On May 21, 2015 Medical Home News submitted a series of questions to SETMA (see http://jameslhollymd.com/Letters/medical-home-news-questions-for-catching-up-with-dr-james-l-holly).  The first question was:  “You have an extraordinary passion for your practice, your patients, and you pursuit of excellence.  Where does that passion come from?”

As other healthcare providers you read my answer to this question, they realize that this answer derives from my personal story.  They are invited to substitute their words and their story for mine.  While this introduction to the intent and dynamic of the TCPI is based on my experience, its ultimate value will be as it provokes others to share their story within thier own practice, community and within the TCPI community. 

There is an old adage which states, “It’s my way or the highway,” TCPI modifies that to say, “This is our highway; it is an example from which you can build your personal highway.”  The building of that highway requires that you be willing to face where you are and who you are, as you envision where and what you want to become.  It is founded upon the implications of Abraham Lincoln’s 1858 declaration:  “If we can first know where we are and whither we are tending; we can better judge what to do and how to do it.” 

The Source of My Passion

My father did not go to college but started work as a laborer with Louisiana Power & Light Company.  In 1947, when I was four, we moved to a company house at Camp Livingston, a decommissioned, military base outside of Ball, Louisiana.  Our family of four shared a two-bedroom house with another family.  My father traveled to Monroe every Monday morning and returned Friday night.  Within a year, he ran the power station at Camp Livingston and we moved to Natchitoches where he ran the power company’s interests over a large part of north Louisiana including Camp Polk which would become Fort Polk.  Graduate engineers were sent to him for training.  I watched his self-sustaining energy and drive, and his commitment to excellence without supervision and without guidance.  I saw rich, educated and powerful men defer to my father because of his character and personal integrity.  I learned.

Years later, while riding down an unpaved, country road, my father stopped and hailed a man plowing in the field.  The man walked over and my father said, “I thought you were going to be by the house last Friday?”  The man responded, “One of the kids got sick but I’ll be there this week.”  As we drove on, I asked my father what that was about.  He said, “He couldn’t pay his light bill and I paid it for him.”  This was Louisiana, my father was Caucasian and his friend was African-American.  I learned.  He would never let children go without heat and power.  Although he made less than $5,000 a year, he was never without money to help others.

As my social liberalism grew, my father expressed concern.  He had lived a life of compassion and kindness to others, but had never opposed his culture.  I started aggressively opposing that culture when I was 17.  I responded to my father’s concern and said, “Daddy, everything I believe and everything I do, I learned from you.”  As my personal faith grew, it only reinforced the lessons I had learned from my father until I would define myself as “a social liberal, a fiscal conservative and a theological fundamentalist. “   My father is deceased, but I still live with a desire to be like him, to be a man of integrity, honor, compassion, and fearlessness. 

The Honor of being a physician

The other great influence on and driver of my life is the overwhelming gratitude which I feel for the honor of being a physician. Forty-three years later, 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 in 1973, the same year I graduated from medical school.  After the first half of the race, he was no longer running to win.  He was running for the sheer joy of running. 

Like Mikhail Baryshnikov, the great Russian ballet star, Secretariat is competing only with himself and his achievement was breathtaking.  When he crossed the finish line and the race was over, he was still running as no one believed a horse could.  Secretariat had done something which had never been done before and which has never been done since.  I am drawn to this race as I have come to the point in my life when I am working for the sheer joy of my work.  I have frequently said, “I have a passion for which I am owed no credit and over which I have no control as it is a gift from God.”   Whatever your personal belief system, the principle can apply.

In the movie, Saving Private Ryan, Ryan, now in his seventies, approached the headstone of Captain John Miller who gave his life that Ryan could live. In the most poignant moment in a great film, tears stream down his face, as he crumpled before Miller’s tombstone, 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.  My debt and yours did not originate so dramatically, but it still exists.

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 trust. 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, our professors and the public which funded our education.

What nobler calling could one have than the opportunity to collaborate with others in their quest for health and hope? The honor of the trust and of the 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.

Next week, we will examine how this source of passion relates to CMS’ TCPI.