Special Reports |

Presidential Address—CHEST 1998* FREE TO VIEW

D. Robert McCaffree, MD, FCCP
Author and Funding Information

*From Dr. McCaffree is Chief of Staff at the VA Medical Center, and Professor of Medicine in the Pulmonary Disease and Critical Care Section at the University of Oklahoma Health Sciences Center, Oklahoma City, OK; and he is past president of the American College of Chest Physicians (1998).

Correspondence to: D. Robert McCaffree, MD, FCCP, Department of Veterans Affairs Medical Center, 921 Northeast 13th Street, Oklahoma City, OK 73104-5028; e-mail: robert-mccaffree@uokhsc.edu

Chest. 1999;115(4):1155-1157. doi:10.1378/chest.115.4.1155
Text Size: A A A
Published online

Let me begin with a statement of gratitude and a series of thank-you’s to many, many people. First, I should thank all of you for allowing me this year’s stewardship of the American College of Chest Physicians (ACCP). It has been a stimulating and rewarding year personally. I need to thank some of my mentors, especially Drs. Deborah Shure and Bart Chernow, my immediate predecessors, and Dr. Allen Goldberg who will take the reigns of the College this evening. I also thank Dr. Mark Rosen and the 1998 Program Committee for the truly outstanding scientific program they have organized this year. I also thank all of my partners in the pulmonary section at the University of Oklahoma. There were many times when I was called away at the last minute, and these occasions seemed to occur only when I was on-call. My partners in the pulmonary section, lead by Dr. Gary Kinasewitz, have never failed to respond to provide support for me this past year. I owe all of them a great big thank-you—and a great many weekends. Most importantly, I thank my family, my constant source of joy and support, and the ones that have taught me the most important lessons of life—our children, Sara and Matthew, and my wife and life partner for almost 30 years, Mary Anne. This has been an extremely busy presidential year in the McCaffree household since Mary Anne became the President of the Oklahoma State Medical Association, the first woman to hold that position. Finally, I want to thank the staff of the ACCP. Let me say that our Executive Vice President, Al Lever, has assembled a truly outstanding staff. They have made this year much more pleasurable and doable with their enthusiasm, understanding, help, energy, insights, and synergy they bring to the job.

This has been a full year with many more accomplishments than I can cover here. But let me summarize a few of these to give you a flavor of some that your College is doing for you. First, I think that I can categorize all of these accomplishments with two words—value and vision. We have tried to bring great value to your membership, not only from the monetary perspective, but from the perspective of what you have told us your needs and expectations are. We have also tried to direct our activities with a vision toward the future and a proactive approach toward what we think the future may hold. A few of the areas of accomplishments that I want to mention include our strategic plan, alliances and collaborations, community service, public health advocacy, public policy advocacy, international activities, and The Chest Foundation. First, approximately 1 year ago, some of us met to reevaluate, and in fact, completely restructure our strategic plan. The plan is ambitious and aggressive. We have identified the following nine major goals: first, to enhance the education of our members and others; second, to fulfill our role in health advocacy; third, to increase membership growth and participation; fourth, to foster support and reward clinical research; fifth, to establish global partnerships and networks; sixth, to develop and maintain effective marketing and public relations; seventh, to build and maintain an effective organizational structure; eighth, to ensure the financial liability of the ACCP; and ninth, to embrace state-of-the-art technology. Each of these major goals has several strategies underneath it. This strategic plan was meant to be a living document and we have, in fact, reevaluated and altered the document since it was initially developed.

Next, we feel that building alliances and collaborations with other groups of similar interest is important for our members and for their goals. Some of these alliances and collaborations include the Effective National Action to Control Tobacco (ENACT) Coalition, a coalition of which we were a founding member and containing approximately 45 public health organizations brought together to advocate for congressional passage of part of the proposed tobacco settlement last year. As you know, we were unsuccessful with that, but the coalition remains committed to advocating for significant aspects of that settlement plan. For the last several years, we have met with the leadership for the Society of Critical Care Medicine (SCCM) on issues of mutual concern. I am pleased to announce that in the area of education, our first combined critical care examination review course will be held in Orlando in August 1999 in conjunction with the SCCM. We have also worked with the SCCM and the American Thoracic Society (ATS) on public policy advocacy issues. Recently, we have reached an exciting agreement with the Mayo Clinic to work with them on their worldwide tele-education network to present programs of interest to our members. We have worked with and had discussions with other organizations such as the American Association of Respiratory Care, the American Association of Physicians of Indian Origin, the World Health Organization, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Agency for Healthcare Policy and Research, the European Respiratory Society, and the American College of Allergy, Asthma, and Immunology. We feel by strengthening these alliances and collaborations, we continue to add value to your membership. Next, when I took office last year, I stated that I wanted the ACCP to serve as a forum and to highlight models for community service, such as the Chicago Asthma Consortium, one of the most successful community alliances directed toward this very important public health problem. In developing these ideas, Dr. Dan Banks, then our Governor from West Virginia, asked us how we recognized our members. At that point, a light went on and I asked Dr. Banks, Dr. Rosenow, and Dr. Goldberg to develop criteria for a Community Service Award Program. I am pleased to announce that we will be presenting our first two Community Service Awards to two of our members later on this week. In the area of Public Health Advocacy, I have already mentioned the ENACT Coalition. We have also become partners with the World Health Organization and their tobacco-free initiative and are a founding member of a new coalition called ACT. This coalition is directed toward transnational control of tobacco products. And finally in this area, let me highlight what I feel is one of the most significant programs that we have developed, and that is our Women & Girls, Tobacco, & Lung Cancer educational program. This program has been developed by our Women’s Health Task Force headed by Drs. Diane Stover and Carolyn Dresler and is an outstanding educational program directed at a very vulnerable population. In the area of public policy advocacy, we have partnered with the SCCM and the ATS in areas of evaluation and management documentation guidelines and critical care reimbursement issues. Our College is, in fact, an international college, and we have developed some exciting new concepts regarding educational programs in support of efforts being developed by our international members. We have also worked on developing new models for membership for our international members recognizing the huge financial discrepancy present across the world which provides a significant hurdle to membership in some areas of the world.

Finally, let me mention the accomplishments of The CHEST Foundation. As you know, this is the philanthropic arm of the ACCP. Some of the issues upon which The Foundation has focused, include end-of-life issues, smoking cessation, asthma, tuberculosis, the mini-residency awards, and various research and educational awards. At our last meeting, The CHEST Foundation, at the suggestion of one of our Regents, Dr. Udaya Prakash, approved a challenge grant to provide relief for the people who suffered the tremendous devastation of Hurricane Mitch in Nicaragua and Honduras. This grant matches dollar for dollar contributions from our members for this relief effort. The initial grant was for $10,000. This was raised to $15,000 by one of our members, Dr. Sukhdev Grover. I am very proud that The Foundation has taken this step, and I urge all of you to contribute to this matching fund which will provide a minimum of $30,000 for these relief efforts.

Let me present a very personal view of what I view as the most important forces shaping the challenges to the ACCP in the future. Let me begin with three separate observations. First, I have heard our members say, “We support what you are doing for tobacco control and other issues, but we are struggling day-by-day to provide care to our patients. We are suffocating under paper, and we are only allowed 7 min—not 15—in which we are to see our patients. Next, for every dollar spent on traditional health care, two dollars are spent on alternative approaches, most of which have little evidence of efficacy. Why? Obviously, people get some element of satisfaction. Third, Krause1 in his book, Death of the Guilds, points out that most decisions have been taken out of the hands of medicine and have been placed mostly in the hands of the market, and to some extent, in the hands of government. This is certainly no surprise to any of you. The problem is that the values of the market are frequently in conflict with the values of medicine—values such as compassion and caring for all.

The most common theme of all of these observations is that there are many forces attacking the very heart of medicine. What do I mean by the heart of medicine? At its most fundamental, it is a relationship between two people—the person who is diseased, who brings to the relationship his “wounded humanity” in a phrase of Dr. Edmund Pelligrino (Director of the Center for Clinical Bioethics, Georgetown University Medical Center), and the healer. This relationship is a contract, an agreement, a statement on a part of one saying, “I will share with you not only my discomfort but also my greatest fears and concerns,” and a response on the part of the healer saying, “I will be your advocate. I will listen to you with compassion and respond to you with caring, and when appropriate, with action, but action based on knowledge and evidence.” The heart of medicine on another level one step removed from this includes relationships between the person with the “wounded humanity,” the healer, and the society in which they live. This social contract is so often ignored by the market—by making medicine a commodity to be bought and sold, by the “business” of medicine. Make no mistake, this threat to the very essence of medicine is real and is relentless. Moreover, this threat is not only to the care of our patients today, but to the care of our children and grandchildren because these same forces threaten both medical education and research which are our doors to the future.

Having outlined this challenge, what then should be the response of our College? In answering that, let us look at some selected trends which may help form that response. First, the health care of the future will include the participation of an educated patient and those decisions affecting his or her life. Second, the most successful organization of care in the future will include multiple people with different expertise, but with similar goals. Third, organizations, including health care, which succeed in the future, will not only provide value as I mentioned, but will be driven by values.

Based upon these trends, what should be the response of our College? First, we must recognize our need to provide accurate information to our patients. Today, 40% of Internet “hits” are health related. Every news program has something on health. As you stand in line at the grocery store, the headlines scream out something related to health. In a recent paper, there was an article entitled, “Eighty Ways to Live Longer.” Some of the advice was sound, some was wrong, and most had no evidence to support it. We have the responsibility to give our patient’s the best evidence—evidence supported by data so they can make better choices. We must engage our patients in their broader, philosophical issues. We must make them aware of possible choices on their part, on the part of payers, and on the part of government and the implications and consequences of those choices. Second, we must celebrate and continue to develop the multidisciplinary nature of the College. We can be the forum for health professionals of different expertise to come together and learn from each other. We must continue to build alliances and develop collaborations. Third, we must be directed and driven by fundamental values—values of respect, compassion, and care for individuals as well as the society in which we live.

Having outlined these daunting tasks, I leave this office, but not my active involvement with the College, with cautious optimism that we will respond appropriately and successfully to these challenges. I have this confidence largely because of the nature of the College and the people who devote their time and energy to its tasks. We have often referred to the College as a large family, and I think that it reflects the values of caring and concern. But it may be equally as appropriate to refer to us as a community—a community of caring, compassion, and action rooted in knowledge and evidence. It is these values and this character which will carry us forward.

As I leave you—as I leave us—with these challenges, let me end as I began. This has been one of the greatest experiences of my life. As I prepare to pass the gavel to Dr. Goldberg, I look forward to the College’s continuance to meet the needs of and challenges to our members and our patients with foresight, vision, enthusiasm, and those values which will win the day. Thank you.

This Presidential Address was presented at the Opening Ceremony of CHEST 1998, the Annual International Scientific Assembly of the American College of Chest Physicians, Monday, November 9, 1998, at the Metro Toronto Convention Center, Toronto, ON, Canada, and it has been edited for print.


Krause, EA (1996)Death of the guilds: professions, states, and the advance of capitalism, 1930 to the present.,29-78 Yale University Press. New Haven, CT:




Krause, EA (1996)Death of the guilds: professions, states, and the advance of capitalism, 1930 to the present.,29-78 Yale University Press. New Haven, CT:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543