Leadership, character and taking a stance for the right reasons

One of the great things I've experienced as the College's president is hearing from members about their experiences with ACP, their strong beliefs in what it stands for, and the great respect that the organization has nationally and internationally.

Just a few days ago, I was in a national meeting about quality and patient safety. I had the opportunity to interact with panel members, including a nationally known cardiologist who serves as chief medical officer of a large health system. He has the designations FACP and FACC after his name. He is proud of both, but said that the FACP designation carries a different meaning for him.

First, his father was a Fellow and considered that recognition very important. It conveyed the professional respect of his peers. Second, the cardiologist is particularly proud that in his view, ACP always tries to do the right thing for America's patients and the profession, even when some of our policies are controversial. He said, “The College always leads for the right reasons.”

I've been told many times that our policy positions are forthright, not self-interested but developed with consideration of the best interests of our patients. For the College, leading in medicine is about living our values every day, and leadership is the first of our core values.

There's a story about General Norman Schwarzkopf, commander of the armed forces in the first Gulf War, giving a lecture on leadership to a large crowd. He outlined his 14 principles of leadership, and as he finished describing the 12th, he told participants to take their notes, roll them into a ball and throw them on the floor.

He then said that the last two principles are the most important: number 13, “When given command take charge,” and number 14, “Do what is right. It is a sign of character. Have strength of character, a prerequisite to having the courage to do the right thing.” He also said, “Leadership is a combination of strategy and character. If you must be without one, be without strategy.” I'm proud to say that I believe the College always works to do the right thing for our patients and our profession.

A recent example is how ACP stepped forward to express concern about recent actions that challenge the physician's professional responsibility and autonomy in the physician-patient relationship. This controversy was well described in a January ACP Internist article, “Lawmakers try to ‘script’ what doctors say.”

This is an area of concern for many College members, as laws are being passed or considered that attempt to have the physician be an agent of the state by restricting speech or requiring procedures or tests that are not medically indicated. Some state legislatures have prohibited discussion of important health risk factors, proscribed specific conversations about health issues, or mandated testing that is medically unnecessary.

This is not a partisan political issue, as the legislative actions or regulations have come from both ends of the political spectrum. A recent example of character was the terrific leadership of ACP's Florida chapter in partnering with other associations to lead the effort to overturn a state law prohibiting discussions of gun safety.

The physician-patient relationship is one of the most important interactions in life, with significant ethical obligations for physicians. It allows patients an opportunity to share their burdens, fears, hopes and worries with a physician who promises to maintain secrecy, and to act in the patient's best interest.

An essential component of this relationship is the confidence of our patients that our counseling and advice are strictly confined to what is best for them. Patients need to know that these discussions are confidential and not subject to state interference, as long as their statements do not indicate actual or potential harm to others.

This is not to say that there is no role for government in protecting patients and the public. However, any state actions should be few and should be focused on patient protections such as use of informed consent, serious public health issues, safety issues, and perhaps even cost.

In response to these concerns, the College has developed a policy that defines the principles of government involvement in these issues and also provides guidance for legislators and regulators on the appropriate role of government in patient-physician communication and interaction. This policy can be found online.

ACP's stance attempts to bring reason to the issues and provide guidance to legislators considering regulating the patient-physician relationship. In this instance, as in many others preceding it, the College chose to lead and to do what is right. We should be proud.