Harvey A.K. Whitney Award Lectures

What Will Be Your Legacy?

The Harvey A. K. Whitney Lecture Award recognizes the legacy of Harvey A. K. Whitney, a pharmacy pioneer who touched the lives of so many pharmacists directly and indirectly through his leadership, publications, and mentoring. The recognition of an individual for his or her “outstanding contributions to the practice of pharmacy in health systems” is a very public way to continue to recognize the many important contributions that reflect his legacy.

Two years ago I sat with friends to listen to Bernie Mehl as he delivered his Whitney Lecture. During dinner, David Zilz asked me, “What do you want your legacy to be?” The subsequent discussion focused on the importance of resurrecting the Master of Science program at the University of North Carolina (UNC) School of Pharmacy, created by my friend and mentor, Fred Eckel. Dave was doing what he does best— provoking thought, challenging a colleague, and offering guidance. The conversation continued throughout the evening, and on my return home the following day, I became increasingly concerned at my inability to relaunch the UNC master’s program. I was full of self-doubt for days and continued to question my contributions to the profession.

My confidence was restored the following week when my staff at the UNC Hospitals and Clinics surprised me at a staff meeting by presenting several testimonials simply thanking me for being their leader! I was deeply moved by that event, and it led me to realize that all of us will likely have multiple legacies. If a predominant part of mine is that I have enabled my colleagues to take better care of sick people in my own health system, I will be quite satisfied.

Several months ago, a UNC alumnus gave a $20 million gift to the UNC School of Pharmacy. My son, a second-year pharmacy student, lamented that he would likely not be able to repay the school of pharmacy in a similar way. What ensued was a great discussion about how to make a lasting impact on the profession in lieu of a financial gift.

The point of my sharing these anecdotes is that legacies take many forms and that everyone will leave a legacy. My question to you is, what will be your legacy?

Defining legacy

The American Heritage College Dictionary defines legacy as “something handed down from an ancestor or a predecessor or from the past.”(1) Other definitions include leaving money or property to survivors, which I consider an inheritance. This definition conveys the sense that something is passed along. What is absent from these definitions is the sense of importance that the person who left the legacy may have felt and the effort that was invested in creating or contributing to that legacy.

In his book Unlocking Your Legacy: 25 Keys for Success, Paul Meyer(2) defines legacy as “something handed down from our generation to the next, such as a sum of money or a piece of property.” He suggests that it includes traits, habits, talents, and attitudes that are social, physical, mental, spiritual, and emotional and concludes that “In essence, everything you are and possess today, whether good or bad, is your legacy.” That daunting notion forced me into a period of self-reflection. Eventually, those internal deliberations became a source of renewal and motivation. I am hopeful that this discussion will convey a sense of optimism, hope, and continued dedication to your family, colleagues, and the profession of pharmacy as you consider your answer to the question I have posed.

Why am I suggesting that thinking about your legacy is so important? Foremost, we would not have a Harvey A. K. Whitney Lecture Award without the legacy of Harvey Whitney. Without consciously doing so, my parents gave me a sense of the importance of a legacy by naming me after my father and by teaching me the things that are important to them. Milton Skolaut instilled the importance of continuing the Duke legacy begun by Tom Reamer through his own actions as my role model and by setting high expectations for my performance. I learned of the Ohio State legacy for training leaders and expanding pharmacy services initiated by Cliff Latiolais through my earliest mentors—Clyde Buchanan and Fred Eckel. The strength and power of this legacy continue to motivate me as I collaborate with those who have become part of the Ohio State legacy.

I have come to learn about the strength and endurance of the University of Wisconsin’s legacy through many friends who are an active part of that institution. Indeed, as an honorary Badger resident, I feel a kinship and responsibility to contribute to the Wisconsin legacy. I learned about the ASHP legacy from the many board members and past presidents with whom I have worked over the years. It was Dr. Joseph Oddis, however, who galvanized my commitment and responsibility to ASHP and its legacy during our first meeting after my election as president. I was welcomed with a smile, a handshake, and the words, “Hello, Mr. President!” I listened to Joe as he described to me how important what we did was to ASHP and our constituents. Even more importantly, Joe continues to greet me in the same manner, signaling that the responsibility endures and that the legacy is alive.

The notoriety of the legacy and the success that has been enjoyed over the years are through the collective efforts of those who adopt the vision, value, sense of purpose, commitment, and responsibility for maintaining that legacy.

Refining your legacy

All aspects of life are important, and each has its respective legacy. Everyone leaves a legacy, whether it is done purposefully or not. A colleague used to tell me that I lead a charmed life, suggesting that luck has a lot to do with success (and perhaps one’s legacy). Being in the right place at the right time is important; however, I believe in the sentiment expressed by Vince Lombardi who, when asked about getting a lucky break in a game, responded that great individuals and teams make their own breaks. In other words, taking advantage of opportunities leads to progress and accomplishment. Similarly, one must make an effort to become a vibrant contributing part of a legacy or refine one’s own legacy—it must be a deliberate process in order to maximize the outcome. Paul Meyer(2) even suggested that those who are more committed to such a goal usually leave a better legacy behind.

If we choose not to be purposeful about leaving a positive legacy, our indifference could have profound negative results. I am reminded of Bill Zellmer’s Whitney Lecture in which he noted, “There is a distinct possibility that future social historians will characterize the current course of health care as excessive folly motivated by power and greed and unguided by a moral compass.”(3) His entire lecture motivated me to continually revisit my priorities, as well as those of the organizations and constituencies I serve, and to take periodic bearings to see if my and the profession’s course is our own “true north.” The alternative is distasteful to me—leaving my future and that of the profession to others that could result in changes with which I might disagree or cannot understand. In the worst-case scenario, the result could cause a total loss of direction and relatedness for me toward our profession.

It should be emphasized that not all legacies are good and that good legacies can be adversely affected by people whose values and acts are contrary to existing legacies. The pharmacist from Kansas City who diluted drugs for administration to patients with cancer undoubtedly hurt his patients and marred both the profession and his alma mater. The actions of a Pennsylvania pharmacist who diverted controlled substances had a similar effect.

I will use a principle-centered approach to describe how someone might refine his or her legacy. Paul Meyer(2) does a phenomenal job of this in his book, and I encourage those of you who are interested in your own personal development to read it. For my current purpose, I will focus on six principles. They are fundamentally representative of what some describe as strength of character and include caring, honesty and integrity, attitude, commitment, leadership, and stewardship.

Caring. The most basic and perhaps most important principle is caring. Exhibiting a caring attitude conveys a sense of value through personal investment in an individual, project, or goal. Caring includes commitment and responsibility, sometimes with personal sacrifice, to make a difference. It is the backbone of our mentoring program for professional students and residents at UNC and a critical element in any organized staff development initiative. Caring for an individual demonstrates respect or admiration and is demonstrated by listening and offering guidance with warmth, constructive criticism with sensitivity, encouragement, unconditional support, inspiration, and motivation. Strengthening and continuing a legacy require purposeful action. Caring is the first building block in creating a legacy because it engenders commitment from others. Caring is also fundamental to ASHP’s mission—to help people make the best use of medicines. Without a caring attitude, we significantly diminish our value to society and, eventually, the need for our existence.

Honesty and integrity. Honesty, in terms of truthfulness and sincerity, is taught to us by our parents as young children. Integrity, adherence to a set of ethical and moral beliefs, is learned over time, but it begins to evolve during childhood. Combined they engender trust, a banner we fly each time we refer to pharmacy as America’s most trusted profession. As adults, however, the basic tenets of honesty and integrity become much more challenging to maintain as we are exposed to life’s temptations and corporate pressures to meet expectations that may compromise our beliefs. We must learn, through observation and experience, how to make the correct choices and assume the consequences of our decisions and actions. Also embodied in this principle is the setting of priorities, demonstration of loyalty, and standing our ground for what we believe is right. The principles of honesty and integrity are the most difficult to maintain, as reflected by Meyer,(2) who concluded, “whatever the price, integrity (and honesty) has greater value.”

Attitude. Having a positive attitude is currently our profession’s most widespread challenge. Practicing in a national health care system whose financing system is nearly broken has put significant pressures on practitioners, resulting in the development of negative attitudes, if not hopelessness, in many of our colleagues. This is tragic because our attitude affects who we are and everything we do. Self-development gurus consistently refer to the power of a positive attitude. Attitude is a choice we make. It can be infectious, and we usually attract friends and colleagues with a similar attitude. I am a strong advocate for optimism, enthusiasm, contentment, self-confidence, camaraderie, and, of course, having fun and laughing as much as possible. I have learned that my attitude improves my quality of life and my effectiveness as a parent, pharmacist, and leader. Positive attitudes enhance creativity, energy, and strategic opportunism and affect the people around us.

Commitment. Commitment is essential to contributing to or establishing a legacy since it is a required element of anything that we believe should endure. The definition of commitment is “the state of being bound emotionally or intellectually to someone or something.”(1) It includes perseverance with an undeniable effort. Commitment becomes challenging when we face adversity, when persistence is required, when our principles or goals are opposed by others, and when we assume risk. As pharmacists we must be committed to service, our mission, lifelong learning, and each other.

Leadership. Some see leadership as the responsibility of only a few, but I see it as a principle that must be lived every day by each of us since we all have a responsibility to others. Leadership conveys a sense of purpose requiring vision and planning. It is about taking action despite the risks and is enhanced by being passionate about one’s mission and goals and being a vibrant part of a team effort or partnership. It is also critical for leaders to adopt a service attitude toward the people for whom they care. An attitude of service is the obligation we assume for the covenant we enjoy with our patients and, for leaders in the profession, the colleagues who follow us.

Stewardship. The final principle I want to highlight is stewardship. Stewardship is different from leadership in that people frequently equate the leadership of groups as having a single leader. While some may be comfortable as self-designated “followers,” we are all stewards of our profession, our organization, our family, and our societal responsibilities. Stewardship translates into being responsible and serving others and leads to stability in meeting those responsibilities or initiatives of which we are a part. Having a sense of stewardship for our profession differentiates us from those who simply have a job.

Personal effectiveness. What I have described above are principles important for enhancing a legacy and maximizing personal effectiveness and one’s quality of life. I recently read a book entitled My Father, My Son, by Admiral Elmo Zumwalt Jr. and his son Lieutenant Elmo Zumwalt III,(4) which was given to me by the admiral’s daughter, Mouzetta. I had met the admiral and was quite enamored by his charisma and accomplishments. In an obituary for the admiral, the following was written, “As this great warrior passes on, he leaves behind a legacy and a lesson for the leaders of today and tomorrow. In order to make a difference for others and a lasting legacy for the future, tackle the difficult issues, question the status quo, and make changes that attack the very heart of the problem.”(5) I have come to appreciate the strength of character that the admiral exhibited throughout his career and the contributions he made. All pharmacists need to strengthen their character, individually and collectively, as a part of what Zellmer(3 )referred to as “nourishing the soul of pharmacy.”

Augmenting your professional legacy

Undoubtedly, many of you are on your way to leaving an indelible professional legacy. However, our profession is in dire need of widespread support and action on many fronts to ensure that our individual and collective legacies are characterized by enhancing our value in helping sick people improve the quality of their lives. I offer the following opportunities for adoption by all pharmacists to this end:

1. >We must educate and mentor people, especially pharmacists. We
   need to imprint the beliefs and values described above (and many
   others) that will enable them to make a difference. We must acknowledge the importance of lifelong learning. We need to create
   partnerships with our colleagues in academia and other practice
   settings to ensure future generations have the optimism, commitment, and stewardship to make our profession absolutely essential
   and its practitioners invaluable.
2. We must improve our attitude about the practice of pharmacy by
   ensuring that it is consistently positive. Our attitude is evidenced in
   our thoughts, speech, and actions, all of which must be positive. We
   must convince colleagues who have become pessimistic about their
   practices and the future of our profession to have hope and to
   appreciate the value of their practice and the importance of exhibiting a positive attitude. Those with persistent negative attitudes
   should be encouraged to make a change in their practice or retire.
3. All pharmacists, but especially health-system pharmacists, must
   embrace their societal responsibility for ensuring that people make
   the best use of their medicines. We can no longer ignore incomplete
   or ineffective drug therapy outcomes once patients leave our hospitals and clinics. Over a decade ago I suggested that partnerships
   between health-system pharmacists and community-based pharmacists must be created to achieve our professional goals and societal
   mission. It is past time for this to happen. Individually and collectively through ASHP, we must “walk the walk.” It is our future.
4. We must expand our “face time” with the patients we serve. Our
   patients must become our strongest advocates and they will once
   they appreciate our expertise, understand our value, and demand
   our active participation in improving their health. The days of
   hiding in the basement or behind a counter or surrounding ourselves with other providers where our value is disguised must end
   now.
5. We must develop more collaborative practices with physicians and
   other providers who focus on optimal outcomes. This will undoubtedly increase professional risk, potentially modify our roles, and
   require an attitude of service toward patients. It will be a contentious
   process, requiring hard work, creativity, and long-term commitment but will be incredibly rewarding once we have succeeded.
6. We must be proactive participants in health care reform, especially
   the issue of providing direct patient care, as well as reengineering
   health care financing and provider reimbursement. We must realize
   that pharmacists are among the most clinically astute providers and
   have excellent business skills compared with other health professionals. Reengineering health care will require selflessness, adherence to
   ethical principles, confidence in the value of our contributions, and
   standing up for ourselves. Most of all, however, it will require the
   understanding and support of the patients for whom we provide care.
7. We must never lose our focus on patient safety. Pharmacotherapy
   brings more hope for improving health than any other intervention,
   but because drugs are associated with our profession more than any
   other, pharmacotherapy is accompanied by more risks for our
   profession. As technological advances yield more sophisticated
   drugs that require more careful and consistent monitoring, health
   risks will only increase. The current emphasis in health care regarding medical errors will eventually subside, but our professional
   leadership in and focus on patient safety must never diminish.
8. We must more successfully engage the pharmaceutical industry and
   develop our common purpose. I have learned, through Milton
   Skolaut’s mentorship and my own experiences, that continuing an
   adversarial relationship weakens both the profession and the industry. I am firmly convinced that, without a generally symbiotic
   relationship, this industry will be regulated into mediocrity and our
   profession into extinction. We must capitalize on each other’s successes to lead efforts to reform health care collaboratively, and I would
   propose that we use our social conscience as the basis of our efforts.

At the very least, I hope I have provoked you to consider the importance of your legacy. I have discovered that my legacy, at least subliminally, has been on my mind for many years. I have also realized that powerful and enduring legacies require the effort of many as opposed to the acts of a single individual. You are entitled and obliged to take whatever steps you deem appropriate to be a part of our professional legacy. You will have a legacy, whether you want to or not. Since you have sovereignty over your life, I remind you of the words of William Ernest Henley’s poem Invictus, which closes, “I am the master of my fate:/I am the captain of my soul.”

I am but a small part of the successes I have shared with many others. There are too many to acknowledge all of them individually, but I am compelled to share the honor of this recognition with several friends and colleagues. Fred Eckel began mentoring me when I was an undergraduate and continues that task today as a source of insight and professional commitment to me always. He is a dear friend. I owe so much to Milton Skolaut, who put up with me for 16 years at Duke, teaching me by example and setting high expectations. He is a consummate politician and strategist who made sure I stayed on track and taught me how to build a topflight department of pharmacy.

I always had the support and encouragement of the Duke University Medical Center leadership and the staff of the department of pharmacy. They allowed me to grow professionally and look beyond the walls of the hospital to improve the role of the pharmacist and the profession.

More recently, I have enjoyed the support and encouragement of my colleagues in the department of pharmacy and hospital administration at the UNC Hospitals and Clinics. I hope our legacy will be the enhancement of ambulatory care services to parallel the sophistication and effectiveness of inpatient services in a completely integrated way. I was enabled to maintain my ties with my colleagues in academia with the support of the entire faculty of the UNC School of Pharmacy.

The leadership and mentoring of Dean Bill Campbell have been invaluable over the years in many ways. The support of Dr. Celeste Lindley for many years was also important to my professional growth.

I owe more than most of you will know to my two closest friends and colleagues, Phil Schneider and Tom Thielke. We have been close for many years, but our sequential election as ASHP president brought us together on many issues and initiatives. If you search your heart for what “best friends” means, you will understand what Tom and Phil are to me.

I owe almost everything to my parents, Jim and Mary McAllister, who provided a loving and safe home for me and my siblings. They are the best parents I know. My father taught me about strength of character and the importance of hard work to achieve my goals. My mother taught me about loving and caring and gave me her ability to survive on little sleep. I will never be able to thank them adequately for all they have done.

Conclusion

I conclude by recognizing the best legacy I will ever leave behind, my children Jennifer, Jim, and Meagan. They are the most important part of my life. They all have strength of character, know that great accomplishments require hard work and perseverance, consistently make good decisions, and realize that caring and loving are the critical elements of life itself. I am truly blessed to have had the pleasure and honor to have such wonderful children. They are all destined for greatness. A line from a favorite movie is “God gave us children so we would have roses in December.” It is only the summer of my life, and I already have a rose garden.

I leave you to ponder the question, what will be your legacy?

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Any references cited in this lecture are available in the PDF version.

Originally published in Am J Health-Syst Pharm. 2003; 60: 1625-30.
© 2003, American Society of Health-System Pharmacists, Inc. All rights reserved.
Posted with permission.