A Letter to the Medical Community from Dr. Thomas J. Nasca

March 30, 2020
The frontlines.

Cartoon by Mike Luckovich of the Atlanta Constitution-Journal. www.ajc.com
The frontlines.

Cartoon by Mike Luckovich of the Atlanta Constitution-Journal. www.ajc.com

Dear Members of the Profession of Medicine, our Faculty Members, and the Residents and Fellows of the United States,

It is with a deep sense of pride and gratitude that I send you this note today. Around me I see the aspirational best of our profession, and that of our nursing, pharmacy, respiratory therapy, laboratory personnel, and pre-hospital caregivers emerge in response to this tragic, emerging pandemic. I also see the recognition of our colleagues who clean our care spaces and our instruments, who man the phones, who order the supplies, and who administer our institution, each of whom labors at personal risk to help us help others.

I am especially close to the situation of our residents and fellows, not only because of the position I am fortunate to hold as the leader of the ACGME, but also because one of my sons is a resident, living and working to save lives in these trying times. While I worry about him, I do not worry that he is ill equipped, unsupervised, asked to do things that he is not prepared to do, or to work to exhaustion, increasing the likelihood of breach of infection control. I feel this way not out of ignorance, but rather because I know that his program director, his chair, and his faculty members are working shoulder to shoulder with him, looking out not only for their patients, but also their residents, my son among them.

And I hear stories of kindness and bravery, willingness to do whatever it takes to help another, and creativity in solving problems and challenges at the bedside and in the laboratory. Over the next few weeks, I hope to share some of these stories sent to me (with permission) with all of you. You see, these stories are the wind behind our sails, the gifts large and small of others that will sustain us, even as we attempt to sustain and heal the American public.

The first of these stories comes from years ago, in my role as dean at Jefferson. I gave a graduation speech, reminding the graduates of the reasons they worked so hard to become accepted into medical school four years earlier. I drew on Dr. Edmund Pellegrino’s construct of the Virtuous Physician, and pointed out that, at the core, their motivation was altruism.

I received a warm response to my talk at that joyous occasion, but was stunned when I was approached during the march from the stage by a prominent board member, who chided me that altruism “doesn’t really exist.” “It’s all enlightened (or not) self-interest,” he went on to say. This response has always pained me, because I have been privileged to mentor thousands of medical students, more than eight hundred internal medicine residents, and dozens of nephrology fellows. Each of those individuals nurtured altruism in their souls. Each of them was motivated by a desire to help others. Sometimes we fail, and are less virtuous than we desire, but we aspire to be that Virtuous Physician, regardless of our age, experience, specialty, or position. Virtue is, after all, a habit, not an end state. We practice perfection of that habit every day.

Now I can point to you all, the clinicians of today, called to demonstrate altruism, the quiet persistent bravery of doing the right thing, for the right reason, to help another, even when it places you at some risk. You! You are living proof that altruism is alive and well in American medicine. You are a beacon of hope in a time of despair. You are the people who will tell them the truth. The American public is trusting you in their time of fear, confusion, and illness.

You are the heroines and heroes of whom we are all so proud!

But in order to continue your heroic efforts, you must take care of yourselves. You must adhere to strict infection control principles and actions. You must hold your colleagues to those high standards. You cannot help others if you are ill. You cannot save another, if you are a patient in the ICU. You cannot protect your family if you are not safe in your clinical practice.

Be openly thankful to those in this stressful time who are with us, helping to save lives. Our brave and compassionate nursing colleagues, our respiratory therapists, laboratory personnel, those who clean our care spaces, our pre-hospital care colleagues, the police and fire professionals who keep us safe, those making sure that we can put food on the table, and those collecting the trash. A kind word of thanks from you will energize them to continue their wonderful work!

You are defining what is good in all of us. You are showing the way forward through a dark and frightening time. You are the bridge over troubled waters for those we serve. Thank you for being those Virtuous Physicians that Dr. Pellegrino envisioned!

Be safe, be sure, be compassionate, and be your best!

Most sincerely,

Thomas J. Nasca, MD, MACP
ACGME President and Chief Executive Officer