Lecture pst SG yrs. 10/8/90 vol. 22 #27 cover
Speech

“Exasperation on Both Side of the Stethoscope”
By
C. Everett Koop, MD, ScD

American College of Surgeons
San Francisco, CA
October 8, 1990

Because I was a board certified general surgeon and later a board certified pediatric surgeon,
unlike many physicians, I straddled two specialties — surgery and pediatrics. Indeed, my highest
academic appointment at the University of Pennsylvania was Professor of Pediatric Surgery and
it was followed a number of years later by the same title in the Department of Pediatrics.

In modern days, the Surgeon General has rarely been a surgeon. Indeed, the first contact that got
me interested in government service was when I was asked in August of 1980 by a Senate staff
person: “Don’t you think it’s time that the Surgeon General was a surgeon!” When I was finally
confirmed as Surgeon General by the Senate in November of 1981 the pediatricians looked at me
as their representative in government. The American Medical Association, because the Surgeon
General has a seat in the House of Delegates, used me as a constant source of information as well
as a sounding board for their ideas. The surgical societies to which I belonged, on the other
hand, were, to say this as kindly as I can, aloof. For example, I was asked to bring a brief report
and update on pediatrics and public health at every annual meeting of the Academy of Pediatrics,
while I was in office. I felt constantly a part of the American Medical Association and
particularly felt that I was a source of straight-forward information in my activities in the House
of Delegates that helped them in their decision-making My activities with surgeons, on the other
hand, were confined to an after-dinner speech I gave for an ophthalmological group in Hershey
Pennsylvania and I was asked to an after-dinner speech to the American Pediatric Surgical
Association atop of the Trade Towers in New York City.

This speech was an invitation to speak before a plenary session of the American College of
Surgeons of which I had been a member since my residency days and I chose to speak of the
unrest and growing hostility between patients and physicians by titling my speech,
“Exasperations on Both Sides of the Stethoscope”. I acknowledged that I was saddened and
angry and I acknowledged that much of the difficulty was our own fault and gave the reasons
way I thought that was true.

I talked about the fact that Congress had to step in and enact legislation, setting up a National
Practitioner Data Bank on physicians, so that we could find the bad-apples in our number, which
we had neglected to do as we so poorly policed ourselves. I wasn’t speaking in favor of the data
bank. I called it a tragedy that could have been avoided.
I mentioned that the activity of surgeons as part of the medical professions actually gave the
option of ending up in one of four places a decade hence and went into some detail on what those
were.

Obviously, this was not a soothing lecture that my audience particularly wanted to hear. I told
them that they had their good reasons for exasperation, but asked the question why were their
patients exasperated. I then gave thirteen reasons why I thought we had gotten into the situation
we then faced, offering solutions along the way. This meeting was in San Francisco and the San
Francisco Chronical aided and abetted my cause by devoted four full columns on the front page
about the deterioration of health care in America.

I closed with a plea. I didn’t ask for a return to the nostalgic days of yesteryear, but I did suggest
that the doctors of American, in dealing with the patient are representing all of American
medicine and therefore, representing American health care. I gave a positive message and did
not need some futuristic manifesto promising what we intended to do. What we did need,
however, was a clear and persistent affirmation of the many good things we did, day in and day
out to make our system of medicine — once we took things at hand — potentially the best in the
world.

This was a lecture I would not have given as the Surgeon General. This is a wonderful
transitional piece, because J not only called on my lifetime experience in medicine, but my eight
years as Surgeon General, and perhaps most important, my most recent experience of producing
five one-hour Prime Time television specials on the state of health care in America. One could
say that this lecture was a philosophical summary of my life in medicine up to this time with a
significant look to the future. °

Attached to this lecture is an editorial by the CEO of the American College of Surgeons as well
as an article from their bulletin on America’s uninsured as well as a pertinent clipping from page
one, section B of the New York Times of October 3, 1990