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Ann Thorac Surg 2003;76:S69-S84
© 2003 The Society of Thoracic Surgeons
a General Thoracic Surgery, Section of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
* Address reprint requests to Dr Miller, Emory University School of Medicine, Division of Cardiothoracic Surgery, 1365 Clifton Rd Building A, Atlanta, GA 30322, USA
e-mail: joseph_miller{at}emoryhealthcare.org
Presented at the 50th Anniversary of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 14, 2003.
Abstract
This article contains a brief history of the Southern Thoracic Surgical Association since it was founded in 1953, and a synopsis of each Presidential Address that was available for review. Not all Addresses were available or could be obtained.
The concept of a regional society of our specialty was first conceived by two members of our association, Dr Hawley Seiler and Dr James Murphy. Between 1950 and 1952, numerous letters and discussions were held between these two individuals. Doctor Murphy was originally not enthusiastic about the idea and discouraged it. However, 1 year later Dr Murphy contacted Dr Seiler to say that he would be very interested in helping to organize such a group. He stated "The idea we discussed last fall of a local association for thoracic surgeons might be worth reviving."
Doctor Seiler then contacted Dr DeWitt Daughtry and invited him to join in the effort. A letter was drafted and sent out to 66 potential members under the letterhead of the three individuals mentioned above. Forty replies were received, 38 in favor. An organizational meeting was held in Atlanta on October 26, 1953. Only seven attended; but they were so sure that they had a good idea that they agreed to hold an organizational meeting a year later.
On May 4, 1954, during the meeting of the American Association of Thoracic Surgeons in Montreal, a second organizational meeting was held. Thirty-eight individuals attended. At this meeting a decision was made to form a new group to be known as the Southern Thoracic Surgical Association (STSA). The new association was to be composed of both academicians and surgeons in private practice. Doctor Murphy was elected the first President and Dr Seiler, Secretary, a position he would hold for 15 years. Doctor John S. Harter was named Chairman of the Program Committee and Dr Paul Sanger was named Chairman of the Constitution and Bylaws Committee. A statement was formulated to be included in the constitution that the purpose of the association would be to establish a forum for the advancement of the scientific aspects of thoracic surgery for the physicians practicing that specialty in designated southern states. The meetings were to have free and open discussion and offer an opportunity for the exchange of ideas. It was proposed that the association occasionally meet in resort areas and there be social overtones to our society.
The first regular meeting of the Southern Thoracic Surgical Association was held December 5th and 6th in Hollywood, Florida, with 54 surgeons present and 17 papers presented. The minutes of the first annual meeting recorded 95 charter members. Doctor James D. Murphy was elected President and dues of $5.00 were instated.
The second year of the association a membership committee was formed. There was to be no set number of members but each had to have American Board of Thoracic Surgery certification and at least one half of the applicant's practice had to be in the field of thoracic surgery.
At the second annual meeting at the Greenbrier Hotel, the Council came into being as the governing body of the organization and the first official Council Meeting was held on December 4, 1955. A final count showed 120 charter members who were known as the Founders Group. This was closed on December 5, 1955.
In 1956 the third meeting was in Miami Beach. The scientific program was excellent and the first social evening was held and gave an indication of many such occasions to be enjoyed in future years. Doctor Murphy was to write: "I had no idea so much could be accomplished in such a short space of time." From then on Dr Seiler and Dr Murphy performed all of the site selection and administrative duties during the early years. Each successive meeting added to the solidity of the organization.
By 1960 the Council planned the first meeting out of the country. The STSA met at Nassau, Bahamas. More than 100 members and guests attended. The highlight of the Nassau meeting was the establishment and presentation of the first Osler Abbott award.
The Osler Abbott award was established in honor of Dr Abbott, who raised discussion to a new art form. In1960 at the AATS Dr Abbott discussed from the floor 26 consecutive papers. The award was the brainchild of the Secret Committee, a group that roamed the streets of Old Nassau in search of a suitable prize to be awarded to the member who excelled in discussionship and who was the most voluble during the scientific sessions. The first Osler Abbott award winner was Dr Joseph A. Peabody of Washington, DC. He ultimately won the award twice being one of two members to win it twice. Table 1 lists the Osler Abbott award winners.
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In 1961 the meeting was held in Memphis, Tennessee. The gavel and Certificate of Appreciation were awarded to the outgoing presidents for the first time at this meeting.
In 1962 the second out of the country meeting was held in Jamaica. It was highlighted by the establishment of the President's Mixer.
In 1964 the establishment by Smith, Kline and French to award a monetary sum for the best scientific paper was begun. Now given annually, this has become known as the President's Award and is the Association's highest honor. The first recipient was Dr Bert Glass for his paper entitled Experimental Studies on the Reversibility of Pulmonary Hypertension. The year 1964 also marked two other occasions of historical significance to the Association. The Annals of Thoracic Surgery agreed to start publishing papers from the annual meeting. The Editors of The Annals (Fig 1) have been very supportive of the STSA over the years, for which the society is very appreciative. Nineteen sixty-four also marked the inauguration of an award unique to our association, the Tiki Award. There remains some mystery and perhaps some controversy concerning its origin and purpose. It is now recognized as being given for the most memorable slide used at the meeting. The first recipient was Dr Watts Webb. Doctor Webb explained Tiki is the God of Fertility, so chosen because one slide begets another. Only two people have won the award twice: Dr M. Ruzzuk and Dr Francis Robicsek. The original winning slide depicted DP/DT and the pressure-volume loop. Nineteen sixty-four also marked the death of Dr James Murphy, our first president.
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In 1966 a representative from the STSA became a member of the Board of the American College of Surgeons.
In 1967 President Edward Munnell established a committee for an official seal of the STSA to be developed.
In 1971 Dr Seiler was President, and the meeting was held in Tampa. His Presidential Address was The Early Years of the Southern Thoracic Surgical Association. It should be read by all members.
The 25th Silver Anniversary Meeting was held at Marco Island in 1978. A special ceremony was held to recognize all past presidents and their wives or widows. In 1978 Dr Harold Urschel suggested a presidential medal be authorized, similar to that used in other societies.
The present
In 1979 the administrative function of the Society was turned over to Smith, Bucklin and Associates. This continued until 2002 when Dr William Sasser, our 48th President, organized our move to the STSA to form our own management team. Our current Executive Director is Ms Christine Eme.
Each successive scientific meeting was outstanding and the list of past presidents reads like a Who's Who in thoracic surgery (see Appendix).
In 1996 Dr William Alford was our 43rd President and gave his landmark presentation on The Heritage of the Southern Thoracic Surgical Association. It is from his address that a large amount of this material has been taken and paraphrased.
Our society has never been richer in number of members, resources, or quality of both the scientific meeting and social functions (Table 2).
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The education programs and talks continue to be outstanding at each meeting. In any given year, the presenters are a Who's Who in Southern Thoracic Surgery. With the start of publication of our articles in 1964 by The Annals of Thoracic Surgery, the contents of our meetings became widely circulated. Our Presidents have been at the forefront of North American thoracic surgery in leadership, committee appointments and other endeavors.
Part of the uniqueness of the STSA has been to hold some of its meetings out of the country. Beginning in 1960 when the first meeting out of the country was held in Nassau, Bahamas, a total of 10 have been held outside the United States, generally in Puerto Rico, Mexico, or the Caribbean. Between 1976 and 1990, none were held outside because of US tax laws. Some of our most memorable meetings have been held offshore.
The social interchange between members and guests has always been one of the highlights of the meetings of the STSA. The President's Mixer and black tie dinner give members the opportunity to reminisce and visit with friends. The athletic events of tennis, golf, fun run, and fishing tournaments further enhance the social aspects of our organization.
The 50 meetings of the STSA have seen our organization grow in both numbers, strength, and quality. Doctors Murphy and Seiler must have realized that their intended goals for the organization have been achieved. The outlook for the future of the STSA is brighter than ever.
The presidential addresses: a synopsis
Prior to 1971, the Presidential Addresses of the Southern Thoracic Surgical Association were not published. It has only been since 1971 that this has occurred. There were no addresses published between 1978 and 1984. To synopsize or paraphrase a Presidential Address is done with significant trepidation. I will try to present what I feel was the intended meaning of each author but I apologize up front for any misrepresentation of his intended message.
The two historical papers by Drs Seiler and Alford have already been cited and will not be mentioned again.
Table 3 lists the title of the Presidential Address and the year given. Please note that from a thorough search, I have some of the titles between 1978 and 1984 but have no copy of the Presidential Address. It was a tremendous experience reading through these addresses. They are a remarkable compilation of prevailing surgical history and thought from the last 30 years.
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1972, Doctor A. Robert Cordell
The Influence of the Arts on the Evolution of Medical Practice
Published in the North Carolina Medical Journal 1973;34:866–70.
In one of the most eloquent presidential addresses, Dr Cordell has summarized the influence of literature on physicians and medicine in general. He points out that prior to the latter half of the 19th century, physicians in general were not generally held in great esteem. He uses a great number of illustrations from the past to illustrate this. He points out that it was in the latter half of the 19th century that a dichotomy was resolved and literature and medicine entered a stationary period. The "family physician" came into his own and the physician, with a practicing resident, began to figure centrally in the literature. He quotes Robert Louis Stevenson: "There are men and classes of men that stand above the common herd; the soldier, the sailor and the shepherd not infrequently; the artist rarely; rarer still the clergyman; the physician, almost always as a rule. He is the flower of our civilization."
Doctor Cordell goes on to show that tuberculosis was a terminal disease at the time and how it entered into the operatic plot and literature during the end of the 19th century and early 20th century. He notes that it was in Eric Segal's "Love Story" the heroine dies of leukemia. For literary purposes that was a satisfactory and believable mode of exit in the 1970s. It was properly dramatic and can be as lingering as needed for the development of the plot. He quotes: "It is interesting to speculate about the disease that will replace leukemia when research forces it to retire from the stage." He did not know that AIDS was just around the corner.
He points out that spectacular successes have become the byword over the past 2 decades. "We have been placed in the unique and unbelievable position of being expected to accomplish miracles in every operation."
Doctor Cordell points out that we now live in a time of information overload and that the average patient is a sophisticated consumer of medical knowledge. He advises that we as physicians must be willing to work with them in this environment.
1973, Doctor James Pate
Southern Thoracic Surgery, unpublished.
In Southern Thoracic Surgery, Dr Pate has given in detailed form a history of medicine and surgery as practiced in the South during the Civil War and the experience and knowledge gained from that conflict. In his unique style, he states that a presidential address should be a subject based on three approaches: summary search, a minimal amount of philosophy, and some degree of entertainment. In this he accomplished all three. He points out that the scarcity of paying patients limited the numbers of physicians, but allowed Southern medical students to pursue academia more widely and leisurely.
By the time of the war, the. South had made major contributions to surgery. McDowell of Kentucky had developed abdominal surgery. Marian Sims of South Carolina had given the world operative gynecology. Paul Eve of Nashville recognized the value of thoracentesis. Innovation, builders of thought, independence of investigation and coverage learned from a hard frontier life, superimposed on travel, education, and contemplation became the hallmark of the Southern surgeon.
Numerous entities were highlighted by Dr Pate including vaccination, anatomy, missile wound, triage, control of hemorrhage, treatment of thoracic aortic injuries, tracheostomy, infection, empyema, pneumothorax, heart and lung.
He pointed out that the surgeons of the Confederacy who survived the war became surgical leaders. In 1975 he pointed out that we were training a class of coronary artery surgeons with a ridiculously shallow knowledge of areas in thoracic surgery. His address is well worth reading.
1974, Doctor Bert A. Glass
The Relationship of Axillary Venous Thrombosis to the Thoracic Outlet Syndrome
Published in The Annals of Thoracic Surgery, 1975;19:613–21.
Doctor Glass opens his address with words that continue to typify the Southern Thoracic Surgical Association. He states that "I know of no other organization in which scientific excellence is so successfully blended with a profound determination to prevent the officers, members, and program from becoming 'stuffed shirts.'" Not only did the STSA present him the award for the best paper, but the Tiki Award (worst slide), and the Osler Abbott Award (for most papers discussed and favored with irrelevant discussion).
Doctor Glass points out that presidential addresses have ranged from philosophical exorgesis organized research, massive clinical series, to a number of historical developments of the Southern Thoracic Surgery. He pointed out that we have had an occasional address on literature and art as they relate to our specialty.
Doctor Glass himself presented eight cases of venous obstruction at the thoracic outlet. He pointed out the anatomy of the thoracic outlet and how it could be related to venous compression.
1975, Doctor Frederick H. Taylor
The Compleat Thoracic Surgeon
Published in The Annals of Thoracic Surgery, 1976;4:310–316.
In his presidential address, Dr Taylor quotes and paraphrases Izaak Walton's The Compleat Angler in his comparison with thoracic surgeons. He points out that a "good angler" must not only bring an inquiring, searching, observing wit, but he must bring a large measure of hope and patience, and love and propensity to the art itself. In his discussion he points out that grades are not always the measure of how we should evaluate applicants for medical school. He goes through a number of historical examples including John Hunter and Joseph Lisster. He discusses both the science of surgery and the art of surgery. He pointed out that we applaud the cures of modern medicine if they bring no side effects worse than the malady itself. We are grateful for the added years if they are not a burdensome prolongation of illness, disability and gloom.
He was the first of our presidents to point out the future problems of our profession with lawyers, social, legal, and political problems. He stated: "Let us beware of any group—professors, practitioner, lawyers, or government bureaucrats who attempt to perpetuate themselves." He pointed out that surgeons are men of action, but at times contemplation is also necessary. Both action and contemplation are two qualities necessary for "the compleat thoracic surgeon."
1979, Doctor Harold C. Urschel, Jr
The China Syndrome, unpublished.
In his Presidential Address, Dr Urschel focused on the topic of humor and how it relates to medicine, the STSA, and the world. He states that "humor is mankind's most enduring avenue to empathy for it is the shared insight or mutual outlook that binds families, friends and acquaintances." He states, "It is the broadest expression of human faith that we have for humor is made of honesty and love." He then goes on to point out the uniqueness of humor in our association in relation to the Osler Abbott and Tiki Awards. He points out that humor has provided tolerance, perspective, and self-critique.
He then points out the significance of the China Syndrome. He defines it as the delicate balance between a highly honed instrument of great productivity and a critical overage that would cause an accident with subsequent self-destruction as well as destruction of the world all the way to China.
He then relates the knowledge he had learned from a trip made to China and the significance of the Chinese people. As the STSA is growing in numbers, he raises the question: "Are we facing a China syndrome?"
He quotes from Stanley Marcus: "Search for excellence and demand the best." He states this is what the STSA should seek to achieve.
He concludes with these remarks about humor: "Humor shuns pomposity and sham and all falsehood. It is the broadest expression of human faith that we have. It is made of honesty and love. It is a prelude to faith and laughter is the beginning of prayer. This is the difference between the United States and the rest of the world. In essence, the STSA will never have fear of a China Syndrome."
1984, Doctor Charles R. Hatcher
The Private Practice of Medicine in the United States: Glorious Past, Troubled Present, Uncertain Future
Published in The Annals of Thoracic Surgery, 1985;40:4–7.
In his introductory remarks, Dr Hatcher pointed out that physicians were once held in the highest esteem as a profession but are now viewed "as just another profession." He suggests two possible causes of this are, one, overspecialization and the team approach to medicine, and, two, the rising cost of health care.
He pointed out that "Goals of highest possible quality and unlimited access are expressed in good times, but the current economy brings home the reality of high budget deficits and limited resources."
He proposed six cost reduction proposals: one, emphasize alternative delivery systems and ambulatory care; two, increase patient deductibility and coinsurance; three, emphasize wellness and preventative medicine; four, increase competition among providers; five, improve productivity; and six, impose some restrictions on access to the resources.
He further emphasized that physicians must participate in the business of medicine as well as in the practice of medicine. He states: "We must be actively involved in the bursar aspects to preserve our specialty."
1985, Doctor George C. Kaiser
CABG: Lessons from the Randomized Trials
Published in The Annals of Thoracic Surgery, 1986;42:3–8.
Doctor Kaiser discussed three large cooperative randomized trials and evaluated their effects on medical and surgical management of ischemic heart disease on survival and other secondary end points.
His conclusions from the three trials were as follows: (1) CABG increases survival in patients with left main coronary stenosis, three-vessel disease, in the elderly patient, and those with impaired left ventricular function, and left ventricular aneurysm; (2) CABG decreases incidence of sudden death, and nonfatal MI; (3) angina pectoris is relieved; (4) symptoms of congestive heart failure are not improved (5) risk factors are not modified; (6) CABG is palliative; and (7) CABG is extremely useful in the management of ischemic heart disease in selected patients.
1986, Doctor Richard B. McCelvein
Concatenations
Published in The Annals of Thoracic Surgery, 1987;43:463–8.
Doctor McElvein defines "concatenations" as the linking of events and ideas. These may occur over varying periods and in many parts of the world. For ideas to become useful, they must come into play, exist or be recognized in a social, psychological, political, financial, and moral setting.
Doctor McElvein traces the development of three important aspects of thoracic surgery and historical context. He discusses thoracic anatomy, pleural drainage systems, and the development of thoracic anesthesia. He starts at their foundations and then traces them to their current status. He points out that progress is sometimes erratic and sometimes occurs without any good plan but it is made by those who observe, record, analyze, and synthesize.
1987, Doctor J. Alex Haller, Jr
Operative Management of Chest Wall Deformities in Children: Unique Contributions of Southern Thoracic Surgeons
Published in The Annals of Thoracic Surgery, 1988;46:4–12.
Doctor Haller discusses significant aspects of the historical development and surgical heritage of certain chest wall deformities. He discusses Bifid or cleft sternum, Poland syndrome, pectus carinatum and pectus excavatum.
He points out the tenets of management of chest wall deformities in children. These are summarized as follows: These should be repaired in childhood if they are severe and progressive, generally between ages 4 and 6. The basic ingredients of repair are resection of the deformed, overgrown cartilages and repositioning of the sternum with an osteotomy, with or without internal fixation.
Appropriate credit was given to Dr Mark M. Ravitch and his contributions to the field.
1988, Doctor O. B. Harrington
Cardiac Transplantation in a Private Hospital
Published in The Annals of Thoracic Surgery, 1989;47:338–9.
Doctor Harrington presented a unique experience of 25 orthotopic transplants carried out in a private hospital from 1986 to 1988. He outlined the therapy:operative care and postoperative status of these 25 patients. Mortality was limited to three patients and the overall success rate was 88%. He concluded that this practice could be successful within the confines of a private institution not supplemented by tax dollars.
1989, Doctor Richard E. Clark
Who, Hobbies, and Heroes
Published in The Annals of Thoracic Surgery, 1990;49:515–21.
Doctor Clark states that the purpose of his address is threefold: first, to describe who we are, how many we are, what we are doing, and what we have accomplished, and what price do we have to pay? Second, to suggest that high-performance, high-stress, no margin-for-error professionals must have an outside interest, a hobby, to survive and to thrive. Third, there is a need for heroes in our lives; an image to recall to point the way and encourage us in times of trouble and to share in our triumphs.
He outlines the current status of our society and the stressful situation that we find ourselves in. He quotes from both Osler and Newton on the value of having a hobby and an outside interest. Newton states "get a hobby—preferably two, one for outside and one for inside."
Doctor Clark concludes by pointing out the importance of heroes in our lives. Heroes are our beacons in the downpours and in the fog. Heroes enrich us and inspire us to persevere and to help us realize that our lives are all worthwhile.
1990, Doctor Harvey W. Bender
Preparation, Trust, and Responsibility
Published in The Annals of Thoracic Surgery, 1991;51:352–56.
Doctor Bender points out that presidential addresses generally fall into one of three categories. The first is to present a scientific paper based on an area of his or her special interest and one that frequently chronicles important advances in the management of a disease process. The second is historical, one that reviews and documents turning points in the development of our specialty and emphasizes the important role played by previous leaders in the field. The third type is a philosophical address.
Doctor Bender emphasized the importance of the American Board of Surgery and The American Board of Thoracic Surgery plus the Residents Review Committee of each specialty in the preparation of our thoracic surgical residents. He utilizes the Johns Hopkins residency system under the director of Dr Alfred Blalock as an example of the training of future academic surgeons. He notes the changing paradigm of training in both general and thoracic surgery.
He concludes that it is the trust that our patients put in us that makes us responsible for their welfare and future.
1991, Doctor Robert M. Sade
The Different Drummer, the Double Agent, and Future Dilemmas in Bioethics
Published in The Annals of Thoracic Surgery, 1992;53:183–90.
With his presidential address, Dr Robert Sade introduces the field of bioethics into the Southern Thoracic Surgical Association curriculum. He defined the discipline of ethics that deals with the way we make choices that will enable us to achieve the good life.
He points out that the two fundamental principles of bioethics are "autonomy" and "beneficence." Autonomy means "self-rule," the right of every person to choose his or her values and act on them. Beneficence is to do what is right for the patient. The threats to autonomy and beneficence comes from many sources but are mostly economic due to spiraling health costs.
He goes into great detail with examples of autonomy and beneficence. In his concluding paragraph he points out that we must not forget who we are and why we are here. When it comes to taking care of an individual patient, we have to keep clearly in mind the principles that rise from the nature of our healing profession. In the care of the sick we must commit ourselves to seeking a single master, which is the search for the truth of what is medically best for this patient lying on the sickbed in front of us. And ultimately we must respect his vision of where his own good lies, as he, like each of us, steps to the beat of his own different drummer.
1992, Doctor William A. Cook
Unsocialized Medicine, the Decline of Surgical Collegiality
Published in The Annals of Thoracic Surgery, 1993;55:569–75.
In his opening paragraph Dr Cook states that election to the presidency of an organization is thrilling in direct proportion to one's respect for the organization, and paradoxically humbling in equal measure. No president has loved the STSA more than Dr Cook.
Doctor Cook goes on to credit the great mentors he has had such as Dr Fiorindo, Dr Simeone, Dr George Clowes, Dr Watts Webb, Dr Donald Paulson, and Dr Robert Shaw for his academic growth and achievement. He points out that in the Southern Thoracic Surgical Association, collegiality, scientific interchange, and fun for all occur in one setting. He pointed out the great tradition of the Southern such as the Osler Abbott Award and the Tiki Award.
He quotes from Theodore Roosevelt who when asked "why participate?" said: "Every man owes a part of his time and money to the business or industry to which he is engaged. No man has the right to withdraw his support from such an organization that is striving to improve the condition within his sphere." Doctor Cook will long be remembered for introducing the fishing tournament into the social events of the Southern Thoracic Surgical Association.
1993, Doctor Gordon F. Murray
Thoracic Night Lights: The Residency
Published in The Annals of Thoracic Surgery, 1994;57:263–5.
In his Presidential Address, Dr Murray traces the history of the surgical residency. He quotes Osler as stating: "If graduation meant the completion of his education, how sad it would be for both the practitioner and how distressing to his patients." The physician should illustrate the truth of Plato's saying that "Education is a lifelong process."
Doctor Murray is uniquely qualified to write on this subject having been a member and officer of all of the educational bodies of thoracic education: ABTS, RRC, and TSDA.
The surgical residency program was founded by Halstead at Hopkins in 1889. He intended to establish "a school of surgery" in which surgeons served in a training program of a defined length, with increasing responsibility, ending with a period of autonomy. Halstead declared, "we need a system which will produce surgeons of the highest type, men who will stimulate the first youths of our country to study surgery and to devote their energies in their lives to raising the standard of surgical science."
Doctor Murray then traces the foundation of the first thoracic surgical residency starting with John Alexander at Michigan. He concludes with a statement from Churchill: "Give us the tools and we'll finish the job." The tools for structuring a thoracic surgical education are knowledge, commitment, and enthusiasm.
1994, Doctor Ronald C. Elkins
Congenital Aortic Valve Disease: Evolving Management
Published in The Annals of Thoracic Surgery, 1995;59:269–74.
Doctor Elkins presented his pioneering work on congenital aortic valve disease. He traced the history of the surgery for congenital aortic valve disease and presented his life work of 256 patients operated on for congenital aortic valve disease. The report was a detailed scholarly approach to a complex problem and has become the reference paper in the field.
1995, Doctor Frederick L. Grover
The Bright Future of Cardiothoracic Surgery in the Era of Changing Health Care Delivery
Published in The Annals of Thoracic Surgery, 1996;61:499–510.
Doctor Grover gave one of the great presidential addresses when he presented a historical assessment of both cardiac and thoracic surgery but looked at what we must do to maintain our status for the future. In his summary, he stated: "It is imperative that we collect data to reflect the quality, and value of our work, and to ensure that significant quality is not being sacrificed for cost containment. We cardiothoracic surgeons must develop our own information management strategies so that we can control our future."
Doctor Grover traces the historical significance of those individuals who are responsible for his career. He traces the significant historical development of both cardiac and thoracic surgery. He then turns his attention to "the industrial revolution" in health care. He quotes from an article by Johnson who calls the current era of health care, the "economic era." He describes three historical eras of the health care industry in this century: the charitable era, the technological era, and the new economic era.
Doctor Grover reports that the effect of managed care in a challenging health care environment has been reviewed in four key articles. (Please see his own article for those references). He stresses the need for quality performance data. As you know, Dr Grover is responsible for the cardiothoracic surgical database for the Society of Thoracic Surgeons. The STS cardiac database has become the standard by which all cardiac surgeons in our country are compared. In his concluding paragraph, he quotes from Dr Kenneth Shine, President of the Institute of Medicare: "Quality is the anchor piece on which we can focus delivery during these changing health care times." Let us, as the current generation of cardiothoracic surgeons, accept these challenges and successfully carry the proud and productive tradition of our specialty into the 21st century.
1997, Doctor Kit V. Arom
It's Not Too Late to Wake Up, Be Proactive and a Leader in the Field
Published in The Annals of Thoracic Surgery, 1998;65:8–12.
Doctor Kit Arom has been one of the unique presidents of the Southern Thoracic Surgical Association. He has presented or been a coauthor on many papers in the STSA in the last 30 years. His curriculum vitae is remarkable.
In his presidential address he acknowledges those who have gone before him and have been his preceptors, and at the same time he acknowledges the value of data acquisition. He states that the "wake-up call" came in 1993 when three different payers asked surgical groups and hospitals in Minnesota to fill out their data collection forms. These forms were developed by individuals who were not adequately trained in data collection. Out of this came one of the first cardiac databases and serves as an example for many other states.
He points out that it is never too late to begin. He ended his address with a personal quote: "Surgeons who can put aside competitiveness and general feelings of mistrust for their peers or other professionals, and who are able to effect change and identify areas of improvement and act upon them, will be reformers of our current system rather than those being reformed."
1998, Doctor Hendrick B. Barner
From the University of Washington to Washington University: A Personal Journey
Published in The Annals of Thoracic Surgery, 1998;67:301–4.
Doctor Hendrick Barner describes in eloquent language his personal journey and his reasons for entering the field of medicine, and specifically the field of cardiovascular surgery. He details the influence of his father upon him and his reasons for going into academic medicine.
He points out the deficiencies of the HMO's but states that we have to learn to live with them. He points out that our economic income will decline and medicine may become more like that practiced in Canada and Europe. He adds that "the next generation of physicians will live with managed care, serve citizens with distinction, and find their own self-fulfillment in the practice of medicine. Doing the right thing for the patient will continue to define the integrity of the physician and surgeon of the future."
1999, Doctor William A. Baumgartner
Reassessing Our Core Values
Published in The Annals of Thoracic Surgery,2000;69:321–5.
Doctor Baumgartner presents a thought-provoking address comparing the core values of large companies with our core values in medicine and showing how they are similar. Core values are defined as "the organization's essential and enduring tenets—a small set of general guiding principles; not to be confused with specific cultural or operating practices; not to be compromised for financial gain or short-term expediency." Core purpose is defined as "the organization's fundamental reason for existence." He quoted from the president of Merck: "Our business success means victory against disease and help to humankind." The core values of the Johns Hopkins School of Medicine are "unwavering commitment to excellence; integrity; respect for the individual; dedication to discovery and innovation; foster leadership through education and teaching."
He points out that the most important challenge to residency training is to maintain the appropriate balance between clinical service and education. Core values of patient care, resident education, and research are not mutually exclusive. The Internet with CTS net has helped us to overcome some of these problems. By maintaining resident education, and training as core values, we can preserve our specialty and provide for the care of future patients with cardiovascular disease. He concludes that "we should be willing to do right no matter what the cost."
2000, Doctor Donald C. Watson
That Magic Moment, unpublished.
Doctor Donald Watson presented one of the most brilliant presidential addresses to date. He analyzed the STSA from the aspects which make our association unique and also the qualities that make cardiothoracic surgeons unique. He recounted two personal stories that changed his practice and career forever.
He utilizes a number of examples to show our diversity and differences. He points out that differences in generations and experience are one form of diversity in our organization. Doctor Watson points out that we must consider external realities that have an important impact on all of us. In addition, one of the basic assumptions about how and why things should be done in medicine is changing. He adds that we are under more scrutiny than ever. We are faced with the changing face of technology and the need to cope with its sequelae. The digital generation is forcing us to think in a completely different way.
Doctor Watson noted that we, as cardiothoracic surgeons, have accomplished many things that some have considered impossible. He points out that we, as cardiothoracic surgeons, have potential capabilities beyond those that we consider normal. Because of our training and our discipline we are in a unique position to experience, and facilitate what some have called "peak experience." There are times in our life when something quite unusual, even impossible, happens. He describes these times as those "magic moments."
2001, Doctor William A. Sasser
A Passion to Heal
Published in The Annals of Thoracic Surgery, 2002;73:11–4.
Doctor Sasser notes that a lot of physicians have become dissatisfied with medicine and are planning to quit. In contrast Dr Sasser points out that he personally "still finds great satisfaction in taking care of people." He summarizes his career: "I have helped many people wage battles against disease. We win some battles and we have lost others. One of the most important jobs in each of these battles was to inspire hope and to be a friend. With this philosophy, my relationships with patients and families have persevered. These relationships are the cornerstone of my practice."
In discussing doctor-patient relationships, he quotes from Dr J. Willis Hearst: "I am excited about the changes occurring at breathtaking speed. I believe however, that certain things should not change. They are honesty, trustworthiness, integrity, kindness, and caring." Doctor Sasser points out that his rules in dealing with patients are as follows: one, every patient is important; two, never lie to a patient; three, never discuss money.
He quotes a lung cancer patient at the Massachusetts General Hospital: "I have learned that medicine is not merely about performing tasks for surgeries, or administering drugs. These functions, as important as they are, are just the beginning. For as skilled and knowledgeable as my caregivers are, what matters most is that they have empathized with me in a way that gives me hope and makes me feel like a human being, not just an illness."
2002, Doctor Constantine Mavroudis
A Partnership in Courage,
Published in The Annals of Thoracic Surgery, 2003;75:1366–1371.
Doctor Mavroudis takes the topic of courage, defines it, traces its historical aspects from Plato to Aristotle and places it into the context of medicine. He defines "courage" as the individual selfless pursuit of the moral good while risking personal harm, injury, or death. The main qualities of courage are the overcoming of fear and the ability to endure. He then defines "interrelating courage" as the courage that exists between the surgeon, the patient, and the patient's family. He further defines the type of courage that drives surgeons to perform new and avant-garde operations and the kind of courage that patients exhibit when they agree to the risk of the new technology, new techniques, and new medications. He traces four examples of this type of courage that he was personally involved in from the Viet Nam War.
He quotes from Shelp, a medical ethicist, regarding the place of courage in the physician-patient relationship. He points out that the desired virtues of the physician of compassion and confidence meld with the desired virtues of the patient, namely gratitude and compliance to form the framework within which the physician and his patients will interreact. When knowledge and faith do not suffice, it is courage that bridges the gap.
He concludes by saying. "In the end, the synergy of this interrelated courage will result in the interreaction that transfers the nature of confidence, compassion, compliance, and gratitude. We will look into the eyes of our patients and see the essence of what we will do, we will feel their innocence, we will accept their courage, and we will endure with them."
2003, Doctor Joseph I. Miller, Jr
The Complete Cardiothoracic Surgeon: Qualities of Excellence
The Annals of Thoracic Surgery, in press.
Doctor Miller discusses two aspects of cardiothoracic surgery: The governing bodies of cardiothoracic surgical education and the qualities of the complete cardiothoracic surgeon in the second millennium. He points out that the governing bodies of cardiothoracic surgical education are the American Board of Thoracic Surgery (ABTS), the Residency Review Committee for Thoracic Surgery (RRC) and the Thoracic Surgical Directors Association (TSDA). He discusses the function and purpose of each as it relates to the training of cardiothoracic surgical residents.
He then turns his attention to those qualities of excellence that define a complete cardiothoracic surgeon in the second millennium. He points out that these attributes include excellent surgical skills; knowledge of cardiorespiratory physiology; teaching proficiency with a knowledge of thoracic surgery and surgical education; radiologic expertise; knowledge of health care economics; knowledge of new surgical technologies; leadership; adaptability; knowledge and history of the specialty; persistence; pursuit of a hobby; and "faith." In closing, he adds that these qualities may be summed up as scholarship, leadership, courage, and faith1,2.
Presidential addresses
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