From the Battlefield to the Reading Room, Making Service Priority One
“Arma virumque cano” – Aeneid
I first read Virgil’s stirring poem as a ninth grader, not knowing I would one day count myself among the warrior class, part of the story “of arms and the man” that begins Virgil’s Aeneid. When I first took the Oath of Office in 1991, I never envisioned I’d commit myself to that cause for 25 years.
Such is the odyssey of life. On behalf of all who have worn the uniform, I would like to thank and commend the College for highlighting military radiology in this issue of the Bulletin.
Societies have mostly edified military virtues, particularly during epochs of conquest when revisionism runs freely. While America isn’t currently in an epoch of military conquest (or, arguably, even success), society has found the wisdom to place the responsibility to govern where it justly belongs in a free nation, with the political class.
Our citizenry generously venerates the military and those who serve without impugning them for their foreign adventures. According to Gallup, today’s U.S. military enjoys the highest confidence rating of the major public and private federal institutions included in the analysis. Of note, the military and the police are the only public institutions with more than 50 percent of Americans reporting “a great deal” or “quite a lot” of confidence.1 This is the direct result of the disciplined application of faithfulness, integrity, and courage.
Over 400 radiologists serve on active duty around the world today, and thousands more veterans and civilians serve in military and Veteran’s Administration (VA) hospitals, where nearly 20 million Americans receive their health care through the Military Health System and the VA. These institutions are foundational to graduate medical education, research, and innovation. In the 1970s, the VA created the first electronic health record, called VistA/CPRS. In the following decade, Army medicine became a pioneering force and principal funder of PACS technology. These two health care systems remain unique in America for their global integration and focus on population health and preventative care. For decades, the radiologic-pathologic correlative course at the Armed Forces Institute of Pathology (AFIP) was a universal rite of passage superseded only by one’s pilgrimage to Louisville for the then in-person ABR Exam.
With Congress’ closure of Walter Reed and as tradition gave way to technology and led to the demise of the oral exam, the ACR stepped in to rescue an endangered national treasure and preserve the common training experience in the form of the American Institute for Radiologic Pathology, a new iteration building upon the success of the AFIP. This issue highlights the strong and longstanding partnership between the College, the military, and the VA.
Military service and College membership are highly complementary at the individual level as well. My engagement with the ACR arose from a newly found, urgent interest in becoming involved in organized medicine. I had just returned from a life-changing personal and professional experience aboard the Navy’s hospital ship Mercy, where I spent six months as the sole radiologist caring for thousands of victims of the massive 2004 Asian tsunami. That experience touched me in many ways; not only did it spark an enduring commitment to national public service, but it also demonstrated the singularly critical role that radiology plays in modern health care delivery through imaging and image-guided intervention. The field hospitals ashore were staffed by outstanding and dedicated medical teams, but their outcomes couldn’t compare to Mercy, simply because they lacked imaging capabilities.
This global catastrophe presented a unique setting to witness firsthand radiology’s singular ability to make the diagnosis and set patients on the successful path to recovery. No clinical service was more influential in transforming third-world medicine into first-world medicine. I returned from deployment with a single-minded commitment to help ensure imaging was accessible to patients everywhere and would be recognized for its vital contribution to positive patient outcomes. As I became involved in the College, I realized that my goals aligned exactly with the ACR’s mission.
For someone enmeshed within a public health care system, involvement with the College has provided an important lens into the strengths and weaknesses, trials and tribulations of the private health care environment. As the Navy’s chief medical officer, I applied these lessons to make the public system better. I hope those in the private sector find in this issue some best practice and leadership ideas that they can apply to their practice.
To all those who continue to stand the watch, thank you.
Stephen L. Ferrara, MD, retired Navy captain and former Navy chief medical officer