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The Fourth of July weekend is upon us, and that means vacations, outdoor barbecues, and fireworks. At this time of year we normally recognize some of the greats of the American Revolution: George Washington, Thomas Jefferson, Benjamin Franklin, and maybe even John Adams or Alexander Hamilton (depending on how well you paid attention in history class). After that, memories and names get hazy. But even if John Hancock's is the largest, there were 56 other signatures on the Declaration of Independence. The fame of these men hasn't always lived on (consider how many of the ones we do remember have their faces printed on money), but they were important to the cause of Independence none the less.

Three physicians served in the Constitutional Convention: James McHenry (Maryland), James McClurg (Virginia), and Hugh Williamson (North Carolina). All three served in the military during the Revolutionary War, Williamson became a U.S. House Representative, and McHenry went on to serve as the third Secretary of War. In what way could these three's lives and service inspire us today, as medicine stands on the cusp of its own Health Information Technology (HIT) revolution?

Dr. James McHenry
We like to think the modern world saw the rise of the wanderer citizen, as people move from state to state to seek education and jobs. But being mobile isn't exactly a novel concept: we tend to forget that our nation began with waves of immigrants coming to the New World in search of opportunity and fortune.

McHenry defined this type of early wandering American. Born in Ireland in 1753, he traveled across the Atlantic to attend Newark Academy in Delaware, then took an apprenticeship under Dr. Benjamin Rush of Philadelphia, and eventually joined the revolutionary American forces in Massachusetts in 1775. His military service includes working as a military surgeon and physician (both at a hospital in Cambridge and as a member of the 5th Pennsylvania Battalion), being captured by the British in 1776, and joining General Washington's personal staff after his parole (where he served without rank or pay for two years). After the war McHenry joined his family in Maryland, for which state he served as a delegate to both the Continental Congress and the Constitutional Congress. As I said earlier, he served as the third Secretary of War under both Presidents George Washington and John Adams.

This doctor-turned-solider-statesman was obviously not frightened by innovation or new challenges. Even though he didn't go to a military academy, and had never served prior to the Revolution (where he spent most of his time treating soldiers and serving as a secretary), McHenry went on to lead a fledgling nation's new war department. He joined the Federalist party and worked to increase the efficiency of the early U.S. military. His desire for order and strong infrastructure, coupled with his meticulous records, convince me he'd have been first in line to adopt an Electronic Health Record (EHR) in his practice.

sources:

• Berkin, Carol. "James McHenry." Maryland Delegates to the Constitutional Convention. National Constitution Center. 2002.
• The Founding Fathers: Maryland. The National Archives.
• Wright, Jr., Robert K. and MacGregor, Jr., Morris J. "James McHenry, Maryland." Soldier-Statesmen of the Constitution. US Army Center of Military History. 1987.

James McClurg
This physician was a native citizen, born to a Virginian family in 1746. While he originally studied at the College of William and Mary, he also received medical training in Paris and London. But his loyalty to the United States was proven when he returned to Virginia in 1773 to serve as a militia surgeon. During the Revolution he balanced teaching and politics, working with his alma mater and also attending the Constitutional Convention. He later returned to Virginia to serve as president of the state medical society and a member of the Virginia executive council. He was even considered for secretary of foreign affairs in the new nation, and though he never became a member of the federal government he advocated for the Federalist position and a strong role for the executive branch of government.

Dr. McClurg strikes me as cut from the same cloth as some of the doctors we see participating in health policy today. Had there been workgroups discussing a revolution in the medical world in the early 1800s, it's quite possible Dr. McClurg would not only have been asked to serve on one but that he'd have volunteered as well. He didn't find it strange or unethical to lead both in the medical and the political arenas; instead, he straddled both, not only publishing well-respected academic works but also weighing in on the debate over presidential power. He didn't wait for the government to tell him what to do or declare he was a "pure" medical man. He worked on policy directly, helping to create the country he would be part of. Today he might have been called a policy wonk, but during his time he was known as man with "a foundation of learning, on which, if he pleases, he may erect a character of high renown ... a Gentleman of great respectability, and of a fair and unblemished character."

sources:

• Berkin, Carol. "James McClurg." Virginia Delegates to the Constitutional Convention. National Constitution Center. 2002.
• Mount, Steve. "The Framers of the Constitution." USConstitution.net. 2010.
• Scheepstra, Sasja, Huisman, Henk, and Daanen, Jeroen. "A Biography of James McClurg 1746-1823." National Archives and Records Administration The Founding Fathers' Page. University of Groningen, The Netherlands. 1997.
• The Founding Fathers: Virginia. The National Archives.

Hugh Williamson
This Pennsylvania native was born in 1735 to Irish immigrant parents. Prior to his medical studies, Williamson was an academy rector, Latin tutor, theological student, and mathematics professor. After graduating from University of Utrecht in the Netherlands he began practicing medicine in Philadelphia, where he became a leading philosopher and scientist who worked with Benjamin Franklin and was appointed to make presentations on the newly discovered force of electricity to the London Royal Society. Once the Revolutionary War began, Williamson returned to the colonies and eventually took up residence in North Carolina, for which state's militia he served as surgeon-general from 1779-1782. He went on to that state's House of Commons and eventually the Constitutional Convention. While a Federalist, Williamson was not without reservations, being against such works as the founding of a central bank and other popular ideas of federal power. Known as a vocal debater, he was also able to work out many compromises that allowed the states to create a final model of government. Writing in the defense of the Constitution, Williamson wrote that it would decide whether the new country was a "system of patchwork and a series of expedients ... [or] the most flourishing, independent, and happy nation on the face of the earth."

What would Dr. Williamson fit in today's medical debates? He certainly wasn't your typical American patriot: in fact, he spent about as much time abroad as he did at home, and was even in England while the Declaration of Independence was signed. His foreign ties led some to accuse him of being a double agent. But there's no doubt that he was instrumental not only in the founding of the American nation but in its medical and scientific beginnings, helping to found the first secular college in the new world and serving in the very first Congress over in the House of Representatives.

The double agent accusation instantly made me think of Dr. Donald Berwick (President Obama's nomination to head up the Centers for Medicare and Medicaid Services) and the current spat over his "romance" with the British health system. I'm not making a case for or against that type of health care here, but merely showing that this type of questioning isn't new: it's as old (even older) than our country. Forming a new nation naturally made some distrustful of someone who seemed so close to the very power being rebelled against. Dr. Williamson didn't make things any easier by being such an outspoken debater and advocate of his sometimes unpopular political ideas. But his continued service to his country's political and intellectual growth proved his patriotism to his critics, earning high praise from such leaders as Thomas Jefferson: "he was a useful member, of an acute mind, attentive to business, and of an high degree of erudition."

Having unpopular ideas or learning from other countries doesn't necessarily mean one can't be a patriot for one's own country as well. The best debaters and leaders are those who can both retain their views but learn to make sacrifices for the greater good. Judging by his record, I'd say Dr. Williamson might have been on the contentious side of the EHR/HITECH debate, with some strong ideas about patient privacy and doctor's sovereignty; however, I think he'd have worked with the system to air out his issues, and would have been open to compromise in order to accomplish the greater good of achieving a modern health system that could be a model for the world.

sources:

• Berkin, Carol. "Hugh Williamson (1735–1819)." Virginia Delegates to the Constitutional Convention. National Constitution Center. 2002.
• "Hugh Williamson, North Carolina." Signers of the Constitution Biographical Sketches. National Park Service. 2004.
• "Hugh Williamson: Physician, Patriot, and Founding Father." Books from Our Faculty. UNC School of Medicine Department of Social Medicine.
• Wright, Jr., Robert K. and MacGregor, Jr., Morris J. "Hugh Williamson, North Carolina." Soldier-Statesmen of the Constitution. US Army Center of Military History. 1987.

Conclusion
These three men were very different: one a member of a homegrown American family, one a second-generation citizen with strong ties to the mother continent, and one a new immigrant who helped make the country he adopted. But they each, in their own way, balanced medicine, military service, and politics to help lay the foundations of the nation we live in today. Their views might not have been completely in line with each other, but they fought for their and future generations' right to have those differing views.

I'd like to believe that we still have that ability today. There are still doctors willing to straddle the lines of the medical and political worlds, working to improve not just our nation's health but our nation as a whole. Whether you agree with everything they do or not isn't the point: the point is that if you disagree, it's especially important to be part of the political process.

This year, let's not only celebrate the gentlemen gracing our dollars, but the spirit of innovation represented by these three founding physicians. Maybe if we studied and remembered that spirit a little more, we'd have a better chance of embracing the positive changes that HIT can bring to our country, and could turn our quarrels into some healthy debate on how to bring about that change.

With that food for thought, I bid all a happy Independence Day.

a little something extra: For those readers who haven't figured it out by now, I'm a bit of a musical fan. If you get bored with the usual fireworks and marching anthems, I'd suggest the musical 1776. Just bump it to the top of your NetFlix queue or make a trip to your local library. It's got great songs, excellent performances, and I guarantee you'll never look at the Founding Fathers in the same way again.

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