engendered by both the media and the legal system. I am confident that this society will continue to lead the way by relaying through extenders, both human and electronic, the “art” of medicine by the truths of honesty, perseverance, and humor. Although we may not be able to “direct the wind,” we can certainly “adjust the sails.” Insistence on Perseverance leads to endurance, which has brought us to this place; And Honesty has verified our existence, In spite of society's crazy pace. So add some Humor And dispel the rumor That we in medicine have no face." @default.
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