J. Chris Hawk, III, M.D., oral history interview, November 25, 1992

              
DR. BROWN: This is an interview with J. Chris Hawk, III, 
M.D. who served as President of the state medical association in 1991 and 1992. The interview is conducted by Dr. Laurie Brown, honorary member of the society, and Manya Greene, in Charleston, in Dr. Hawk's office, on November 25, 1992. We will talk with Dr. Hawk about his term as president and then anything he wants to add, we will be glad to let him have it. Dr. Hawk, the first thing I am going to ask you is a little bit about your family, your background, where you were born, who your parents were, just a little bit about your family of origin, and where you grew up. 
DR. HAWK: I was born in Virginia. My father was a resident in surgery at the time at the University of Virginia. We moved to Charleston, South Carolina when I was four and I grew up in Charleston and attended public schools and then went to college at Davidson and subsequently to Vanderbilt Medical School. I was one of nine children, the second oldest. We had a close family. It was a l ot of fun growing up. I never felt like there was any particular pressure on me, for example, to go to medical school, but I think I always sort of leaned towards being a physician. My father is a well known member of the medical profession and the medical society, having served as president about the time I came back to South Carolina. My mother is now an attorney but at the time I was growing up, she was a full time mother and subsequently was chosen as the American Mother of the Year. So I had very strong parents and obviously that had a lot 
to do with my subsequent career. 
DR. BROWN: All right, in medical school, you were at Vanderbilt? 
DR. HAWK: Yes sir. 
DR. BROWN: Tell me just a little bit about medical school. Was it hard? What were some of your experiences? 
DR. HAWK: I remember when I went over to Vanderbilt to interview, one of the people who I had known in college said that medical school was just like college except there weren't any liberal arts courses. You spent all your time studying science and I remember that we basically worked all the time during the day in classes and labs and at night studying, but it wasn't that tough. It required a lot of work and everybody did a lot of work, but it wasn't overwhelming. I enjoyed the time I was in medical school and I don't think it was until I went on and became a resident in Boston later that I realized just how good the education had been that I had received in medical school. There were some people who I was very influenced by when I was a medical student. One was a pathology professor who taught surgical pathology. He was a crusty old guy. He had actually been a friend of my father's in their training as cancer surgeons and I really enjoyed him and took a real interest in cancer in part because of him. Another physician who influenced me strongly was a pathologist who taught the second year pathology class. He was just an outstanding teacher and yet was a great friend to a number of students and I still have a tremendous 
admiration for him. In fact, I plan to see him when I go to 
Nashville next week for the AMA meeting. 
DR. BROWN: Good. 
DR. HAWK: The third person who was a tremendous influence on me as a medical student was an internist who taught all the third year students. He had an incredible love, not only for teaching but also being a physician, he had tremendous dedication to doing absolutely the best that anyone could do and I really was inspired by him, I think, to be the best physician I could be. 
DR. BROWN: Now how did you decide what type specialist you would be? Was there anything in particular? 
DR. HAWK: Well at that time, Vanderbilt had almost all of its graduates going into specialties. They had very few people who went into family practice. I think I had always leaned a little bit towards surgery because of my father's influence, not that he talked to me about it or pressured me, just that I was interested in what he did and I was a little bit more attracted to that and as I went through the rotation as a third year student, I think I enjoyed surgery the most and I decided then that that is what I would do and as a consequence, I did sort of a mini-internship as a fourth year student, taking no surgery but taking everything else, so that I could sort of get a lot of 
internal medicine before I started my surgical training. A Then 
after your surgical training, you decided to come back to 
Charleston.
DR. HAWK: I trained in surgery in Boston at Massachusetts 
General which I was concerned would be a cold stuffy place up north but actually was a very warm place in terms of the support that the various staff gave the physicians. I finished training there and about the time I was finishing and looking for a job, I decided to go into practice with my father. He was practicing alone at that time in private practice and probably I had always had it in the back of my mind that I might come back to Charleston, but I really never talked about it or made a decision until I was just about finished with my training. Before I came back, I had served for 1-1/2 years with the military in Japan which was a little bit shorter stent than expected, but because I was on an unaccompanied tour, I was allowed out early and came back to Charleston after I finished with the military. 
DR. BROWN: Did you get to visit your father's old home in 
China while you were in that section of the world? DR. HAWK: I didn't go to China. They had significant 
restrictions on who could visit China, and although I traveled some in the orient, I was stationed in Japan, I went to Korea and Taiwan, and Singapore, I did not ever visit mainland China, and I 
still have not visited there. DR. BROWN: I see. Now, were you married during the 
residency? DR. HAWK: I married before the start of my fourth year at medical school to someone I had met at my sister's wedding. My older sister had a friend who came to her wedding, and I met Fran 4 
there and we dated while we were seniors in college, and then she worked in the Far East for two years and when she came back, we got married after that. When we were in Boston, we had our four children, including twins while I was Chief Resident. 
DR. BROWN: And what was Fran's name? DR. HAWK: Fran Sallie was her name. DR. BROWN: Your children are sort of beginning to grow up a 
little bit, aren't they? 
DR.  HAWK:  My  daughter  is  now  a  sophomore  at Dartmouth  
College.  She  has  an  interest  in  possibly going  to medical  
school.  My  twin boys  are  juniors in high school  this year,  and  

my youngest son is in the ninth grade in high school. 
DR. BROWN: How did you sort of get to beginning in what we say is organized medicine, medical, I don't want to say the hierarchy, but medical policy making, etc., medical society work and such as that? 
DR. HAWK: Well, I got started in an unusual way because my father was the president of the state medical association when I moved back to Charleston and went into practice with him. I have actually jokingly said that I was taking calls for him before I had a license, which is true, just because it takes a couple of weeks to get your license, and he was traveling frequently on weekends on medical society business, so I had that introduction watching him that year he was president. The first committee I served with was about 1979 on voluntary cost containment, and it is interesting to see what's happened in the thirteen years since then because we haven't made any progress really in terms of cost containment. For us at that time, it was voluntary and for those of us who took it seriously, it could make a difference, but it has never been done seriously, unfortunately. When I first started, my first job I really had with the medical society was a trustee and that was about 1985. The prior trustee had finished his term and nobody else was really interested in committing the time that was necessary and I was interested at some point of being the trustee and volunteered then even though I think I ~as 
pretty early on, I guess I was 38 or so, and that, in my opinion, 
was pretty young to be starting as a trustee but that is when I 
started. I think in the county society you were active
DR. BROWN: 
even before that, weren't you? 
DR. HAWK: I was active in the county society from the time 
that I got to town working on things like the nominating 
committee and planning committee but I never had any formal 
office with the county society. 
DR. BROWN: You said something about cost containment. What 
were some of the real major issues during your term as president 
of the state association? 
DR. HAWK: There were three really major issues during my 
year. 
The first was RBRVS which is the Resource Based Relative Value Scale. 
It was the result of about ten years of work to change the reimbursement for physician, primarily in Medicare, but I suspect that everybody thinks it will work down to other insurance companies as well, but to have better reimbursement for 
work or primary care and less for specialty work or procedures. The reason that was a hot issue was that when the federal government came out with its fee schedule, it included a 16% cut for a lot of things such as behavioral offset and it took a real grass roots effort to get anything done about that, and we were able through writing letters and contacting our congressmen to get that 16% reduction down to about 5%. The 
second  major  issue  was  HIV  testing for physicians and other  
health  care  workers.  Shortly  after my  year started,  the CDC  
issued  its  recommendations  for testing of health  care  workers,  

and that was that people who did invasive procedures should know their HIV status. At the state level, we decided it was appropriate to have a testing mechanism so that if physicians in the state wanted to be tested that we could insure their confidentiality and we started working to set up what was subsequently called HIV-HBV safety network, and physicians and other health care workers can be tested under that system with confidentiality. As it has gotten started, it has really turned out that this is the expert panel so that physicians or other health care workers can come to this panel and find out how they need to modify their practice and whether there should be any restrictions on it. This has just been going on for the past year, but I think it is going to be a forward thing for a committee for physicians over the next two years. The third major issue that faced the medical society and all the medical 
profession was the full issue of health care reform, and there were fifty or so bills before the U.S. Congress during my time but none of them passed, but that is still a major issue. We had a large issue in our state society and our state legislature which was Representative Billy Houck's bill which would have changed the way the hospitals and physicians are reimbursed so 
that  their  prices  or  fees  can  only go  up  a  certain amount  each  
year  that  would  be based  on  whatever the rise in the CPI  was.  
That  bill was  strongly opposed by the hospitals and by  a  number  

of physicians and it created quite a furor within the profession. I think we may look back on that bill a few years from now wishing we had something that did as much to protect physicians as that bill actually did. But those were really the main issues that we faced as a state medical association during my presidency. 
DR. BROWN: May I take it then that you are fairly well satisfied with how these issues were resolved? 
DR. HAWK: They are not issues that could be resolved or solved during one year. I think that the progress we made on them during the course of the year was satisfactory. For example, on the RBRVS, I think that we were able to keep physicians in a cooperative mood so that they were willing to work to see that this change was successful. It is still too early to say what will happen with that, but I think it is the basis for appropriate reimbursement of physicians in the future. I think that we have made a start towards the HIV testing system. 
I think in ways it is a tremendous waste of money, but I think as 
physicians, we needed protection from what the federal government was requiring. I think this is as good a way there is to do it. DR. BROWN: Is there anything else you would like to say about what went on during your term as president? 
DR. HAWK: I gave my inauguration speech on what I call the ABCs of being a good physician. I have heard obviously a lot of speeches over the years that concentrated on things that organized medicine was doing and it seemed to me that physicians were hassled to the point that many of them were so frustrated they were thinking about what else they should be doing. thought it was important to try to address that and to encourage them in their work and also to encourage them to be good physicians and so I talked about the things beyond ability that make a good physician. I talked about bedside manner, community service, dignity for your patients, ethics, fun, setting goals, and humor, and as I look back on it, that message was very well received. A lot of people commented on it after they read about it in the journal, and I decided to take that theme around with me as I spoke to county medical societies and other groups because I think that we can be good physicians despite all the hassels that involve our practice, all the regulations, all the red tape, and all the changes that are coming back and the bad press we are getting and I think it is important that we do that, and that we be the best physicians that we can be. I was talking to someone recently about this and it really occurred to me that the role model for that good physician was my father and I don't really know anybody who embodied that better than he did. He was a superb clinician. He was well respected by his colleagues. He was loved by his patients, and yet he did more to serve organized medicine in this state, or did as much as any physician in his generation. I think it is a tremendous credit to him, the job that he did, and I am proud to follow in his footsteps. People talk to me about that, mentioned that I was following in his 
footsteps, and that is what I was doing, following. I was not really filling his shoes, but I was at least following in his 
footsteps. 
DR. BROWN: I think anybody who knew or knows John Hawk certainly would agree with that. He is a real fine physician and Christian gentleman. 
DR. HAWK: No question about it. 
DR. BROWN: Is there anything else you can think of during that time. I might mention myself that you said that you made no progress against cost containment, and I think Ms. Greene here can verify this, in talking to every past president, cost containment has been one of the big things. 
DR. HAWK: I think that is right. I think cost containment is really the issue right now. The AMA's program for health reform, Health Access America, which is now 2-1/2 years since it was introduced, its main thrust is really access for people who have no insurance, but an equal part of it is for cost containment, and I think that costs have really gotten out of 
hand for many reasons. It is not just one simple reason and that 
is also the reason we haven't been able to control costs, but I think it is going to be the main problem that our society faces, as we come up with any kind of health care reform. It is discouraging to me that the proposals that have been presented have not really adequately addressed the problem and President-Elect Clinton's plan is just as weak as the others in really addressing cost containment. Until people are ready to talk about rationing, I am not sure that we are really going to make any progress in terms of cost containment. 
DR. BROWN: Now, ásince your time as president, have you still been active in the state medical association and other organized medicine? 
DR. HAWK: Well, it's only been a very short time, I'd say only six months, but I am currently an AMA delegate. We now have term limitations so that you can only be a delegate for ten years and I think that is going to be plenty long enough for me, and that may be too long, I do plan to continue to do that. I enjoy that and I think it is an opportunity to be a part of the decision making process for the profession and I think it is important that people who are committed to improving the profession be willing to make that commitment and I am willing to do it. I have also this year been on a couple of other committees that are, I think, starting to do things. One is the HIV Safety Network. We have just gotten that going this year, and I think has gotten off to a good start and I hope to stay 
with it long enough to be comfortable that it is going to be able to do a good job to protect physicians. Then I am working this year with the public relations committee for the state medical association and that is a committee which has been around for a long time but we have become more active this year, not because of anything I did but because of what a single member did. He brought in a suggestion that we start doing some things, and as a consequence, the committee has gotten more active and has added some new members and has now become a very active committee to try to address some of the issues concerning public relations. 
DR. BROWN: Not only the state medical association, but you are active, I understand, in the local society. 
DR. HAWK: I think you always have to keep up your activity in your local society, no matter how far along you go. One of the things I have done with the local society this year is to be one of the physicians for the many internship programs where lay leaders in the community spend two days with physicians, a half day each with four different physicians. I enjoyed that. I thought it was a good opportunity to have lay leaders learn a little bit about what really goes on in a doctor's practice. I think all of them enjoyed it and I think all of the physicians did. It was a good exchange on all sides. 
DR. BROWN: Do you have any comment about any particular physicians or legislators or anyone you would care to comment on, anybody who might have helped you out or been real with you on issues during your presidency of the state association? 
DR. HAWK: Well, we did not have any issues that got really 
far enough along that it was important to have a legislator for us or against us. As I mentioned, Representative Houck was a retired physician from Florence who introduced a bill but that really did not get far enough along to be the major issue that everybody thought it was. I think that the people who have been most influential along the way have been other SCMA physicians, particularly people who have served in the presidency, and have continued to be very influential and committed to .improving the work of the association and medical profession but I don't have any legislators who I think have been that influential during my time. 
DR. BROWN: You have told us what you think are the major issues in medicine today, would you sum that up again a little bit? What you see facing medicine now. 
DR. HAWK: The main problem that we have right now are two. We have a lot of people who are uninsured or under insured and it is estimated to be between 35 adn 40 million and we have costs that are out of control, probably in the neighborhood of 14% of the gross national product this year. I am not sure what plan is going to be finally improved to address these issues. The AMA has a good comprehensive plan that probably does not go quite far enough on cost containment. President-Elect Clinton has a plan which he has not completely unveiled to address this issue. This plan is the most likely one to be accepted but I think he is already beginning to realize just in the month he was elected, or three weeks, that it is not a simple problem and it is going to require not only a lot of planning but a lot of cooperation. Those are the two main issues that face the health care system. I think that what faces physicians, maybe even tougher, and that is how do we adapt or adjust to whatever changes come along. Physicians are what insure the quality of our health care system. I think the quality up until now has been excellent and I think it is important that physicians be willing to make the commitment not to lower the quality with whatever health care reform comes along. So, we need to do that. The way I would summarize that is that we need to be the best physicians that we can be and I think that if we are good physicians, then we will maintain that quality with whatever health care system is developed. 
DR. BROWN: I take it you are optimistic about the future of medicine then? 
DR. HAWK: I'm not sure how optimistic I am. I think it is going to be tough but I think there are going to be a lot of tough things for the country to face. I think it is possible for us to be optimistic, but also realize there is going to be a lot of work and lumps along the way. I think we are going to take our lumps, we have taken our lumps, but I think it is possible for us to come up with something that is better, not only for our patients but also for the medical profession. 
DR. BROWN: Are there any other comments that you would like to make about anything we haven't covered. DR. HAWK: I think it is a tremendous honor to be president 
of the state medical association. You get a lot of respect from people that you don't necessarily deserve, that you haven't really worked for. I didn't realize that until I was the president. I guess if somebody had asked me about it, I would have said, sure, but to me that was something that was a pleasant surprise. Like everything that I did in the state association, I think you get more out of it than you put into it, and that is probably true for just about everything you do, and I think it is important to remember that and it is important also to remember that we need good people to continue to take on tough jobs like working in your local medical society and the state medical society. One thing that those of us who have been along that road need to do is bring on the younger physicians to develop and be the leadership for the next generation. 
DR. BROWN: Would you do things different in the state association if you became president again this year? 
DR. HAWK: When I became the president, I didn't really have an agenda, I think some people have an agenda, but I realized it wouldn't be possible to correct all the problems we had in one year and my agenda was really to be pro-active to try to address the issues, and at the same time, maintain an emphasis on our role as good physicians. I don't think I would change that, no matter what it was. I really kind of think somebody along the line every few years needs to remind us there are things besides laws and regulations and that is why I chose to talk about being a good physician. 
DR. BROWN: I think that was a great theme personally. One more thing, I want to ask you now. Other than spending your time in the operating room and the office, seeing patients and working in the state association and medical society, what kind of hobbies do you have? What way do you spend your spare time. Spare is in quotes. 
DR. HAWK: That is something I need to work on, ways to spend my spare time better. I enjoy playing tennis. I work at regularly at a fitness center, probably don't take enough free time to do other things and that is something I realize I need to work on, more leisure. 
DR. BROWN: Activities in your church and your family? 
DR. HAWK: Well it is interesting you can almost overlook something, although I have always been active in the church, I've been probably more active in the last few years, even during the time I was president. I started teaching Sunday school three or four years ago and this is teaching the senior high which is a job most people wouldn't want to have, but it has been a lot of fun. It's been a challenge. I think in the same sort of way that people bring on new leaders in the medical profession, it is important that those of us who are committed to teach our youngsters in church school as well, so I have enjoyed that. It's been a challenge but it's also been an opportunity and it is one of those things also that you get more out of than you put into it. 
DR. BROWN: Dr. Hawk, I think this concludes our interview. 
I appreciate you talking to us. I appreciate it and Ms. Greene appreciates it, and the state association for their archives, I am sure, will appreciate it in the future, and it has just been a pleasure to talk to you. I want to ask you one more question. Would you do it all over again? 
DR. HAWK: In a heartbeat, certainly. As I said, you get more out of it than you put into it and once you've been there, you realize it. I would do it again and that's why I am still doing things. 
DR. BROWN: Well good. Thank you very much. 
DR. HAWK: Thank you. I appreciate it.