February 27, 2009

The Nation's Doctor

As Surgeon General, from 1998-2002, Dr. David Satcher described his role as the “Nation’s Doctor”. In 2007, he testified before Congress stating in part, “I believe that it is the responsibility of the Surgeon General to communicate directly with the American people….” (Committee on Oversight and Government Reform The Surgeon General’s Vital Mission: Challenges for the Future Testimony by David Satcher, M.D., Ph.D. July 10, 2007.) Surgeon General nominee, Sanjay Gupta has already proven that he can communicate with the American people. The prevailing argument however, is that it takes more than a reporter to be the Surgeon General. His first challenge will be Congressional approval. After approval, Dr. Gupta will likely spend the majority of his time winning the support of those who believe he is not qualified.
Only two of the last eleven Surgeon Generals are easily remembered: C. Everett Koop and Joycelyn Elders. C. Everett Koop was Surgeon General from 1982-1989. He is a Pediatric Surgeon and continues to make television appearances. He was very public during his service and fit the stereotype of what most Americans associate with wisdom and experience. The Surgeon General warning labels and C. Everett Koop are synonymous in the minds of Americans who witnessed the obscure office become a very public platform. The second memorable Surgeon General is Jocelyn Elders who was Surgeon General from 1993-1994. She is a Pediatric Endocrinologist and created a media firestorm with comments about masturbation. Her firing began a rift in the perception of what the Surgeon General should promote. Public health advocates and political conservatives do not always agree on what message the Country should hear.
These two examples demonstrate contrasting communication styles and media experience. Media knowledge is a vital skill for an effective Surgeon General. It is this role as the “Nation’s Doctor” and his ability to communicate that illuminates the choice of Dr. Gupta for Surgeon General. Dr. Gupta is a neurosurgeon who has already become a trusted source of information for millions. However, he may not have the support of many in the scientific community or the Public Health Corps, which he would oversee. As with many institutions, experience is the currency that pays the dues. Other physicians also look at the choice as a threat to public health and primary care because he is a sub-specialist without a Public Health degree. The past eleven Surgeon Generals have had specialties to include neonatology, family medicine, nephrology and veterinarian medicine. The current acting Surgeon General Dr. Steven Galson specializes in Preventative Medicine and Occupational Health. Dr. Gupta’s credentials as an expert in neurosurgery confirm his ability to practice medicine. His success in public health would depend on taking full advantage of the vast resources at his disposal. If Dr. Gupta utilizes the scientific and medical advise of experts to analyze the evidence and then, uses his skills as a communicator to direct the National health goals he has the potential to be one of the best remembered Surgeon Generals in a generation. Imagine 15 year-olds talking at lunch, “Dr. Gupta said, ‘Ephedra can kill you.”
The Office of the Surgeon General may be poised for the spotlight and focus America’s medical needs toward the best care practices. Or it may become another distraction from important issues. We may see how ready for change everyone is and how an effective communicator can make a difference.

Jeff Hutchinson, MD, FAAP, FSAM
COCM Website and Blog Editorial Advisory Committee Member