Presidential address: Communications and communicating effectively
1991; Elsevier BV; Volume: 13; Issue: 2 Linguagem: Inglês
10.1016/0741-5214(91)90210-l
ISSN1097-6809
Autores Tópico(s)Medical and Biological Sciences
ResumoYa-Ta-Hey!—with apologies to native Americans as well as afficionados of John Wayne movies. Buenos Dias, Bonjour, Buon Giorno, Dobro Dan, Dzień Dobry, Guten Tag, Kaliméra, Kon nichi wa, Naharak Sa'eed, Nín Hăo, etc. Being able to understand a language is an obvious prerequisite for effective communications. Having parents with multilingual talents and a personal challenge in learning to speak English I have been acutely aware of the barriers affecting communications. The United States of America has frequently been called a “melting pot.” Slightly more than 200 years ago our Founding Fathers gave serious consideration to German as our national language. Spanish is now becoming an important second language. French and English are official languages in Canada. Many languages abound within our borders spoken by recent immigrants. Our membership roster contains names that represent our expansive worldwide heritage. With the world rapidly shrinking, with our populations increasing, with war being outmoded in many ways, and with the conquest of many devastating diseases there is more of a mandate than ever for us to communicate effectively. When I was questioning a patient 11 years ago in an attempt to determine the cause of recurrent and severe headaches, he asked in turn, “Doctor, wouldn't you have headaches if you had the responsibility for 175 million people living on more than 30,000 islands representing five major religions who spoke more than 300 dialects?” We are the International Society for Cardiovascular Surgery (ISCVS). Medicine in western civilization has many derivations from both Greek and Latin terminology. Contributions from the Arab speaking world, China, India, and Japan are widely known. Additional contributions from ancient civilizations including the Aztecs, Egyptians, and Incas have also been described. The study and practice of medicine and surgery have always been international. The Hippocratic oath, as we are informed by those who provided translation from the original Greek, contains the abmonition to new physicians to communicate properly. Other well-known documents, particularly related to communicating the desires for personal freedom, would include the Magna Charta (1215) and the Bill of Rights (1775). Speeches such as Lincoln's Gettysburg Address are widely recognized. Circumstances, timing, and later repetition have contributed to knowledge and memory of specific comments such as those by President John F. Kennedy in Berlin (1961) and Dr. Martin Luther King's “I Have A Dream Speech” in 1962 in Washington, D.C. with many others of equal importance too numerous to include. Recognizing that there have been few days in recorded history of the world where there have not been one or more wars in progress, breakdown in communications or the inability to communicate effectively have been major contributing factors. In our dedicated efforts to provide the best care possible for those who have the misfortune to suffer from vascular disease and injury we have an additional opportunity and responsibility to communicate effectively and efficiently worldwide. I have chosen to review “communications and communicating effectively” in part because of the recent exciting events in many locations of the world and in part because of the remaining challenges for all of us as citizens of the world. Representative of the former, who could have imagined in recent years the rapid fall of the Berlin Wall as witnessed through the eyes of my 20-year-old daughter on New Year's Eve of this year! Hunger, representative of the latter, remains a significant challenge in many areas of the world affected by changing climatic conditions, economic limitations, expanding technology, and social strife. Communications—(1) the act or process of communicating; (2) the imparting or interchange of thoughts, opinions, or information by speech, writing, etc,; (3) something imparted, interchanged, or transmitted; (4) a document or message imparting information, opinion, etc; (5) a passage or means of passage between places. (Random House Collegiate Dictionary. New York: Random House Publishing 1975.) Obviously, the subject is complex with a multitude of ramifications. I will attempt to emphasize selected areas of particular concern and importance to us as vascular surgeons. Of the many challenges confronting those in health care delivery today is the most basic ability to communicate effectively with patients. It is widely recognized that the “doctor-patient relationship” has changed dramatically in this century. Many factors are involved, and it is beyond the scope of this endeavor to attempt to provide an analysis. Instead I would like to challenge all of us to continue to make a supreme effort to maintain appropriate and effective communications with those to whom we are dedicated in service. Any physician who has also been a patient might have additional empathy and tolerance toward even the most demanding of patients. We must strive to improve communications among our colleagues. This is a continuing challenge for all of us recognizing that we have not always been particularly successful. It is in our own best interest to communicate effectively, and our profession will benefit. These efforts to improve communications must extend to our peers in many other professions including the legal profession and to those in industry. The ultimate benefit is to our patients. All too often complaints and criticism result in counterproductive actions and activities that benefit no one. As life becomes seemingly more complex every day, cooperative efforts and support for mutual benefit are increasingly important for future survival. Diplomacy and mediation are extremely valuable components in communicating effectively. Differences in opinion can usually be resolved equitably at the same time we maintain the opportunity for individual expression and innovative thoughts. An important ISCVS commitment and investment for the future is through the Student Fellowship Awards, first under the direction of Dr. James Stanley, and carried on under the direction of Dr. Robert Smith this past year, which will assist those who will represent our future. We are hopeful we will be able to help them learn how to communicate effectively. Possibly one of the most challenging areas of communications by physicians is with government activities at all levels. Having had 30 years of experience I have found that the federal system is frequently maligned by the frustrating analysis of the various phases of response to communications. The first is to ignore any requests; the second is to respond by answering “no” because that is the easiest and it should stop the request; the third, realizing there may be some merit to the request or that the requestor may have some political clout, is to respond by offering to help and then doing nothing; the fourth is to begin to make an attempt to answer the question; and, the fifth is to develop a true interest and appropriate response. A former Walter Reed hospital commanding general and remaining member of our faculty, Dr. George Baker, shared a few thoughts with me regarding communications, and the merit of the following approaches might be considered when the frustration titer reaches its zenith:•COMMUNICATIONS•When in Charge → PONDER•When in Trouble → DELEGATE•When in Doubt → MUMBLE It has been documented repeatedly and is well known that governments should be for the people, by the people, and of the people. Thomas Jefferson, Abraham Lincoln, and others have stressed that governments should serve the people. In our democracy we have the freedom to communicate our views and to elect those who have similar views. Although this privilege has been abused to a minor degree, the freedom to communicate an expression of one's personal opinions is one of the most cherished personal possessions. We must be more willing to work within established government bureaucracies or others will dictate to us. Fortunately, there are an increasing number of responsible individuals in government organizations who are willing to listen to those who are experts, such as in our specialty of vascular surgery. It is in our best interest to respond when a request for assistance is received from government offices. The importance of communications is cited frequently; however, reemphasis attests to the remaining challenge of communicating effectively. In a new emerging society in 1990 all four documented goals require effective communications, and one stated goal was “to overcome serious barriers in communications.” Knowledge and understanding are important, nevertheless, implementation and retention are equally important. Articulate, concise, and accurate communications are mandatory in scientific exchanges. Intellectual and personal integrity of the highest order are mandatory. Whereas there is a universal understanding of the importance to continue to study throughout a medical career, we should all remind ourselves that this study should include efforts to improve our ability to communicate at the highest scientific level possible. In medicine with a constant search for truth being of the highest priority it does require maintaining an open mind with an interest in continued learning. This requires evaluation and reevaluation even in areas where there has been general acceptance of information and/or principles. Communicating effectively requires an ability to also listen to the comments and recommendations of others with a sensitive understanding. Maintaining flexibility and a willingness to change when appropriate is aided by an ability to communicate effectively. Obviously, communicating with highly educated and experienced individuals has merit. Nevertheless, everyone who has something to communicate warrants appropriate attention and consideration. Even the most insignificant-appearing information may be of value to the investigator whether in the clinical setting or in the basic research laboratory. With the tremendous explosion of information available, however, an ability to select and retrieve critical information at the appropriate level of priority is becoming increasingly challenging. Although extensive reference lists can be generated by computer today, specifically from the last decade, there is danger in overlooking valuable information and experience from the recent past including that of many of our members. One positive option for the future is based in computer programming, yet this remains an area where many have not achieved a comfortable ability to “communicate.” Technology is advancing at a rapid rate, which should provide more user-friendly equipment for all of us to be able to expand our communicating abilities in the future. We do recognize and appreciate the limitations of human mental capacity, and it is obvious that the computer provides an important extension for our abilities to retain and retrieve information that is pertinent to a specific problem or question with this required information available within minutes. The use of facsimile machines to communicate has expanded in an explosive manner in the last several years to the extent that one message was received recently stating “in the future please communicate with me only by FAX”! A review of the presidential addresses of our Society provides an important perspective regarding the original goals, changing objectives, and valuable contributions of our membership. I have had the privilege of knowing all but one of the past presidents, and I have enjoyed personal exchanges on numerous occasions under a variety of circumstances with most of them. Early positive influence at Stanford came from Drs. Emile Holman, Frank Gerbode, and John Connolly. Drs. Harris Shumacker, Charles Rob, and John Foster have been kind enough to work with me on our full-time faculty in my current responsibilities. Drs. Allan Callow and George Johnson participate on our clinical faculty, and many others from Dr. Geza de Takats to Dr. Ronald Baird have been kind enough to serve as visiting professors for us. Dr. Michael DeBakey has provided sage advice as a senior advisor, and Dr. Frank Spencer provided expert professorial guidance in helping me write Vascular Trauma. All of our past presidents have communicated effectively in a variety of ways. We all know and appreciate the dedicated and effective efforts of our ninth president and the man we honor at our 1990 joint meeting SAVS/ISCVS(NA) meetings as a surgeon, scholar, and editor of the JOURNAL OF VASCULAR SURGERY, Dr. D. Emerick Szilagyi. A unique aspect of the early years of our Society was that a president served 2 years. President Harris Shumacker, our fourth president, identified in 1958 that he had the unique responsibility of delivering two presidential addresses, therefore, he elected a more philosophic approach for the second to follow his first on a scientific subject. He reviewed what he termed “Human Values in Medicine.” He encouraged surgeons to spend time talking and listening to their patients and families. He also identified more than 30 years ago our unique position in medicine, which permits us to know and have exchanges with individuals from other nations. Through these communications we all recognize that we have similar interests and objectives. Dr. Shumacker2 stressed the following: “From our acquaintance with him (the international surgeon) we realize that, though government policies may vary, people everywhere have the same yearning for a peaceful, happy, healthy, productive life.” It is, also, becoming increasingly obvious with more frequent demand for “response to crisis” that any organization with one annual meeting of the membership and two annual meetings of the Executive Council has significant limitations. Reasonable effective communications can be and have been used and maintained through a variety of systems. As in any democratic organization those elected to office should respond appropriately to the constituency. Establishing and maintaining effective communications remains a formidable challenge. The dedicated and sincere efforts of the Executive Council have been augmented and complimented by concerned members who have served on committees and who have offered suggestions and assistance in a variety of ways. There will be further comment later on the important addition of a representative from the regional vascular societies to the Executive Council to complement the representative from the American College of Surgeon's Board of Governors. These two identified members have the critical and somewhat overwhelming responsibilities to expand and improve communications. When varying opinions exist, as has been the experience, it is necessary to attempt to develop a consensus noting minority positions appropriately in communicating for the Society. Developing the consensus to be communicated is not always easy. The concerns of those in private practice differ from those in academic surgery, and many other differences could be identified as priorities are established by individuals and for our Society. Past president James DeWeese (1985) queried the membership with a detailed questionnaire in an attempt to identify areas of concern and to establish a priority listing of those concerns. Past president George Johnson (1986) used the detailed questionnaire approach in a different format. In an attempt to complement these important efforts I have contacted directly approximately 25% of our membership whom I have had the privilege and pleasure of knowing. In addition to an invitation and request in writing, contacts and follow-up were made by personal meetings and telephone exchange. In addition to the important reference material cited, Dr. Henry Hamiovici has provided us with the early ISCVS history. Internationally, we in the ISCVS have not been particularly effective in our ability to communicate and exchange with other surgical disciplines as witnessed by the separate biannual weekly meetings. Many disciplines meet at the time of “surgical week” every 2 years. There are some of us who believe that there was considerable gain when ISCVS was included, and we should continue to communicate our concerns and questions for the future as we contend with increasing demands and decreasing resources. We are proposing that our North American ISCVS chapter provide additional support for other ISCVS chapters, and this will be coordinated with the assistance of ISCVS president, Dr. John Ochsner. One aspect of the proposal will be to have an official representative attend the annual meetings of the other chapters to represent all of us in the North American Chapter of ISCVS. Despite differences in objectives and organization the combined efforts of the Society for Vascular Surgery with the North American Chapter of the International Society for Cardiovascular Surgery have been mutually beneficial and supportive. The abilities and desires of the two program committees have had several changes in directions and emphasis. Nevertheless, and despite this and other limitations of the negative side on the ledger, there have been many positive accomplishments. The annual combined meeting has become the most important exchange opportunity in the world for those interested in the management of patients with vascular disease and injury. A challenging question for all of us that has been raised independently by a number of members is why we have not been more effective in creating an entire week of complimentary activities and programs with an emphasis on the management of vascular disease and injury. The management of vascular trauma is covered frequently in more detail in other meetings at other times of the year. I will return to the American Venous Forum, however, after an abortive attempt to coordinate activities this important component of our specialty was separated and moved to another time of the year. Similar to the establishment of two bodies within government such as those within the Congress of the United States, ISCVS and SVS can maintain individual identity and direction at the same time that communications are maintained and improved for mutual advantage. With representatives who frequently change in the offices of the two Societies represented on the Joint Council the actual original agreements are not well known nor understood. To improve communications an effort is currently being made to inform those involved, confirm and expand agreements, to establish a memorandum of understanding, and to identify future options to maintain appropriate knowledge for all involved. The JOURNAL OF VASCULAR SURGERY, which has developed into the premier journal for the management of vascular disease and injury within the first few years of its existence, is an accomplishment of which both societies can be justifiably proud. The leadership of our eighth president, Dr. Michael DeBakey, as the first editor, followed by that of our ninth president, Dr. Emerick Szilagyi, complemented by the effective support of the associate editors and the Editorial Board with the support of the Joint Council and its Publication Committee are all noteworthy. Nearly 15 years ago the Joint Council of ISCVS/SVS agreed to the establishment of a forum with officers and representatives from regional vascular societies. Because the forum was determined to be a valuable exchange confirmed on an annual basis this forum was held annually for 10 years. Communications that rely on definitions can be confusing, and this has been and probably remains an additional challenge. Approximately 4 years ago most of the officers and representatives from the regional vascular societies determined that there were essentially five “sectional” vascular societies representing the Eastern, Midwestern, Southern, and Western sections of the United States and Canada in general. A representative from each of the five sections was selected with a chairman to communicate for all involved. This individual, Dr. Jonathan Towne, was invited to be an active participant in the activities of the Executive Council of the North American Chapter of the International Society of Cardiovascular Surgery after discussion by the Joint Council and with concurrence of the Society for Vascular Surgery. A very important communications link an opportunity has been established. From the minutes of the meeting of the Editorial Board of the JOURNAL OF VASCULAR SURGERY, June 12, 1988, in Chicago, Ill., the Editor, D. Emerick Szilagyi, MD, documented the following, “The association with the regional vascular societies has continued to be mutually beneficial. It has provided for the regional societies a forum for publishing selected articles on their programs. The JOURNAL has greatly benefited from a supply of manuscripts generally of good to excellent quality.” The Joint Council of ISCVS/SVS created a committee to study establishment of an appropriate exchange or forum for venous disease and injury under the chairmanship of Dr. John Bergan. The ultimate decision by the Joint Council was to encourage establishment of an entirely separate organization which was accomplished. Initially, efforts were made to have the meeting contiguous to the annual ISCVS/SVS scientific exchange; however, there was concern about extending the commitment of time and resources. The two annual meetings of the American Venous Forum, first in New Orleans last year and in San Diego this past February were successful beyond the hopes of the founding members. A significant question related to communicating effectively, however, is related to where manuscripts from annual presentations should be submitted for publication. Recognizing that many disciplines including dermatology, medicine, and radiology share an interest in the management of venous disease, there has been a general belief that a broad exposure should be critical in determining the best format for publication. Current American Venous Forum president, Dr. Lazar Greenfield, and his Executive Council have the challenging decisions in establishing and developing appropriate options. Another question that might be presented concerns the future consideration of including these activities in an annual “vascular week.” The ISCVS/SVS collaborative efforts with the National Institutes of Health for an annual February research exchange has been extremely successful and valuable and a combined effort for which we can all be proud. The leadership of Dr. Frank LoGerfo complemented now by the leadership of Dr. G. Patrick Clagett provides a truly outstanding opportunity for communicating the most recent basic and clinical research activities and thoughts among our colleagues who are dedicated to providing the best possible support for those who have the misfortune to suffer from vascular disease and injury. The combined activities of ISCVS/SVS have supported the important activities of the National Association for Biomedical Research, which represents the scientific community in legislative issues related particularly to important and even critical live animal research. ISCVS/SVS Joint Council efforts have addressed and continue to work on a variety of challenges of interest and concern to vascular surgeons. Although not successful with every effort the record will attest to the increasing effectiveness in communicating appropriately to achieve desired goals. My SVS counterpart, President William Fry, has reviewed standards for us in detail based on his vast experience. Ethics and morality were reviewed in January of this year by President Garrett of the Southern Association for Vascular Surgery in another important message for all of us. The medical-legal problems in our litigious society, soaring health care costs associated with rapidly expanding and expensive technology, personal economics for physicians including physician reimbursement, recruitment of highly qualified students into medicine, the retention of trained physicians, maintaining quality assurance, and continuing education with the explosion of information available are only selected aspects of the current challenges for those interested in vascular surgery. Public relations and the “image” of physicians has been of particular concern and focus. Recognizing that other medical specialists have been highly successful in marketing themselves, we have found there is concern about advertising and the realization of economic limitations. Based on memorable and recorded human experiences that are myriad, would it not be as easy to be diplomatic making an effort to be considerate and cooperative in contrast to jumping to a confrontational mode? What do we elect or prefer to recall—pleasant memories or nightmares? In the combined ISCVS/SVS activities we have had our share of confrontations and disruptive activities that we accept, protecting the opportunity for questions and dissenting views in search of the ultimate truth or the common good. Nevertheless, we can be justifiably proud of the numerous accomplishments of our combined efforts that have established a broad foundation adding to the outstanding pioneering experiences of those who preceded us while we recognize the remaining formidable challenges for the future. It does not matter what our individual opinions might be or which direction we elect to pursue; it is in our common best interest to communicate as effectively as possible to preserve limited and dwindling resources in our efforts to be as constructive and positive as possible in meeting the goals in our profession to provide absolutely the best care possible for those who suffer from vascular disease and injury. As members of the medical profession we have the unique opportunity to communicate freely using a common language of dedication as we search for the truth scientifically to help those who suffer. Yet, this also creates additional responsibility for us to be effective in our actions and efforts. We might think of the many roots of the banyan tree that provide mutual support for the main trunk, as identified by an international friend for me. We should concentrate on the many features that make us similar instead of focusing on divisive factors that make us different. Instead of accepting excuses for why tasks have not been accomplished we should concentrate on how we should find ways to achieve our goals. Our future is bright because we have many talented and enthusiastic young men and women who are willing to accept the challenge to be diplomatic and positive in continuing to build on the firm foundation that has been established by those pioneers in international vascular surgery who preceded us. Best wishes to them, many present today, and my sincere gratitude to all of you: my family, my friends, and my colleagues—thank you!
Referência(s)