I am truly honored to have been selected as the 72nd president of the American Association of Neurological Surgeons (AANS). From my viewpoint, this position offers the opportunity and confers the responsibility for the president to engage the organization in activities and offer policies that can best serve our patients and promote our profession.
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| Robert A. Ratcheson, MD |
The “First of Qualities”
I have long been an admirer of Winston Churchill, a man whom I consider the ultimate leader. Churchill had many faults and his career had its ups and downs, but he was always courageous, never hesitated to take a stand and utilized his courage to prevail in the most perilous of times. I have always thought that he set standards which, while born of conflict, are of great importance in everyday life. In his own words, “Courage is rightly esteemed the first of human qualities because it is the quality which guarantees all others.” This concept signals an appropriate response for neurosurgery during this time of relentless challenge to our profession. It will take some courage to continue to focus upon our core mission while expending the energy and resources necessary to meet the challenges that have been brought upon us by a legal system gone astray and to confront the constant barrage resulting from obscure and intrusive regulatory mismanagement.
The AANS is responsible for providing a foundation and infrastructure that allows neurosurgeons to provide the most modern and best quality care for our patients by serving our educational and practice needs. Despite the highly charged times we live in, we must be sure to keep on track. Many citizens question our country’s involvement in a war that daily confronts us with a loss of American lives. Differing opinions and interpretations of momentous issues such as religious values and tolerance, individual liberties, abortion and gun control have fostered political partisanship with a rancor not seen in our country since Vietnam.
Primary Threat, Fundamental Focus
Our own profession is earnestly engaged in a campaign to set straight an aberration of societal intent that has led to the medical liability crisis. Neurosurgeons are committed to combating this threat to private and academic practice and career opportunity. For a growing number of us, the crisis is a real threat to our survival as neurosurgeons and our ability to serve our patients. At present, it is not clear that we will be successful, but it is clear that we must have the courage to persist in our efforts to overcome this suffocating, litigious atmosphere and prevail in our campaign for medical liability reform.
Concurrently, we must keep the focus upon our core mission as a professional association, for it is through this mission that we will best serve society and society’s expectations. The fact is that the fundamental responsibility of the AANS is to serve as the primary resource for the medical education of practicing neurosurgeons. Neurosurgical education is the core value of the AANS quite simply because it is the cornerstone of our profession and of direct benefit to our patients.
In coordination with the American Board of Neurological Surgery, the AANS will participate in the ABNS Maintenance of Certification program, not only by tracking continuing medical education requirements for all American neurosurgeons, but also by providing resources that will be utilized specifically to develop educational programs that meet MOC requirements. Many of these programs will utilize Internet technology, and some will capture existing venues, such as Neurosurgical Focus; however, it is anticipated that the annual meeting of the AANS will continue as the most effective provider of continuing medical education to neurosurgeons. The 2005 Annual Meeting, scheduled from April 16 to 21in New Orleans, “Education and Innovation in Neurosurgery,” will offer a blend of cutting edge neuroscience and clinical information germane to the practice of contemporary neurosurgery.
Another area in which we will move forward is in defining our relationship with commercial partners. The AANS has enjoyed a long and fruitful relationship with industry and remains grateful for its generous support. However, society has rightly seen it as appropriate that this relationship be further clarified in order to ensure that the material presented by medical associations such as ours is unbiased and accurate. The AANS is currently undertaking a review of its guidelines and interactions with commercial and corporate sponsors in an effort to foster the continuation of appropriate relationships.
For society’s benefit we also must act with courage in our efforts to promote the performance of appropriate and ethical scientific research. A case in point is stem cell research, which currently is hampered by governmental restrictions. If we are not courageous in our support for this remarkable technology, which holds promise for the treatment of devastating neurological and neurosurgical diseases, we will find ourselves involved in the same partisan political stalemate regarding stem cell research as we now find ourselves with medical liability reform. We must do all we can to prevent the politicalization of this issue. While there are thorny questions associated with stem cell research, I do not believe that we can allow even the sincere theological beliefs of a few to prevent the alleviation of suffering for so many.
On a related topic, neurosurgeons have made and will continue to make great advances in basic and clinical research for the benefit of our patients, yet relatively few of us contribute to the Neurosurgical Research and Education Foundation of the AANS. The NREF has been a remarkable success, yet there is still much more that can be done. Every neurosurgeon should consider the support of neurosurgical research through the NREF as an obligation through which all of us, and our patients, will receive appropriate reward.
Courage in Conduct
We have shown courage in our programs to monitor professional conduct. Despite the opposition and legal challenges of well-funded trial lawyers, we will continue to identify and discipline those who give false and inaccurate legal testimony. In addition, we must make sure that our professional conduct activities address other forms of inappropriate and harmful practices. We must develop appropriate methodology to allow neurosurgeons to demonstrate competency, and we must eliminate from practice those who do not meet these standards. A major step in this direction is exemplified by the AANS’ interaction with the previously mentioned ABNS Maintenance of Certification program. This program has the potential to offer great benefits and security to our patients. As such, it is deserving of strong support, not only in terms of compliance, but also through organized neurosurgery’s commitment to ensuring that the required educational activities are meaningful to neurosurgical participants. This aim can only be accomplished by keeping educational activities under the direction and control of neurosurgeons.
I have briefly touched upon a number of issues in which the AANS has been and will continue to be a bold participant. There are a whole host of other issues upon which we must have the courage to speak out so that we can ensure that the benefits neurosurgery provides to society are not sidetracked through partisan political concerns.
I feel particularly fortunate to lead the AANS at a time of organizational and financial strength, and I hope that this year you will join the AANS Board of Directors and me in furthering our attempts to discover bold and innovative ways to meet all of neurosurgery’s challenges.
Robert A. Ratcheson, MD, is the 2004-2005 AANS president.. He is the Harvey Huntington Brown Jr. professor and chair of the Department of Neurological Surgery at Case Western University and at University Hospitals of Cleveland