President’s Desk Column

Of harrowing and hopeful times

October 2001
President’s Desk Column

Paul Bachner, MD

I am writing this, the last of my columns as president, on Sept. 17, less than a week after the previously unimaginable, savage acts of terrorism in New York, Washington, and Pennsylvania. Although I intend to share with you my reflections on my term as CAP president and my thoughts about the future of the CAP and American pathology, I would like first to comment on this period of national tragedy and mourning, outrage, and resolve.

On the afternoon of Sept. 11, when the magnitude of the disaster, the uncertainty of the situation, and the impact on air travel became apparent, I requested that all College meetings scheduled between Sept. 11 and 17 be canceled. All CAP laboratory inspections requiring air travel during the same period were canceled. The Washington, DC, office was evacuated as part of the regional response to the attack on the Pentagon and concern about possible additional attacks. The College headquarters in Northfield, Ill., remained open. Today, during a conference call of the Board of Governors executive committee, a decision was made to cancel all CAPmeetings and laboratory inspections requiring air travel through Sept. 30. Inspector training seminars scheduled for this period were canceled at the discretion of the local host commissioners.

For Americans, the events of this past week represent the end of innocence. Previously spared foreign attack on our soil, we Americans became aware on Sept. 11 that our lives had been changed forever.

All of us, as physicians and as citizens, reacted quickly and as best we could. Many donated blood in anticipation of large numbers of treatable casualties. Tragically, as told to me by pathologists in New York, the survivors who could be helped by medical care were vastly outnumbered by those entombed in the twin towers of the World Trade Center and the Pentagon. I thought of this sense of helplessness on Rosh Hashanah at my temple services when the following prayer was spoken: "May those who devote their lives to healing others find skill and wisdom as they labor to speed their recovery . . . Be with all who suffer in body and mind; may they speedily recover and return in health and happiness to the warmth of home, family, and friends."

It is those words I wish to share with you as pathologists continue to provide leadership in their communities, hospitals, and laboratories. Those with forensic training have offered their services to national programs that provide disaster assistance. Pathologists in the disaster areas and elsewhere have helped ensure that blood supplies for the injured would be adequate and safe. In addition, they supported the trauma centers with timely clinical laboratory testing and, using modern forensics and DNA testing, will help identify those who perished.

The CAP communications staff responded to media inquiries and provided support to our members. They made contact with the networks and offered expert speakers. Many of our members, too numerous to name here, explained to the public, through the media, the details of disaster relief, blood transfusion, and, of course, forensic identification. The CAP prepared a list of common questions and answers about body identification and other forensic procedures and made it available to our members, the media, and the public on our Web site and through the CAP’s call center.

The CAP staff responded in other ways. A staff Community Outreach Task Force launched a drive to raise donations for the American Red Cross, and College staff participated on Sept. 13 in U.S. Pride Day by wearing red, white, and blue.

Our leaders, members, and staff share our country’s sorrow and express deep sympathies to the families and loved ones of those who lost their lives in the barbaric acts of terrorism and fanaticism. During this time of national grieving and concern about current and future threats to our country and its citizens, the College has a responsibility to continue its laboratory inspections, Surveys, and other activities. We will not let terrorism stop us from fulfilling our role in the health care system and, accordingly, all CAP meetings and travel were to resume Oct. 1.

As for the state of the College at this time, the end of my term as president, I can assure you it is well positioned for the future. The programs by which the College is widely known—Surveys and Laboratory Accreditation—are stronger than ever. Our information technology resources have been enhanced, and thus our programs are more comprehensive and responsive than ever to the needs of laboratories and members. The Board of Governors has identified education as a primary College mission. Educational programs will be made accessible in traditional ways and through our improved Web presence. They will combine our longtime emphasis on the socioeconomic and management aspects of pathology practice with a greater focus on integrating molecular pathology into daily surgical pathology and cytopathology practice. SNOMED will continue to emerge as the international language of science and medicine and as an important resource for pathologists.

The CAP’s public and government advocacy is more active than ever, thanks to organizational changes in the Division of Government and Professional Affairs—particularly a newly invigorated state affairs network and more emphasis on regulatory issues. Collaboration between the Council on Government and Professional Affairs and the Council on Public Affairs is improving the CAP’s ability to integrate legislative advocacy with grassroots involvement and public communications programs.

What are the areas of concern and opportunity?

• Though many of us believe the economic depredations of managed care have damaged the ability of physicians and our health care system to provide good care to patients, I expect the public and political focus on patient safety, provider accountability, and physician performance and demonstration of "maintenance of competence" to characterize the next decade. As part of this focus, CAP leaders and members will need to address the balance between individual physician autonomy and improvement in the overall level of care. The debate in the past two years about the CAP cancer protocols has made me aware of how important this balance is.
• We will continue to experience tension between calls for patient privacy and confidentiality and the need to maintain a workable system whereby physicians and other health care providers can exchange information.
• The incorporation of new technology into clinical pathology practice will continue to be problematic. It will require continuing work on the part of the College to ensure equitable payment and compensation and the involvement of our members and residency training programs in this area of practice.
• CAP leaders and staff will need to recognize the increasingly diverse nature of our membership and factor that diversity into decisions about programs, resource allocations, and advocacy efforts. We must consider, too, the extent to which we wish to play a larger role on the international scene and carefully evaluate our relationship to other professional societies and the American Medical Association in particular.
• Our leaders and members will need to balance the integrity of our membership, educational, and advocacy efforts with the needs of our successful programs that provide the revenue for our activities.

On balance, the state of the College is excellent. Our fiscal status is sound, and our physical and information technology infrastructures are robust and adequate for the demands we will place on them. Our leadership at the Board, council, commission, and committee levels is outstanding. Your new president, Paul Raslavicus, MD, will bring to his new position energy, commitment, vision, and extraordinary knowledge about the College and the issues facing our members. Jared Schwartz, MD, PhD, your secretary-treasurer, will continue to show his unfailing wisdom, good judgment, and devotion to the CAP’s mission, and your new president-elect, Mary Kass, MD, and new executive vice president, Nicki Norris, will bring dedication and experience to their new posts.

My thanks go to the executive team who served with me—Dr. Raslavicus, Dr. Schwartz, Tom Trainer, MD, and Lee VanBremen—for their support, wise counsel, and friendship. I thank the governors for the quality of their decisions and for their support and indulgence over the past two years, and the committee chairs and members-they are truly the engine that pulls (and pushes) the train. None of the work of the College would take place without our staff, to whom I express my thanks for their support, hard work, good ideas, and friendship. My colleagues and staff in the Department of Pathology and Laboratory Medicine at the University of Kentucky made it possible for me to have served as your president, and to them I express my appreciation. Lastly, my love and thanks to my wife, Susan, who was my companion on far too many trips and who, in addition to maintaining our home for me to return to between my travels, helped me to maintain my perspective and sense of humor.

To you, members of the College, my thanks for the confidence and support you extended to me. I am especially thankful for your willingness to let me know when you thought the College was wandering off the path and for your expressions of support when you believed we were doing the right thing. I sense most of you believe we have done more of the latter than the former. I ask you in the difficult days ahead to continue to show your support of the ideals of the College and our country. I know that American pathologists-and pathologists throughout the world-will continue to practice with excellence to provide the best care to our patients. May God bless this College and its members, our country and its citizens.