No greater honor can come to one than that given him by his own colleagues. Such an honor has come to me by your invitation to give this annual Robert Kennedy Lectureship. As I reflected on the others invited to address our association, as well as their unique contributions to the field, I found it difficult to justify your selection --but I do applaud your choice.
I met Dr Kennedy only briefly at a UAEM meeting, but am cognizant of his enormous contributions to surgery and to emergency medical care. Each Kennedy Lecturer has described these in the past. As I reviewed their papers, and his contributions, I could not help but reflect on one unique attribute of the man --he understood not only the necessity for change, but also change itself.
The process of change is one that, using one analogy or another, a number of Kennedy Lecturers have considered. In his 1974 Kennedy Lecture, 1 that magnificent gentleman, Oscar P Hampton, Jr, reflected on the changes he had seen in the provision of emergency department care. Although he spent much of his time defending academic orthodoxy, he also discussed the methods used by the heterodox, those of us in emergency medicine, to bring about that change. His paper deserves rereading if for no other reason than to gain an understanding of the posture of the orthodox, at least at that time. In 1983, his definition of a specialist bears repeating; it is the classic one, and is still used by the orthodoxy of organized academic medicine. Dr Hampton defined a specialist as one who has "in-depth knowledge and skills in a specific well-defined field. ''1
My choice of topics for this 1983 Kennedy Lectureship requires, I believe, some explanation. In 1931, William H Ogilvie, MD, a surgeon, published in Lancet an essay entitled "Orthodoxy and Heterodoxy in Surgery," which was republished in 1948 in a collection of his essays, z In 1968, when I became chief resident in surgery at Wayne State University, it became required reading for me for reasons which were, at the time, obscure.
The inscription on the flyleaf, written by Alexander J Walt, MB, CHB, has always remained with me --"mostly heterodox." I was not only flattered by being presented this book by my chairman, but was also flattered by the compliment (I thought) paid me by the Inscription. When I read the essay, I understood two things: first, why I was required to read it; and second, how change could occur in the academic arena. As time has passed I have, upon occasion, reread this essay. Despite the analogies to horticulture, athletics, and zoology used by others in discussing change, I have found no other essay as helpful.
The preparation of this address caused a significant amount of introspection on my part. As I thought about the physiologic changes that have accompanied my increasing age, I could not help but reflect on my increasing reluctance to be either the instigator or the acceptor of change. I have become much more orthodox than I ever believed I would. The heterodox resident who was given an essay to read, to become more understanding, has become part of the orthodox Establishment, resistant to change. When, however, I remembered George Orwell's 1984 --"orthodoxy means you