Thomas Jefferson University Presidential Address
by Robert L. Barchi, MD, PhD

The Kimmel Center for the Performing Arts, Philadelphia, Pennsylvania
October 5, 2004

“Shaping the Future of Clinical Care”

Thank you, Mr. Harrison. And a warm welcome to my colleagues old and new, my family and friends, and to everyone who has joined us on this beautiful fall morning.

It is a privilege to gather here in the Kimmel Center, this spectacular space where audiences delight in music, perhaps the most sublime of human collaborations. I will have more to say about collaborations, but for just a moment, let's revel in the sublime ambience of this space, which reflects the combined efforts of so many here in Philadelphia and, in particular, of an individual whose generosity has also been felt at Thomas Jefferson University.

Longfellow called music the universal language of mankind. This morning we have heard this language of music through the marvelous voices of The Philadelphia Singers .

And we have listened to the music of language in the words of Drs. Cohen, Wrenn, and Burke, the comments of Rosemarie Greco, and the greetings of Kelly Champagne and Brian Bowie. Thank you all for your remarks.

And to the representatives of our many sister colleges and universities who join in this ceremony today: your presence here continues a long tradition of mutual support and collaboration in academia. It also underscores the importance of Jefferson's mission as a true university, where we debate a rich wealth of subjects, offer a broad range of courses, and confer a full spectrum of degrees.

Mr. Harrison, it is an honor to accept Jefferson's charter and medallion, not as personal accolades, but as symbols of the great team I am privileged to join. I will share with them in the support of our thirty-three hundred faculty, service to our thirty-six hundred students and fellows, care by our faculty practice of more than 100,000 patients each year, and interaction with the broader community of Philadelphia, of Pennsylvania, and of this country.

But while your kind words of welcome and support give me great personal satisfaction, the focus today should not be on any one individual. This event is not about a person, or even a particular position in the administrative pecking order. Today, we celebrate an institution. We gather to rejoice in Thomas Jefferson University's history, its traditions, its successes, and its rich potential.

This morning's transition in the chain of leadership provides us with an opportunity to reflect on the core values that have made Jefferson great. This afternoon, in our scientific symposium, we will hear about the work of current faculty, drawn from across the institution, who continue Jefferson's tradition of discovery and education.

I am delighted to join this faculty… and this remarkable university… at this juncture in its history. At the same time, I fully recognize that every one of us at Jeff should and will ultimately be judged not simply by our association with this great university, but by what we as individuals add to this community of scholars.

My path to Thomas Jefferson University, named for our third President, began at a sister institution founded by Benjamin Franklin. Jefferson and Franklin -- men with a shared genius for invention and scholarship, men honored for their extraordinary service to this nation. On my arrival at Jeff, I was surprised to find that pictures of these two founding fathers have for many years hung side-by-side in the president's office on Six Scott. Coincidence? I don't know… but both of these men, while laboring for liberty, left their mark in many fields of knowledge, including medicine.

Franklin theorized about the common cold, lead poisoning, and paralysis, while extolling the benefits of exercise. Jefferson, against a torrent of negative public opinion, advocated for smallpox inoculation for every American, and worked to establish a new vaccine for this purpose. In 1809, Thomas Jefferson made his own position clear when he wrote “the care of human life and happiness, not their destruction, is the only legitimate object of good government.” Words that ring especially true today…

All of us benefit from the fact that Jefferson and Franklin, two of the greatest leaders in our country's Revolution, worked tirelessly, often here in this very city, to bring better health to its citizens. But what would these leaders say about health care today? Without a doubt, they would observe that America has a health care system ripe for reform, if not for revolution. In a letter to James Madison, Jefferson himself said that “a little rebellion now and then is a good thing, and as necessary in the political world as storms in the physical.” Well, in health care, it's time for a storm.

Yes, America can provide the best medicine in the world, with the greatest concentration of health care services and a nearly inexhaustible potential. But health care costs are skyrocketing and access to quality care is dwindling. American health care is in crisis.

This crisis is evidenced by the 44 million Americans without health insurance in 2002, the largest annual increase in 15 years. We see it here in Pennsylvania, where more than half of our citizens report problems with medical access or affordability. And tragically, we see it in U.S. infant mortality rate that trails many countries with far lower standards of living. As one recent evaluation said, with echoes of Abraham Lincoln: “our health care system provides excellent care to many of its patients much of the time, but, on the evidence, not to enough of its patients enough of the time.” We face not only a crisis of cost and access, but also a crisis in the very nature of “care.” Indeed, it will be Jefferson's challenge to define the standard of clinical care in the 21 st century, where there are too many patients, too little time, and too few resources.

Clinical care has undergone fundamental changes within the memory of virtually everyone in this hall. At the beginning of my own career in clinical neurology some 30 years ago, the chief diagnostic tools were the history and the physical exam. There were no CAT scans, no MRIs. In those days, we had too few tools…but what we did have was adequate time to look, to listen, and to care for our patients.

Over these last three decades, the changes in my specialty alone have been nothing short of cataclysmic. Functional MRI, as only one example, now enables neurologists to view the inner workings of the living brain with millimeter precision. Our diagnostic toolbox bulges with bigger, better, but hugely more expensive equipment. Our ability to diagnose and treat has increased exponentially. But while we have more tools, we have less time. Providing the kind of personal care to which most of us aspire has become increasingly difficult, even for the most dedicated physician. We are better craftsmen. But are we delivering better care?

Add to this the fact that our patients have far greater access to information, but much of it dangerously unchecked for reliability and validity. Mass media and the Internet have made patients more educated consumers yet, paradoxically, more confused ones.

So what must we impart to the next generation of physicians, nurses, and other health care professionals that will help them master rapidly evolving technologies, employ the best in available therapies, and still deliver what we truly consider “quality care?”

Like academic medical institutions everywhere, Thomas Jefferson University faces challenges both as educator and as innovator in this rapidly evolving health care landscape.

But I derive extraordinary confidence from the fact that, over its nine score years, Jefferson has met similar challenges through the quality and creativity of its people and its programs. Jefferson's history speaks for itself.

Ours was the first medical school in the country to include bedside clinical instruction as part of the curriculum. It was Jefferson graduates and professors who produced medical advances such as the first heart-lung machine, the first cardiac bypass surgery, and the first successful removal of a brain tumor. Our early faculty and alumni have included such medical giants as: Samuel Gross, S. Weir Mitchell, and Edward Squibb.

And Jefferson's record of achievement does not lie just in the past. In recent years, for example, our researchers developed a cancer vaccine to treat high risk melanoma; found the gene for common childhood leukemia; and pioneered the first clinical trials of gene therapy for cardiac patients. Today our alumni, now more than 30,000 strong, lead the way in research, invention, treatment, and scholarship in every branch of medicine and medical education.

Dr. Cohen posed the question earlier: “why would anyone even want to consider becoming president of Thomas Jefferson University?” My answer, like his, is: who could pass up the chance to lead an institution that has provided so much to this nation and to the world? Who, when presented with Jefferson's legacy, would not jump at the opportunity to continue to build on its outstanding record of science and service?

This is the job of a lifetime. Working with Jefferson's trustees, faculty, staff, and students, we can and will build on Jefferson's greatness. Together, we can expand the university's leadership in spawning new research, in broadening medicine's horizons, and in shaping the future of clinical care.

• As a university dedicated to preserving health and advancing health care, we will continue to meet our mission of providing the best education to students at both the undergraduate and graduate level.
• As a university committed to medical research, we will continue to promote investigation that will improve both the health and the quality of life in this nation and around the globe.
• As a university devoted to excellence in medical practice, we will continue to prepare practitioners for the life-long learning that does not and cannot end with a medical degree.
• As a university with almost two centuries of devotion to patient care, we will continue to lead the way from a health care system based on episodic treatment to one predicated on continuous care.
• And as a university with deep roots in this city and state, we will heed Dr. Cohen's words to “bridge” the diversity gap that plagues our health professions, working to ensure that the Jefferson of tomorrow truly reflects the public we serve.

In order to fulfill our own expectations, Jefferson's future must be one ripe with collaboration. We simply cannot accomplish our goals through individual effort alone. Collaborations strengthen us. Partnerships lead to shared goals and incentives. They provide immense leverage. They are fundamental to our future and to our success.

Our primary partnership, of course, is between the university and our hospital. Since our founding in 1824, Jefferson's faculty have diagnosed and cared for patients, and since the beginning, the Thomas Jefferson University Hospital, and its predecessor clinic, has been our key partner in that patient care as well as our primary on-the-job learning site for students, residents, and other health care professionals. Throughout this longstanding relationship, the university and the hospital have been inextricably linked through a mutual commitment to quality patient care, and to a rich and varied experience for Jefferson's students.

Our physicians and our patients also share a vital partnership. We must involve our patients in making the best health care choices, and working together with our patients, we must seek to promote wellness rather than simply to treat disease. In the future, patients must be full partners on the clinical care team, and each of us will have to assume more responsibility for our own health.

In another partnership dimension, Jefferson's clinicians and researchers demonstrate daily the synergy required for successful translational research, what we sometimes hear called the bench-to-bedside movement. This unique partnership ensures a pipeline of discovery from the laboratory to the clinic.

Although Jefferson already collaborates with other academic institutions both within the region and across the country, we must expand these institutional partnerships as well, complementing each other's research and educational strengths.

Finally, Jefferson's partnerships must extend to the community. Our research and our new technology can fuel the engine of growth for the local and state economy. We cannot be an ivory tower of modern science. The university doors must swing wide to ensure that we disseminate new concepts and new discoveries to the world outside. And, as we strengthen our collaborations and partnerships, both within and without our campus walls, just imagine what becomes possible.

Envision with me a Jefferson in which graduates view themselves not as individual practitioners but as members of multidisciplinary teams, working together in the patient's best interest.

Envision a Jefferson that produces problem solvers. Our students learn an incredible amount about the body and mind, but if learning stops with accumulating facts and figures, we have failed. They must be comfortable in moving from data to solutions, from learning to advocacy, from accepting the status quo to leading change.

Envision a Jefferson dedicated to improving access to quality care for the many rather than providing just the pinnacle of care for the few.

How can we ensure that our vision for Jefferson becomes a reality today? One way is to capitalize on every possible opportunity for integration. We must integrate education so that we can develop a new paradigm for instruction in clinical care. Cutting across traditional disciplines, we must rise above the limitations inherent in our current compartmentalized approach. And what better place for this integration than Jefferson, where every key health discipline is represented on the same campus?

Integration applies to research as well. Research should be flexibly connected by common themes – from basic science through clinical trials – that cut across our entire enterprise, enabling us to draw quickly and flexibly upon expertise throughout the university.

It's been said that no one can whistle a symphony. It takes an orchestra to play one. I foresee a future in which Jefferson produces the quintessential academic symphony, through its many partnerships and through its maximal integration across disciplines.

New directions often require organizational change, and change can be uncomfortable. Where to go first? What task to begin with? One of my new faculty colleagues, Dr. Geno Merli, reminded me of a quote by Dwight Eisenhower, then serving as Supreme Allied Commander, a time of particular challenge and stress. Ike said: “taking first things first often reduces the most complex human problems to manageable proportions.” A great concept to keep in mind when institutions dream big dreams.

Jefferson is ideally prepared to turn its dream into reality. We have a long history of clinical excellence, a rich educational tradition, an outstanding research component, an involved community, a committed board, and devoted faculty, staff, and alumni. We have all the elements of first-rate health care delivery on one compact campus. And we are ideally configured to build on Jefferson's rich past and to pursue a promising future of integrated health care.

A future in which far more people in this country have access to high-quality primary and preventive medicine.

A future in which we redefine the education we provide for doctors, nurses, and other health care professionals.

A future in which we recognize that collaboration in research can produce remarkable results that would have been impossible otherwise.

A future in which we maximize the impact of these advances on all levels of our society.

Ladies and gentlemen, it is a signal honor to be part of an institution with such an august past; to be part of a university with such a vibrant present; and to be part of a team working to shape such a brilliant future for Thomas Jefferson University.

I look forward to joining all of you – faculty, students, and staff – in meeting the challenge of change as together we shape the future of clinical care.

Thank you.