As I approach “The End,” I remember

What inspired you to become a physician?

Growing up in the country, on a small farm, and drawn to science and the humanities, in 1961, I entered college to study Veterinary Medicine.   A life changing experience of faith in October, 1961 changed my focus more completely to the humanities.  After graduation from college in 1965, marriage, teaching and graduate school, I returned to my love of science balanced with humanity.  Four years after our marriage, Carolyn Bellue Holly and entered UT Health School of Medicine in 1969.  All my life, I was driven to serve mankind particularly in regard to civil rights.  I, also, wanted to live a life of significance.  For me, medicine became the logical choice.  (see The Honor of Being a Physician which appears at the end of this article)

Together, Carolyn and I made the decision to pursue medicine as a career.  She supported me through medical school and has been by my side for the past 45 years of practice.  The picture accompanying this article is of the two of us, as we have done this together.

What lesson did you learn in medical school that influenced your career or practice?

I learned that it was impossible to know everything.  This lesson has been reinforced over the past fifty years, which drove me to read extensively and to compile what I learned in a “little black book,” which I still have.  In a meeting with the Robert Wood Johnson Diabetes Division, I called this my “Watson Project,”  This idea lead me to adopt electronic medical records (EMR) in 1996 and to design an EMR which, like my “black book,” made it possible to bring to bear upon every patient encounter what is known about critical subjects.

I, also, learned that excellence in medicine and in healthcare delivery required a team of which a physician is a member.  Immediately after graduation in 1973 and before beginning residency, I worked at the Goodall-Witcher Clinic in Clifton, Texas.  Living in the hospital for a month and attending to patients around the clock, and being new to medicine, a LVN taught me a great deal of practical medicine.  She would say, “I have noticed that Drs. Goodall and Witcher did that this way.”

This created in me a great respect for others on the healthcare team and led me to create an interdisciplinary collegial and collaborative culture in SETMA.

I learned the distinction between data, information, knowledge and decision making.   This prepared me to develop data analytics tools and to employ statistical analysis in population health and management.  It developed in me an appreciation for quality metrics as benchmarks of excellence in care.  

The combination of the humility that I could not know everything, the anticipation of the power of EMR even before they existed, the imperative of the team, and data analytics,  prepared me to play a leadership role in the design and adoption of the patient-centered model of care.  As a result, my practice. Southeast Texas Medical Associates (SETMA, LLP), was the first and to date the only practice in American which has been accredited by all four agencies accrediting Patient-Centered Medical Home.

What was your most rewarding experience at the university?

Multiple experiences were rewarding but they all flowed from an initial experience in the first month of the fall semester of 1969.  A chance meeting with Dean Fitzhugh Carter Pannill, MD, resulted in my founding and leading for its first two years a Health Careers Program for high school students in San Antonio.  Meeting weekly with needy students, we introduced them to health careers helping them dream of being doctors, nurses and other healthcare professionals.  

Extending from this, I attended the Student American Medical Association meeting in the Spring of 1970.  At that meeting, I was elected the first national Chairman of the Organization of Student Representatives (OSR) of the Association of American Medical Colleges (AAMC).  For two years, I served as a voting member of the Executive Committee of the AAMC and voted twice on the accreditation of UT Health San Antonio Long School of Medicine.  I also served as a voting member of the accreditation site visit to Cornell Medical College in New York City.

When the Chancellor of the University of Texas System dismissed Dean Pannill because he refused to fire the Chairman of the Department of Medicine over an indigent health initiative,  I wrote all UT Reagents, including Mrs. Lady Bird Johnson, and contradicted the Chancellor’s rationale for dismissing the Dean.  My letter was published on the front page of the San Antonio Express New.  (The links below give a detailed history of these events). These experiences prepared me to spend a career thinking about and commenting on public health policy.

I thought that I would never know a leader who would meet the standard of Dr. Pannill.  However, when I met and worked with Dr. William Henrich, first as the Dean of UT Health San Antonio Long School of Medicine and then as President of UT Health San Antonio, I found that these two men had the same spirit, character, wisdom and vision.  My deep sense of loss at Dr. Pannill’s death was lessened by the warmth and collegiality of Dr. Henrich.

The following document contains a note from Dr. Pannill to me and a note from me to Dr. Pannill on the occasion of the naming of the main auditorium at UT Health.  This document reflects the depth of affection I had for Dr. Pannill and which I have for Dr. Henrich:  Memories on the Dedication of the Auditorium

What is your greatest professional achievement?

Caring for the most vulnerable and neediest patients in my community has been my greatest achievement.  In pursuit of that goal, I founded a multi-specialty practice in Beaumont, Texas, designed and adopted state-of-the-art information-technology tools, pioneered patient-centered medical home ideals and practices, promoted alumni giving at the School of Medicine and published extensive materials on each of these areas.  All of this material is published at www.jameslhollymd.com.  A detailed summary of SETMA’s achievements can be found at:   Accreditations - Awards and Achievements of Southeast Texas Medical Associates, LLP - 1995-2018.

What advise do you have for current students?

Discover and pursue your passion.  Dream so big that others will accuse you of hallucination.  Risk failure for it is only in so doing that your dream can come true.  Recall often Theodore Roosevelt’s often quoted challenged:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.  The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, and comes short again and again, because there is no effort without error and shortcoming; but who does actually try to do the deeds; who knows the great enthusiasms, the great devotions, who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat.”

And, if you are ever tempted to translate your dreams into economic terms remember Winston Churchill’s declaration:  “You make a living by what you get; you make a life by what you give.”

Dream big; give bigger; remember your life will not be judged by how it begins, but how it ends; it will not be judged by how much you have, but by how much you have given; it will not be judged by who you are, but by who you have helped others to be.

A Disclaimer

Recently, I had occasion to read the conclusion to my address upon receiving the Distinguished Alumnus award. This conclusion reminds me of the debt we all owe; it is brief:

"I realize that my 'instrument' which contributes to the symphony created by the alumni of our School of Medicine will someday be silenced. And, as I often try to hear each of the instruments in the orchestra and cannot, sometimes the melody of our lives is absorbed by the whole so that we become anonymous contributors to the opus.

"But whether recognized or not,  until that time, the honor which you have bestowed upon me is received with the humility of knowing that many worthy recipients will never be so honored publicly And that humility will engendered in me the diligence and discipline which is the result of knowing that I have received more than I deserve and that the cost of it to me was less than it is worth and that though I should work diligently for the rest of my life, I shall never satisfy the 'debt of love and gratitude' which I owe to you all."Â  (The full text of his address can be found in the first link below.)

These answers are expanded in the following links,
each of which has additional links within the text and at the end of each document:

The 2012 Presentation of the Distinguish Alumnus Award and Dr. Holly’s Acceptance Address -- Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award University of Texas Health Science Center San Antonio School of Medicine

The Inauguration of the Aesculapian Laurette Society and the Induction of Dr.  and Mrs. Holly -- The Aesculapian Laureate Society

A brief and selected history of UT Heath San Antonio Long School of Medicine -- UT Health Historical Summary in Response to Drs. Henrich and Berggren

A brief review of Dr. Holly’s Experience with the AAMC beginning in 1970 -- A follow-up from the 1970 AAMC Planning Meeting

The Honor of Being a Physician
By James L. Holly, MD
University of Texas Medical School at San Antonio, 1973

Tremulously, Private James Ryan, now in his seventies, approached the headstone of Captain John Miller who gave his life that Ryan might live.  In perhaps the most poignant moment in a great film, tears stream down his face, as Ryan plaintively said to his wife, “Tell me that I have lived a good life; tell me that I have been a good man.”  The sacrifice of others, imposed upon Private Ryan a debt only a noble and honorable life could repay.

Everyone owes such a debt to someone.  The circumstances of that debt may not be as dramatic, but it is just as real.  Years ago, a man asked me, “Aren’t you proud of what you have accomplished?”  I said, “I have worked hard, but what I am is a result of the contributions of many.  And, there are at least seven turning points in which it is obvious that without the providence of God my life would have been much different.  Proud?  Yes, but more grateful and humble than proud.  And, ultimately, I am responsible for the gift and honor of being a physician.”

Traditionally, the professions were law, ministry and medicine.  Yet, the nobility of all contributions to society makes each person’s work worthy of celebration, whether in labor, management, service, manufacturing, homemaking, government, education, law enforcement, fire fighting, military service, or other.  To isolate one endeavor for special consideration is not to diminish the value of any.

Nevertheless, there are few gifts as great as that of the opportunity to be a physician.  The trust of caring for others has always been a sacred trust.  It is a trust which should cause each person so honored to tremble with fear that he/she will not have lived worthily of that honor.  It should cause us to examine our lives for evidence that we have been good stewards of the treasure of knowledge, skill, experience, and judgment which has been bequeathed to us by our university, by our professors and by the public which funded our education.

Reflecting upon thirty plus years of being a physician, I feel a deep sense of gratitude and of humility, out of which grows a sense of honor.  Gratitude is founded upon the debt owed to  so many who have contributed to making it possible for us to be physicians.  Humility is founded upon the confluence of known circumstances, providentially orchestrated, I think, which allowed each of us the opportunity to be physicians.

What nobler calling could one have than the opportunity to collaborate with others in their quest for health and hope?   The honor of trust and respect given by strangers, who share their deepest secrets, knowing they will be held sacrosanct, is a gift which exceeds any pecuniary advantage.  The pursuit of excellence in the care of others is a passion which is self-motivating.

Passion is the fuel which energizes any noble endeavor.  It is what makes a person get up early in the morning, work hard all day, and go to bed late at night looking forward to the next day.  It is a cause of great sadness that today’s society is so devoid of true purpose-driven passion.  Many only vicariously experience passion through the eyes and lives of athletes, movie stars, or musicians.  Ultimately, passion and purpose are what make life worth living.  Those of us, who have been allowed the privilege of being physicians, can and should know the passion of a noble purpose every day of our lives.

Never has there been a time when a physician’s knowledge and skills could have more positive impact upon the lives and futures of others.  Never has there been a time when the role of the physician has been more defined by the concept of “team,” in which each participant – doctor, patient, family, nurse, clerk and others – coalescence into a vanguard against illness and pain.

Now, well into the last half of my career, I do not crumble by the headstone of one who has given his life for mine, but I do stand humbly before the cornerstone of my life as a physician.  I stand there grateful to God, to my parents, to my wife and children, to UT Health Long School of Medicine, to my professors -- among many, Drs. Pannill, Taylor, Wesser, Beller, Fuller, Forland, Gold, Sears, George, Persellin and Cander -- to medical school class mates who challenged me with their abilities and drive, and finally to my associates and partners at Southeast Texas Medical Associates (SETMA) and to my colleagues in Southeast Texas.  Each has contributed and continues to contribute to the passion and drive borne of the honor of being a physician.

The tale is not yet told as to whether I shall have been faithful to this great honor, but it is a responsibility which motivates me daily.  To my university and to all who have contributed to the honor of my being a physician, I say, “Thank  you.”

James L. Holly, M.D.
CEO, SETMA

Adjunct Professor
Department of Family and Community Medicine
UT Health San Antonio
Joe R. and Teresa Lozano Long School of Medicine

Associate Professor
Department of Internal Medicine
Texas A&M University
School of Medicine