Let the Good Times Roll

JORDAN (1908-1975) WAS A SAXOPHONIST AND VOCALIST WHO BRIDGED THE GAP BETWEEN JAZZ AND RHYTHM & BLUES.¹ His inventiveness paved the way for better known performers such as Chuck Berry, Ray Charles and James Brown. Even if you don't know his name, you probably do know some of his work…

     Hey, everybody!
     Let's have some fun!
     You only live but once,
     And when you're dead, you're done
     So let the good times roll…²

Nearing the end of my term as SSVMS President, I must admit to a feeling of relief laced with nostalgia. As I drove home one recent evening in that frame of mind, those words caught my ear.

Listening to music has always helped me at times like this, and as I travel the home stretch it is a comfort. The year is not yet over, and Dr. ChiChi — office companion of all SSVMS Presidents during their tenure — still greets me every morning. At least one more crisis will undoubtedly surface, and I have one last shot from the bully pulpit.

I have tried in my six President's Messages to create an integrated package of work, with thoughts and opinions on complementary issues. All of my titles are purposely active, as Ed Rudin suggested a medical society and its writings should be. I have sought to motivate more than to inform, and have made at least an attempt to beat neither old drums nor dead horses. To recount briefly…

Connect the Dots explores the relevance of organized medicine to today's physician, suggesting that it is the perception of relevance that is missing. Involved physicians need to make the evolving social policy of medicine both real and personal to those not yet involved — to connect the dots for them — so that the effort can be magnified.

Swim the Avalanche emphasizes the very personal nature of today's high-profile health issues. We had all better learn to swim and survive the coming avalanche of change in healthcare. There are roles in this struggle for everyone, and the community looks to us for answers.

Nurture the Young suggests that we excel at teaching the science of medicine, but fail at teaching the profession. Opportunities abound to change this, and the health of medicine lies in the balance.

Get Boarded highlights the tedium, substance and controversy that comprise the activity of the SSVMS Board. SSVMS members should hold Directors accountable to actively represent their views. Office phone numbers and e-mail addresses of Directors are provided to facilitate this.

Change the Message suggests that organized medicine focuses too narrowly on the economic self-interest of physicians. With numerator politics dominating the scene, it is easy to forget that the denominator may not support such a strategy across the board. Much of the current issue of SSVMS Medicine continues this discussion.

So what has all of this to do with Louis Jordan? As I listen to his words and music, I cannot help but feel a sense of celebration. At a superficial level, this springs from my year as SSVMS President drawing to a close. I have worked hard and have contributed something.

But the feeling goes deeper. That seems odd at first. With medicine under assault, physician reimbursements eroding before our eyes, MICRA tenuous, scope of practice battles incessant, and significant discord in our ranks, the good times don't seem to be rolling at all.

To make matters worse, the most significant social pathologies of our time - "entitlement disease" and "accountability disorder" - run rampant at nearly every level, threatening to bankrupt us both as communities and as individuals. With so much wrong in medicine, what could there possibly be to feel good about?

The sense of celebration is not because I am ready to disconnect from the difficult realities of organized medicine. In a very real way, I feel more connected and invested now than ever before. The past year has opened my eyes to a broader professional reality with which I feel a growing bond and ongoing responsibility.

Nor is it because Jordan's music causes me to reminisce about better times. We live in a time of unequalled richness and capability. The difficulties of professional practice aside, we treat and prevent disease and manage health information more effectively now than at any time in history. Fewer people smoke, and more use seat belts, helmets and car seats that ever before. High-resolution images of deeply internal pathologies can be transmitted to distant desktops for real-time review. Diseases such as Hemophilus influenza B have been virtually eliminated. Even aging professional golfers can be surgically renewed to play another public round.

If the goal of our profession is to improve the public health, then we are making progress, even if slowly. The passage of SB 2 and defeat of Prop 54, along with powerful but more private efforts of practicing physicians putting the daily needs of their patients first, speak to the altruism in medicine still alive during these difficult times.

There is indeed much to celebrate. Not just better health for our patients, but better health for us and our families. Not simply all that we have achieved as a profession, but the promise of what we might yet achieve.

But in ways that are both palpable and familiar, the pie is shrinking. Cutting edge medical technology, universal health coverage, quality of life improvements and personalized care all come with a cost that ultimately can only be shared. If we want these good times, we will all have to contribute towards the sticker price…

     Don't sit there mumblin'
     And talkin' trash…
     If ya wanna have a ball
     Ya gotta go out and spend some cash.
     Let the good times roll…

Louis Jordan probably was not thinking about organized medicine when he wrote those words, but they strike a familiar chord. There were serious things to mumble and complain about in Jordan's time just as there are in ours. It did not keep him from celebrating.

And it should not stop us. This was that something deeper I felt in his words. Yes, disenchantment breeds easily in a time of rapidly expanding capability, unbridled entitlement, and limited means because it hurts to pay. And yes, just like everyone else, we physicians will need to compromise and to move from "more" to "enough" if we are to achieve with our communities enlightened entitlement and an accountability that is both measured and livable. We owe it to ourselves, our patients and our children to try.

Of course, this will require some measure of restraint and cooperation beyond our norms. With none of us able to predict accurately how future events will affect us individually, we would do well to invest our time both carefully and cooperatively…

     No matter whether it's rainy weather,
     Birds of a feather gotta stick together…
     So get yourself under control,
     Go out, get together, and let the good times roll!

As we all move forward from the present mire into whatever lies ahead, I wish you a positive outlook, a cooperative ethic, and the wisdom to seek celebration all along the way.

Good times are happening right now; the challenge is to remember to look for them.

paul.phinney@kp.org

1. Let the Good Times Roll, the Story of Louis Jordan & His Music. The University of Michigan Press, 1994.
2. The Best of Louis Jordan. MCA Records, Inc. 1975, (available on CD).