December 1, 2006

Robinson lecturer urges culture change in medicine

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U.S. Rep. Jim Cooper spoke on the growing challenges facing the nation’s academic medical centers at the recent Roscoe R. Robinson Lecture.
Photo by Susan Urmy

Robinson lecturer urges culture change in medicine

In an era of tremendous pressures on academic medical centers, no fundamental changes will be possible without big changes in cultures within the institutions themselves.

That's the message delivered by U.S. Rep. Jim Cooper (D-Tenn.) to a standing-room-only crowd in Light Hall last week for the Roscoe R. Robinson lecture, an annual lecture celebrating the 16 years of leadership by the late vice chancellor of Health Affairs.

Cooper's address was preceded by remarks from Chancellor Emeritus Joe B. Wyatt and Harry Jacobson, M.D., vice chancellor for Health Affairs. It was also the occasion for the release of “Onward and Upward: Vanderbilt University Medical Center 1981-1997,” Robinson's memoir about his years as vice chancellor. Robinson's wife, Ann, daughters Brooke Robinson and Susan Solberg, and grandchildren, Rob and Sarah Solberg, attended the lecture. Copies of the book were handed out following Cooper's lecture.

Cooper, a recognized leader in health reform and a longtime friend and admirer of Robinson's, told the large group that he felt like a “layperson who has been asked by bishops and cardinals to opine on the future of cathedrals.” Cooper said that although there are many aspects of academic medicine that need reforming, medical education is expected to require the greatest changes in the coming decade.

As the 100th anniversary of the Flexner Report approaches, Cooper said he anticipates talk of another revolution will be heard, but is not so sure it will occur. The Flexner Report, written in 1910 by the professional educator Abraham Flexner, radically changed the way medical schools were run in Canada and the United States.

“The smallest business segment of VUMC, the educational function, is also the heart and soul of the institution,” Cooper said. “Some are worried that Vandy, like other medical schools, is in danger of losing its soul. The medical school faculty and students give Vanderbilt its prestige, its excellence and its uniqueness. And yet, this is the part of academic health centers that the New England Journal of Medicine says is most in need of change over the next 10 years.”

Cooper said he believes that Vanderbilt has the opportunity to revolutionize medical education by doing three things: adding a practical component to the medical school curriculum; reducing conflicts of interest with faculty, students and graduates; and requiring rigorous, scientific continuing education so that the Vanderbilt diploma retains its full value.

Cooper said that adding some practical education is necessary — even if it means adding a fifth year of medical school and a course on Medicare and Medicaid so that students understand the largest payers in order to help reform them.

Ending conflicts of interest would help faculty, students and graduates deal with the “seductive power” of pharmaceutical companies. He pointed out a recent Journal of the American Medical Association article that points out that the techniques pharmaceutical and device companies use with gifts, samples, formularies, continuing education, travel, speakers' bureaus, ghostwriting and consulting and research contracts have “corrupted much of American medicine.”

And Cooper said that since many specialty societies require recertification every seven to 10 years, it's conceivable that Vanderbilt should require continuing education of its own graduates.

Cooper encouraged VUMC leaders to think boldly.

“Forty years of non-stop growth, budgets and payrolls the size of small cities and academic arrogance and isolation all work against fundamental change, at least in the near future,” he said. “But my guess is that the insolvency of Medicare, the commercial pressure on physicians to be less than professional, and the louder voice of consumers in health care will force changes sooner than you think. Does Vanderbilt want to lead that change, or follow the herd?”