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CHICAGO -- U.S. Surgeon General Jerome Adams, MD, MPH, gave a rousing speech to his fellow members of the American Medical Association (AMA) at their House of Delegates meeting Monday, calling on them to work harder to diversify their membership.

Adams cited a famous quote from hockey great Wayne Gretzky about his trick of skating to where the puck was going to be rather than to where it was. "[People] can't carry the baton forward if you refuse to hand it to them," he said. "I'm challenging you all to look at your delegations, to look at their age, gender, race, and sexual identity, and ask yourselves if you're looking at where the puck is going. Providing a pathway for people to go in the AMA is critical to their future."

Adams was clearly at home during his talk, which received a standing ovation from an enthusiastic audience. "I'm having a little HOD [House of Delegates] PTSD," he joked. "[At this meeting], I'm used to hearing my name followed by 'You're out of order.'"

"I joined the AMA 20 years ago as a medical student -- and can I be honest? I joined because someone said, 'They'll pay for you to go to Hawaii,'" he continued, referring to the location of the AMA's interim meeting. "So don't take Hawaii off the rotation or you may miss out on the next Surgeon General."

"But I also developed a passion for advocacy," he added. "If it weren't for the AMA, I wouldn't be standing here before you right now."

Adams said he wanted to promote healthier communities by making a connection between health and economic prosperity. "You know the number one issue people vote on? Economic prosperity and jobs," he said. "Health doesn't factor into the top 5 or even the top 10." Health care often ranks highly, but that's because some people are going bankrupt because they can't afford healthcare, he added, noting that his office is planning to issue a report on the health-prosperity connection.

Another issue linked to health is national security, Adams said. He noted that 7 out of 10 young people would be ineligible to join the military because they can't pass the physical examination. "We are a less safe country right now because we're not a healthy country."

Opioids

The opioid epidemic was also on Adams' mind. "In America, more people are dying every day from opioid overdoses than are dying from breast cancer," he said. "The people dying from this epidemic aren't just your patients -- they're family, friends, and if you're like me, my brother."

One way to reduce the epidemic is by de-stigmatizing it, Adams continued. Physicians "must help the public understand that addiction is a chronic disease and not a moral failing," he said. "Make no mistake about it, my brother made bad decisions. But I have to ask you, when's the last time you refused to give someone insulin because they ate fast food? ... As physicians, we must say loudly for all to hear, 'We will not deny treatment to individuals with the brain disease of addiction.'"

The country is actually in the midst of a dual crisis -- undertreated pain and overprescribed opioids, he said. In addition to the stigma of opioid abuse, there is also a stigma about chronic pain sufferers, "and that stigma exists not only with the public, but also with you ... As clinicians focused on patient-centered care, we have to remember that the vast majority of those with chronic pain are not drug-seeking; instead, they're just trying to lessen their pain, or at least cope with it better."

Prevention

Adams also discussed the need for an increased emphasis on prevention, illustrating it with a story involving "Barbara, Dave, and Andy" -- a reference to AMA president-elect Barbara McAneny, MD; current president Dave Barbe, MD; and immediate past president Andy Gurman, MD. The three were having a picnic near a river when they noticed a group of people who had fallen into the river and were struggling.

Andy dove into the water to rescue the struggling swimmers. "He was great ... but his energy started to wane," Adams said.

Dave, on the other hand, went further upstream and grabbed sticks and made a raft, Adams continued. "The raft worked great but it couldn't catch everyone," he said. "Suddenly both [Dave and Andy] said, 'Where the heck is Barbara?'" She had left, saying, "I'm going to go [further upstream] and find out where and why all these people are falling into the river." Barbara made signs and educated people, so fewer of them fell in to begin with.

"We make Dave and Andy's jobs harder if we make them get a prior authorization before they rescue someone, or they're inundated with lawsuits once they rescue someone, or if they stop after everyone they save and document the details," he added wryly, to loud applause.

Getting the people out once they fall in, while necessary, only helps about 10% of people, he said. "But if you focus upstream, 6 out of 10 people will never fall into the river in the first place."

To focus on prevention, "we need partnerships and we need collaboration," he said. "The AMA is not just a community of physicians; it's a community of leaders. You have not only an opportunity but an obligation to make a difference in the lives of patients beyond everyday practice ... We [should] deliver less sick care and better healthcare."

"I challenge you to think of ways you can move care upstream and think of at least one organization you can partner with," he urged the delegates. He ended his speech with a plea for more civility.

"Life isn't black and white, and neither are issues" like gun violence and abortion, he said. "We need to have a full discussion on these issues, and physicians, especially the AMA, need to lead that discussion. Finger-pointing and sound bites and entrenched camps won't get us to where [we] need to be."

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