Installation Speech
Robert P. Roca, M.D.
Let me start out with thank you’s. First thanks to
you, Gary, for your leadership over the past year and especially to your
exemplary commitment to volunteerism. Thanks to Neilson Andrews, our Executive
Director, who manages the organization so thoughtfully and so cheerfully, and to
Josette Fullard, her assistant.
Thanks to our hosts, first to Dr. Jim Truscello, the
head of the Forbush school, to Dr. Steve Sharfstein, the 5th
president of Sheppard Pratt, which as you may know was the only hospital in
Baltimore County when this organization was founded in 1897, and to Byron
Forbush, the chairman of the Board of Sheppard Pratt, former headmaster at
Friends School in Baltimore and the man whose name is borne by this school where
we gather tonight. I also want to
thank my wife of 30 years, Breon Gilleran, and my children, Peter and Julia, for
their love and forbearance.
And of course thanks to everyone who came out to the
country to celebrate tonight. As you
were driving I hope you were able to appreciate the natural beauty that is so
characteristic of northern Baltimore County and of this campus.
But I can imagine that while en route you may have asked where ARE we
going?
Well here is the answer.
This is the site of a day school for children K-12 from across the region
who have emotional disturbances too severe to allow for their education in the
public school system. It has a
teacher/student ratio of about 1 to 8. The
school was formerly on Sheppard’s Towson campus and moved here in 2009 when
GBMC acquired the buildings in which the school was housed.
Prior to the arrival of the Forbush School, this was the preschool and
elementary school for Beth Tfiloh.
How did we happen to meet here this evening?
I could say it was my idea, but that would not be completely true.
Like many of the interesting ideas I’ve encountered in my life, this
one came from my wife. Why not have
the party at the Forbush School, she said.
And I thought, indeed, why not? So we
decided to proceed with this. But,
you may persist, why have it here?
Why
have the party in a school cafeteria in the country?
That’s a fair question.
One answer came to me recently and involves a brief
history lesson. Baltimore County is
now part of a sprawling metropolitan area. You
pass from the city to the county transparently.
But things were not like that in the 1890s.
The city and the country were very different.
The city was where the institutions were, where most of the people were.
As a physician practicing in the city, in the words of one historian, you
had “hospitals and dispensaries and could take advantage of post-graduate
courses, consultations and libraries”. These
things were not available to physicians practicing in the county.
There was limited opportunity for continuing training after medical
school, no specialists, no groups, little occasion for collegiality.
And transportation was difficult. It
could be a lonely experience.
So on April 15, 1897, 18 physicians gathered for what
would be the first meeting of the BCMA. By
the end of the year 41 physicians had joined and agreed to meet monthly at 2:00
p.m. on the third Thursday to talk about the medical news of the day and in some
cases take up legislative causes in the service of the public health (e.g., 1897
advocacy for county legislation requiring that cesspits be watertight to prevent
disease due to leakage . . .). They
met in modest public spaces like the Grange Hall, Colling’s Hall, and
Tracey’s Hotel.
So here we are 113 years later gathered together in a
modest space: a school cafeteria in the country, a setting our forbearers might
find familiar. This may be just a
flight of nostalgia; after all, the world is very different, and medicine is
very different. But the life of the
doctor is in some ways not that different. Many
of us still practice very independently and have difficulty connecting to each
other, particularly those who do not practice in the same office or specialty.
Now, as in those days, BCMA and similar groups are a
countermeasure to that isolation. And
that is important to us as physicians and human beings and it is also important
to the people we treat. Organizations
like this one have several roles, but none is more important than their roles as
connectors of physicians to one another - for our benefit and for the benefit of
our patients. These themes - service
to patients and service to each other – are both embodied in our BCMA mission
statement. And these same themes are
also at the core of the Hippocratic promise we make when we become physicians,
the promise to do our best for our patients but also to look after our
profession and each other.
As we go through our careers we might from time to time
think about how we are conducting ourselves as physicians and ask ourselves
whether we are delivering on our Hippocratic promise in all its aspects.
And as we think about our organizations – including the BCMA – we
might ask the same thing: are they serving our patients, our fellow physicians,
and our profession itself?
You heard from Gary about our accomplishments of the
past year, and I would say that BCMA has been on the right track.
And I would say now let’s keep it up.
Here are some ideas for the next year:
First, we can advance our service to our patients.
How might we do this? Integrating
and coordinating the care we provide is a critical part of doing a good job for
our patients, particularly those who have multiple chronic diseases and many
doctors. It is relatively easy to
see how this might be accomplished in an integrated system, such as the VA, but
it is more difficult to accomplish coordinated care in the community,
particularly in a community of individual or small practices like ours in
Baltimore County.
At this point, ideas like medical homes and accountable
care organizations are just ideas. We
don’t know if or how they will work. I
think that those of us who care for patients every day have ideas about how to
better coordinate the care we provide. We
know the obstacles and the opportunities.
I would like to propose establishing a multispecialty
task force to look at how we might improve clinical communication among
physicians in Baltimore County and perhaps throughout Maryland.
I have ideas about how we might do this by both high tech and low tech
means and by special CME events. This
is an effort that we might want to organize in concert with the Quality of Care
Committee of MedChi. We might want
to do this in league with state specialty organizations representing psychiatry
and geriatric medicine for sure and perhaps pediatrics and family practice as
well.
We also have an obligation to serve our colleagues and
the profession. How might we do this? I
think there is a need and an opportunity to find ways to support our colleagues
who are enduring some some of the extremely stressful experiences that are
occupational hazards of medicine, e.g., being sued.
This might be an opportunity for the Center for Healthy Maryland and the
Maryland Foundation for Psychiatry to work together.
Dr. Priscilla Ray, former chairman of the AMA Council on Ethical and
Judicial Affairs, helped set up such a group in Harris County, Texas with great
success. If we get this off the
ground in Baltimore County, it could be expanded to our sister components.
There
is more. In a time of great turmoil,
we must remain vigilant about legislation and regulation that may favor the
narrow interests other players. We
need to be assertively at the table representing the reasonable interests of
physicians, who are after all the backbone of the health care system, perhaps
the only players in the system who accept “buck stops here” accountability.
We need to make sure physicians don’t get short changed because they are not as well
organized or financed as other interest groups.
We must continue to push for initiatives that address
the physician workforce crisis in Maryland, including current initiatives such
as assignment of benefits, but also more far-reaching initiatives such as those
aimed at improving recruitment of young physicians, so that those we train in
Maryland stay in Maryland. We need
to know why trainees leave Maryland and we need to take action at the state
level to retain them.
This sounds like a lot of work, but we can do it.
We have an energetic and committed team.
It will require effort; that’s the way it is with all important things.
I often think of a line from a song by Bruce Cockburn: “Nothing worth
having comes without some kind of fight; you have to kick at the darkness “til
it bleeds daylight.” I find that
an inspiring line when things get tough. But
you need more than words when facing big challenges.
You need images. Even
better, you need a mascot.
So tonight in closing I am revealing my
mascot, but first I must tell a brief story.
In mid December my wife received a call out of the blue from someone in
the Raven’s organization asking if she could sculpt, on very short notice, a
Christmas present for John Harbaugh, the head coach of the Ravens, who are of
course domiciled in Baltimore County.
It turns out that the Coach was inspired
by the Biblical story of Nehemiah, a prophetic figure who was both a creator and
a warrior, a builder and a defender, and he referred to the Nehemiah story in
his talks to his players. The Ravens
staff wanted to give the Coach an artist’s interpretation of this biblical
figure. So here is what Breon built,
and what was delivered to Coach Harbaugh on December 23: a sculpture of a man
bearing both the shovel of the builder and the sword of the defender, at work
building the wall protecting Jerusalem. This
was Coach Harbaugh’s gift. But to
my mind it’s a worthy (and completely unofficial) mascot for BCMA for the
year. Like Nehemiah, like the Coach,
we look forward to the year ahead, accessorized for what comes at us.