President's Page

President's Page
February 2005

To Raise All Boats:
2005 Annual Dinner Remarks (abridged)

by Leslie H. Secrest, MD
2005 DCMS President

You, the members of the Dallas County Medical Society, are part of one of the finest physician organizations in the United States. Our membership makes us the third largest county medical society in the country, with approximately 6000 members. In fact, we are larger than many state medical societies. Our staff is the envy of all who come in contact with us. The membership of the Dallas County Medical Society is diverse and passionate about its opinions. Our diverse viewpoints, passion, and resolve about the health and the health care of Dallas County residents are our strength and allow DCMS to be an asset in our community. The Society is a resource to our community leaders and encourages the dynamic dialogue that is necessary to develop and provide the finest healthcare delivery system.

As Linda, my wife, reminded me recently that "it takes a village to raise a child," so it is with health care and its delivery. The Society should continue striving to find ways to facilitate the dialogue that will make the health of Dallas residents and the delivery of health care in Dallas an example that others seek to emulate. I propose that our Society encourage further dialogue of the type that was initiated by Lauren McDonald, MD, and the Parkland Hospital Board of Managers that she chairs when they invited leaders from other hospitals to discuss issues of mutual interest. A healthcare "think tank," as suggested by County Commissioner Maureen Dickey, should be created whose mission is to improve the health of Dallas County residents and whose vision is to facilitate the dialogue necessary to develop and implement systems that will produce excellence in health care through a community-shared goal.

Coming from a psychiatrist and psychoanalyst, this makes me suspect, but I will offer a dream for the future. God knows psychoanalysts love dreams—even fragments of dreams. My dream is a system that works on the idea that raising the water level will raise the level of all boats. What can we do to raise the water level such that all our physicians, healthcare providers, and facilities function at a higher level?

We can develop a quality improvement initiative through formation of a DCMS committee whose charge is to facilitate quality improvement and patient safety with all physicians. Such a committee might start by identifying physicians who have a particular interest in those areas. Sharing this information and these concepts quickly will raise the level of all boats, and I know of no community that has come together to do so. Much like the airline industry and nuclear power industry in the past, we have the opportunity to change how complicated systems work, and, through these changes, produce safer patient care and healthier people.

One of my concerns in our rhetoric about improving health care is the idea that we will get there, safe and sound, through "evidence-based medicine." I submit that few people can describe "evidence-based medicine," even if it accosted us in broad daylight. It takes awhile just to appreciate the adage, "The absence of evidence is not evidence of absence," much less, know how to apply 95-percent confidence levels to indicators we follow routinely. Most anything the Quality Improvement and Patient Safety Committee might do could be expected to raise all boats in the practice of medicine.

The last area that allows us to work together to raise all boats is legislative initiatives. When the voice of the Dallas County Medical Society is united about an issue in health care that affects our patients, the impact is unbelievably strong. Think about the number of patients with whom our 6000 members come in contact on a daily or weekly or monthly basis. Realizing that some members see no patients and others see 20 or more per day, let's choose 10 as the average number of patients a physician member sees each day. In one day our membership would be in contact with 60,000 people. At the end of a five-day work week, that number would be 300,000. If we assume that few patients from the first week are seen the second week, at the end of the second week we would have had contact with 600,000 patients—not counting any other individuals involved with a single patient. No other group in the community has the potential to have personally visited with 600,000 people in two weeks. United and organized, we are one of the strongest grass-roots voices in Dallas County, a strong voice in Texas, and a significant voice in the nation. At times we may ask whether talking to our patients about a legislative issue affecting health care is ethical or appropriate. I submit that to be silent about a legislative healthcare issue is unethical. We need to actively seek and identify issues about which we can speak with a united voice and which will raise the water level and raise all boats.

It is my wish that 2005 will be an active and productive year, and we will look back with the realization that we had a good time in the process. I want to thank you for asking me to serve as your President. I look at the opportunity with a level of anxiety and humility for I must live before you what I have tried to help my patients discover. We must tolerate not knowing and approach not knowing with the confidence that we will manage the situations that come our way. As I look back at 121 past Presidents, the Heath Award and Max Cole Award recipients, I am awed by their courage, leadership and ability to solve the situations life brought their way.

So again, it takes a village to raise a successful DCMS President. There are too many of you to mention individually who have mentored me, nurtured me, been firm with me, and helped me discover knowing myself and in so doing, helped me become a better human being. I also thank God for the many blessings I enjoy and the wisdom, strength and courage to pursue a career in medicine.

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