Text of the Opening Address to the First OSR Meeting
By James L. Holly, Chairman, OSR
Association of American Medical Colleges’ (AAMC)
Organization of Student Representatives (OSR)
December 2, 1971

(Author’s Note:  In the Spring of 1970, at the Student American Medical Association (SAMA - renamed American Medical Student Association, AMSA, in 1975), the first Chairman of the OSR was elected. The first national meeting of the OSR was held in December, 1971. This is the address I delivered at this meeting followed by an addendum that explains the history of my involvement with the AAMC, the OSR and UTMSSA.)

The irony in which American medicine finds itself a part, is aptly described by Rosemary Stevens in her book, American Medicine and the Public Interest.   She said:

“Recent developments in medical education represent a striking success.  The average doctor has been transformed in sixty years from an incompetent physician, whose strength lay in the “beside manner” of his mystique, to a specialist… buttressed by an array of diagnostic and treatment aids and techniques.  American doctors are among the best trained technological physicians in the world.  Together, however, they are not providing optimal medical care; and it is this factor which has become the educational paradox- the manpower crisis- of the 1970’s.”

Simply stated the irony is, “Good Doctors but Bad Medicine.”

You and I upon completion of post-graduate training will be among the best qualified physicians in the world today.  We will not practice in the anecdotal medicine of herbs and spices as did our great grandfathers, rather we will practice the medicine of EKG’s, EEG’s, TIDEL VOLUMES, SERUM CREATININES and TISSUE BIOPSIES.  In short, we will be Good Doctors.

But what of our medicine, that is, the delivery of daily health care to John Doe, Susie Smith and Clarence Jones.  In the middle of a crisis, if in the right place, or if financially able they will receive excellent medical care.   However, if in the wrong place, or if financially unable, they may in fact receive no care at all.  In addition the facilities for non- crisis or preventive medicine are almost exclusively restricted to infectious disease and even those are inadequate.  In short, we have a description of the remaining half of our irony, “Bad Medicine.”

Why is this ironical?  Listen to the definition of irony: “an incongruity between the actual results of a sequence of events and the normal or expected result.”  In 1910, the Flexner report addressed itself “to the task of reconstruction of the American medical school on the lined of the highest modern ideas of efficiency and in accordance with the finest conceptions of public service.”  This report facilitated the assurance that our M.D.’s would be Good Doctors.  Unfortunately, good medicine which was expected to follow as a result did not.  In 1970, the Carnegie Commission Report was concerned with the “vital importance of adopting the education of health manpower to the changes needed for an effective system of delivery of health care in the United States.”  Here it is implied that academic and scientific excellence alone in the training of a physician will not insure “Good Medicine.”

What relevance does a discussion of Good Physician and Bad Medicine have to do with an organizational meeting of the OSR? A great deal, I think.

In 1967 Bob Graham, a Student American Medical Association (SAMA) officer, first made the suggestions that the AAMC have an organized student input.  At the Annual meeting in the fall of 1968, the assembly of the association passed a resolution supporting the inclusion of students in the activities of the AAMC.  In the fall of 1970, each medical school dean was asked to send a representative of his institution to the Annual meeting in Los Angeles.  From that group of representatives a steering committee was elected to meet with the president and chairman of the association and devise a plan for student input.  In February of 1971, in Chicago, the assembly approved the recommendation made by the steering committee for the formation of the Organization of Student Representatives.

Now to the relevance of the irony, Good Doctors and Bad Medicine..  We have in name an organization and in fact an irony.  It is my hope that the OSR within the AAMC can while maintaining the academic excellence in medical educations begun by Felxner in 1910, move toward the accomplishment of the concerns of the Carnegie report of 1970, that is, Good Medicine for the United States.

I started medical school at the University of Texas Health Science Center San Antonio School of Medicine (UTMSSA later to be known as UTHSCSASOM) in September, 1969.  In the fall term, the Dean of the School of Medicine, Dr. F. C. Pannill, called for a meeting with students to discuss the formation of a Health Careers Program for San Antonio Minority and Indigent Students.  When the meeting day arrived, I and a fellow student were walking out of the school late in the afternoon when the Dean’s secretary intercepted us and said, “Larry, you have to go down stairs.  The Dean called a meeting and no one showed.”  I told her I had to go home but finally agreed to go.

As a result of this meeting, I lead the Health Careers Program at the Medical School for the next two years.  Every Saturday, we would have a group of Minority high school students visiting the Medical School at which time we introduced them to various health careers.

In the Spring of 1970, the SAMA meeting was held in Los Angeles.  UTMSSA had an official student representative but Dr. Pannill asked me to attend the meeting to represent our Health Careers Program.  During the meeting, discussions, formal and informal, were held about the election of the first Chairman of the AAMC’s new OSR.  As the discussions progressed I was very interested in the role. I asked UTMSSA’s official representative if he were interested in the position and he said no.  I asked him if he would object if I sought the position and again he said no.

After the election and my being named the Chairman, a number of students from the north and northeast said that they would never have voted for someone from Texas if we had not had extensive discussions before hand.  Upon my election, I began meeting with the Executive Committee of the AAMC as a voting member.  Because 1970 was a formation year, my Chairmanship extended into the 1971 academic year.  The first formal meeting of the OSR was in December, 1971.  My first meeting with the AAMC was a strategic planning meet at Airlie House in 1970.  Also, that year UTMSSA went through an AAMC Accreditation visit.  As a member of the Executive Committee, I received a copy of the Accreditation Site Visit Report and voted on the accreditation of my own school while I was a student.  The following year (1971) a one year follow-up site visit was conducted with a subsequent report upon which I also voted.

Texas healthcare politics were active during these early years.  My class (1969-1973) was the first full class to go through all four years at UTMSSA.  Our faculty were outstanding clinicians and academicians with strong teaching and research credentials. They also were socially conscience and immediately began to seek ways to expand excellent healthcare into the minority and indigent communities of San Antonio.   The Chairman of the Department of Medicine, Dr. Leon Cander led many of those efforts and ran afoul of the TMS and State healthcare leaders. 

A number of those leaders pushed for Dr. Cander’s dismissal.  Dr. Pannill refused to dismiss him and so in 1972, the Chancellor of the UT System fired Dr. Pannill.  Unfortunately for the Chancellor he based his action upon the AAMC Accreditation Site visit reports, both of which I had read.  Knowing that the Chancellor had misrepresented the reports, I wrote a letter to each of the regents which included Mrs. Lady Bird Johnson.   I sent a copy of the letter to the San Antonio Express News which, rather than publishing it as a Letter-To-The-Editor, the paper published my letter on the front page of the paper above the fold.  The title of the article was, “Senior Medical Student Challenges Chancellor’s Truthfulness.”  During this time, Bob Dale, the internationally known Editorial Cartoonist for the Express News, did four original sketches on this subject.  When I saw his original pen and ink sketches, I asked for them and he gave them to me.  Framed, these sketches hang in my son’s office to this day.  The following sketch shows Drs Pannill and Cander’s names, and depicts them as victims of the Chancellor.

There was some discussion about whether I was going to be allowed to finish school in San Antonio but apparently when the Chancellor’s attorneys pointed out that my assertions about the Accreditation Site Visit Reports were correct, he relented. 

(Author’s Note:  This letter was sent to the Founding Dean of the University of Texas Health Science Center in San Antonio School of Medicine upon the occasion of the Dedication February 17th of the Dr. and Mrs. James L. Holly Auditorium)

“Dr. Pannill, this note is being send over night special delivery because I want you to receive it before the ceremony Friday night.  It will not bear my signature as I am at my office at 4 AM writing it before we leave for San Antonio. Both Carolyn and I read your note.  I repeat its content here for the benefit of my children with whom I am sharing my note to you.  You said:

“Dear Larry and Carolyn:

This is written in the hope you see it before the auditorium’s dedication as I want you to know that I truly will miss seeing you on the 17th.  It is my turn to be incapacitated by a rebellious hip, and I can barely make it to the table for meals.  It pleases be beyond words that the auditorium is to be named in your honor, as you deserve this and so much more in recognition of what you have done for our medical school.  That has always been my favorite of all of the building as it represents new thought and new loyalties more than any other. You will be pleased to know that Harry Ransom said as much in the Commencement Address in 1970.  I’ll think of you in that context but wish I could be there to join you.  Send me a picture please. 

I still have my piece of the foundation of the school that you and 1973 gave me and I’m glad that you will receive the honor of the name of the building.

All my love and best wishes to you and yours.  Carter”

Dr. Pannill, in my belief system the most valued commendation that one may receive at the end of life is to hear from the Creator the words, “Well done, thou good and faithful servant,” that and the love and devotion of my wife, Carolyn, and of my family are the pinnacles of life.  But in this life, there is no commendation or affirmation which I would rather receive that the one which you have given above and the one that my beloved School of Medicine will give me, my wife and truly my family on Friday night.   Your person, personality, professionalism and example as a physician/professor remain my professional “north star,” which provides an unwavering guide to me every day as I press toward the transformation of healthcare in my little part of the world.  I have your November, 1968 letter of acceptance to the School of Medicine Class of 1969, which Carolyn had framed for me.  It is one of my proudest possessions and I shall carry it with me to the ceremony tomorrow.  I still read it from time-to-time, and particularly value your signature on it. 

I remember the day that I received the letter.  A classmate in a class at Baylor approached me and said, “I understand you are going to be a doctor.”  I had received no notification and he added, “The Pre-Med Advisor told me he received notification of your acceptance to San Antonio.”  Immediately, I knew where the letter was.  It was in the mailbox of our previous residence.  I left school and drove to Bosque Avenue in Waco, Texas.  No one was home and I approached the mail box with some trepidation because I had already decided that I would commit a Federal crime, i.e., I was going to look inside the mail box which belonged to someone else.  I did and there it was.  It was a wonderful day.

I don’t know if you remember where we first had close contact.  I was leaving the school one afternoon and your secretary rushed out and said, “Larry, you have to go downstairs.  The Dean is there for a meeting with students who are interesting a forming a health-careers program for Hispanic children.  I said, “I have to go home.”  She implored me and I went.  You and I, and the other student with me, were the meeting.  As a result of that meeting, I ran the Health Careers Program for two years.  It was that work which led you to send me with the School’s official representative to the Student AMA meeting in Los Angeles. 

At that meeting, a discussion was held about the AAMC planning to organize the Organization of Student Representatives (OSR) which still exists today.  When the students were going to elect a Founding Chair of the OSR, I asked the student who was the official School of Medicine representative if he was interested in the job.  He was not and I asked him if he minded if I volunteer.  He did not.  I spoke to the group and was elected the Founding Chair of the OSR.  As a result, I was the Chair for two years, one during the organization of the group and the second during its first year of existence.  The following appears on the AAMD website currently:

“History

“In 1968, the AAMC passed a resolution calling for the development of mechanisms for student participation in the affairs of the AAMC.  In 1969, the Assembly adopted an addition to the bylaws, creating the OSR. At the 1969 AAMC Annual Meeting, the OSR was created with the following intentions: to facilitate the expression of students' ideas and views, to incorporate students into the governance of the AAMC, to foster the exchange of ideas among students and other concerned groups, and to facilitate students' action on health care issues.

Past Chairs - From the AAMC website

You will remember that as a result of this, I:

1. Attended the AAMC’s 1970 Strategic Planning session at Airlie House in Virginia
2. Attended the AAMC/AMA Annual Education Meetings in Chicago each January
3. Served on the Executive Committee of the AAMC for two years, as a voting member
4. Was the first medical student to be a voting member of an accreditation site visit which was at Cornell Medical College in New York City.
5. Voted on the accreditation of our School of Medicine twice while I was a student.

It was a Chicago Education meeting that I led a meeting of all of the Deans of Schools of Medicine.  You and I sat on the podium.  The oldest dean of a school of Medicine was dominating a discussion session.  I leaned over and asked you what I should do. You said, “Tell him to sit down!”  With consternation, I struck the gavel and said, “Sir, we must move on, will you yield the microphone.”  You said, “My goodness, Larry, I didn’t expect you to do that!”  The audience applauded.  I shall never forget that.  Your sense of humor and propriety were parts of what I so admired about you.

It was my work with the AAMC and particularly in voting on the accreditation of our school which is the capstone of our relationship.  I and all of the students were shocked when you were removed as Dean.  We wanted your name on our diplomas and we raised a ruckus, but alone among the students I knew that the reasons given by the Chancellor for removing you were false. He quoted the accreditation report about deficiencies of the School, when the actual reason was you would not fire Leon Cander, Chairman of Medicine. 

I knew he was not telling the truth because I had a copy of the accreditation report.  I wrote a letter to the Chancellor and to all of the Regents, one of which was Lady Bird Johnson.  I sent a copy to the San Antonio Express News expecting them to publish it as a letter €“to-the-editor.  They did not.  It was front page, 40-point type, “Senior Medical Student Challenges Truthfulness of Chancellor.”  I still have the original pin and ink original editorial cartoons created by Bob Dale for the paper.

There was some discussion, I understand, of the Chancellor taking steps to boot me out of school.  You offered to bring me to SUNY where you were going as Dean and to graduate me.  The Chancellor gave up his plans when apparently his lawyers told him that I had the document which proved that what I was saying was the truth.  The wonderful thing is that the truth is always the best defense.

Dr. Pannill, your distinguished career should have concluded in San Antonio, but the foundation you laid has been built upon with integrity and excellence by your successors.  I thought I would never meet another Dean who would be held in as high esteem by me as I hold you.  Bill Henrich proved me wrong.  When I met him, I thought that it was deja vu (all over again, smile)  I know you have met but he shares your vision, passion, excellence and drive. I am pleased that he became the President of the Health Science Center.

I apologize for this long discourse, but I wanted to write these memories down.  They are a rich part of my life and I want to thank you for them.  It was in your honor that Carolyn and I gave our first contribution to our School.  It will be our honor to continue to support the Distinguished Carter Pannill Professorship and to continue to enjoy the history we share.

I still stand in awe of having the privilege of being a physician.  As I watched and re-watch the movie  Secretariat, I am moved almost to tears at the portrayal of his running of the Belmont Stakes.  After a brief moment, he is no longer running to beat other horses.  He is running for the sheer joy of running. His owner shouts to the jockey, “let him run, Tommy; let him run!!”  The jockey was holding on for dear life.  Secretariat is competing only with himself and his achievement was breathtaking.

Dr. Pannill, our school, your school, the School of Medicine, like Secretariat is running toward a goal, not before imagined possible in South Texas.  You started us; Dr. Henrich and many others carry the torch, and many of us in communities around the country run this race with the abandon and joy of a Medical-Practice Secretariat.  When I stand tomorrow night in the auditorium paid for by my dear friend, with my family, friends, professors, fellow students and colleagues, these are the thoughts I will have.  You are central to them all.

God bless you, my mentor and hero.  Thank you for your love and care.  It places wind under my wings.  Remember what the trainer of Secretariat said the night before the Belmont Stakes, “Tomorrow, he is going to take wings and fly.”  Dr. Pannill, our tomorrow has come and many of us, having taken wings, which you helped fashioned, are flying!  Amazing.

James (Larry) Holly, MD
CEO, SETMA, LLP
www.jameslhollymd.com

PS:  Along with the Pannill Distinguished Professorship, the following are now a part of our School:

1. The Dr. & Mrs. James L. Holly Distinguished Chair in Patient-Centered Medical Home
2. The W. E. Bellue, Sr. (my wife’s father) and W. R. Holly, Sr. (my father) Distinguished Lectureship in Patient-Centered Medical Home
3. Appointment to the faculty of the Medical School as an Adjunct Professor of Family and Community Medicine
4. UTHSCSA (President's Gala)
5. UTHSCSA The Center of Medical Humanities & Ethics - Daniel Duke Music and Medicine Endowment
6. UTHSCSA (President Development Board Fund)
7. UTHSCSA (Endowed Chair of Dr. Husain)
8. UTHSCSA (President's Council)
9. UTHSCSA (Musical Interludes - Peveto Chapel)
10. UTHSCSA (Veritas Program)
11. UTHSCSA (Mrs. Holly's Honor  - 18 Chromosome Study)
12. UTHSCSA (Endowment of Institute of  Primary Care)
13. UTHSCSA (SOM Student Educ Enhancement Fund)
14. UTHSCSA (honoring Mary & William Henrich MD)
15. UTHSCSA (1973 Scholarship Endowment)
16. UTHSCSA (2010 Scholarship Endowment)
17. UTHSCSA (Primary Care Project)

This link is to the audio and text of my address upon receiving the Distinguished Alumnus Award. 
http://jameslhollymd.com/Presentations/UTSAMS-Distinguished-Alumnus-Award-2012-Acceptance-Address

The following is an extract from the above link:

“On November 22, 1968, 44 years ago, I received my letter of acceptance to the 1969 class at UTMSSA.  It is signed by my professional mentor, Dr. F. C. Pannill.  My wife framed it and I brought it with me tonight.    On October 9, 2012, I wrote Dr. William Henrich, the President of the Health Science Center and said:

“As Carolyn and I prepare to go to San Antonio this weekend to receive the honor which I most desired in this life - to be a Distinguished Alumnus of my beloved School of Medicine - I wish to tell you and Mary that if I had a choice of knowing you and being your friend, or receiving this award, I would choose to be your friend.   You have afforded me opportunities which I never imaged would be possible and I am grateful.   You have extended your warm embrace to me and to my family beyond anything I could have imagined and I am grateful.

“As Carolyn and I continue to hope and to believe for your full and complete recovery, we want you to know the esteem in which we hold you and the love which we have for both of you.  

God bless you.  Larry”

In August, 2012, I attended Dr. Pannill’s Memorial Service; on October 10, 2012, I wrote his children and grandchildren and said:

“Today, I am preparing to leave tomorrow for San Antonio.  On Saturday night, I shall receive the 2012 Distinguished Alumnus Award.   I shall carry with me to this event, the framed copy of my letter of acceptance to the 1969 entering class, signed by ‘MY’ Dean, Dr. Carter Pannill.   My greatest regret is that your father and grandfather will not be there.  In my professional career, no person has influenced me more than Dr. Pannill - I could no more call him Carter, than I could stop breathing.  He shall always be the epitome of professionalism, leadership, scholarship and the kind of physician I have always wanted to be.

“You know these things but as I stand before the convocation on Saturday evening, I want to know that I have laid this honor at his feet and expressed my gratitude that I knew and loved him and that he respected me.  No honor could be more valued by me.  I am pleased for you to know that in my judgment, Dr. Henrich and your father are men of the same caliber and cut from the same cloth.  I think your father would like that.”

“Tonight, I remember that I have always been proud of my school of medicine and that I have often wondered if my school of medicine could and would be proud of me.”