When asked what was his biggest surprise on becoming U.S. Surgeon General, Richard H. Carmona, MD, MPH, had a ready answer: “Being nominated,” he said. “I had no idea. I was plucked from relative obscurity, was not a big giver, and had never traveled in high political circles.
“Considering where I came from, where I ended up is the most surreal experience of all.”
His surprise is understandable. Dr. Carmona's path to the position popularly known as America's “family doctor” was, to say the least, circuitous. A self-described “poor Hispanic kid,” he grew up in New York City's Spanish Harlem and came up the hard way.
He has had a remarkably varied career with a list of jobs that includes combat medic in Vietnam, registered nurse, deputy sheriff, and SWAT team member, as well as a trauma surgeon and clinical professor at the University of Arizona.
Growing Up Poor
“Since we were all in the same boat, we didn't realize how poor we were,” Dr. Carmona said. “And despite some tough times, for the most part we were happy. But we all needed medical care and dental care, and most of us didn't have it.
“Today we have a whole vocabulary to describe the medically underserved, but they existed long before they were defined. Paradoxically, I was one of them.”
One childhood advantage that served him well in later life was the early acquisition of street smarts. “You learn a lot of lessons living by your wits,” Dr. Carmona observed.
This skill was especially useful when, as a 17-year-old high school dropout, he enlisted in the army and was sent to Vietnam as a combat medic with the Special Forces.
“It was my first real job,” he recalled. “I saw my first gunshot wound and was wounded myself, delivered my first baby, and took care of my first combat casualties. It was a huge transformation. I went out there as a kid and came back with the maturity of a middle-aged man.”
From Combat Medic to Nurse
Returning home from Vietnam, having earned two Purple Hearts, a Bronze Star, and a world of experience, Richard Carmona returned to school. He passed the high school equivalency examination, made his way through several of New York City's colleges, and eventually began a new career as a registered nurse.
“My experience in nursing made me a much better and more compassionate physician,” he said. “The caring aspects of medicine are not as strongly imparted as they should be in medical school. I've told my residents and medical students over the years that it's the nurses who are the true advocates for the patients.”
Another important lesson from his years as a nurse is the high esteem in which he holds the profession. “Ever since I became a physician, I have always looked upon my nursing colleagues as peers, not subordinates. They are the preeminent caregivers.”
The final step in Dr. Carmona's medical training came when he pulled up roots and moved to the West Coast to attend medical school at the University of California in San Francisco. Four years later, he graduated first in his class. “I caught up,” he said.
Before becoming Surgeon General, he was a clinical professor of public health, surgery, and family and community medicine at the University of Arizona. Harking back to his military training, he was also a department surgeon and a SWAT training officer at the Pima County Sheriff's Department, holding the rank of Deputy Sheriff.
Then, in 2001, President Bush chose him to be Surgeon General, an unexpected choice that few, including the nominee, had foreseen.
Focus on Bioterrorism
Dr. Carmona has extensive expertise in public health preparedness and emergencies, including hands-on experience as the coordinator of Arizona's efforts in bioterrorism prevention and response, a reason President Bush chose him for the post. He also played a key role in creating the state's first Disaster Medical Assistance Team and headed its executive committee.
“The Surgeon General administers the 5600-member Public Health Service Commission Corps, health care professionals who are on call for emergency duty,” said President Bush in announcing his selection. “Members of this force were deployed in New York and Washington, D.C., after the terrorist attacks of September 11 and during the anthrax attacks that followed.”
This new focus on the nation's safety must now go hand in hand with the Surgeon General's traditional focus on the nation's health.
“I have asked Dr. Carmona to lead an important initiative focusing on prevention and lifelong healthy living as a key component to medical care,” Mr. Bush said. He added that Dr. Carmona also would be speaking out about alcohol and drug abuse and the toll they take on society.
Cancer prevention has an important place on Dr. Carmona's agenda. In collaboration with his colleagues, NIH Director Elias Zerhouni, MD, and NCI Director Andrew C. von Eschenbach, MD, Dr. Carmona's office is seeking ways to increase public understanding and acceptance of what we already know about preventing cancer.
“Today, the cutting edge of science is about keeping people healthy,” he observed. What concerns him, as well as Drs. Zerhouni and von Eschenbach, is that the information about the many things people can do to protect themselves against cancer isn't being utilized. The message may be clear, but it doesn't seem to be loud enough.
“We want to synthesize information from cutting-edge clinical science and bench science to create a culturally competent message that will encourage people to change their behaviors,“ Dr. Carmona explained.
The three leaders also are consulting with Francis Collins, MD, PhD, the head of the Human Genome Project, in hopes of utilizing some of the information the project has uncovered.
“We want to look at genomics in terms of predictability so that we can help people who are healthy today remain so,” Dr. Carmona said. “Our new agenda is outside of the traditional agenda.”
It is, however, very much in keeping with the times we live in. “I'm thrilled to have been given this unbelievable opportunity,” he said. “I will do all I can to make the most of it, to serve the people of this country, and leave a lasting legacy.”