Keynote Address to Entering Medical Students
White Coat Ceremony, University of Medicine and Health Sciences
October 7, 2017
Frigate Bay, St. Kitts and Nevis
Thank you for the opportunity to speak with you on this important day and at this meaningful ceremony.
White Coat ceremonies at American medical schools were started by Columbia University faculty member Dr. Arnold P. Gold, a pediatric neurologist, with the purpose of nurturing and preserving the tradition of the caring physician. The first was held in 1993. Dr. Gold and his collaborator, Dr. Sandra Gold, an educational psychologist, promoted the values of Humanism with this ceremony that asks students to take an oath at the beginning of their medical education, not just the end, and to give students guidelines and expectations regarding their responsibilities as physicians early in their education and training.
This process of hearing from an experienced physician, donning the White Coat, and taking the oath, is intended to impress upon students the primacy of the doctor-patient relationship, and to help you accept the obligations of the profession in a psychological contract that can guide you throughout your medical education and career. The principles of excellence in science, compassion, and integrity, and the intent to care as well as cure, are the take-home messages of
these White Coat ceremonies.
You have the opportunity, in addition, to benefit from experiencing medicine here on St. Kitts and Nevis, in the US, and perhaps in other countries during your medical education. And, you have the opportunity and challenge of entering the profession of medicine at a time in which the US health system hovers around substantive change, and an important debate addresses whether access to health care is a right of all our citizens. This is also a time when so many other health
care providers in our system want to partner with physicians to influence the administrative and political authorities, share in responsibilities, and help manage health care decision-making.
You’ll learn to practice medicine as a team sport, with not only physicians in other specialties, but also with nurses, physical and occupational therapists, nutritionists, psychologists, social workers, and others, while you’ll also compete with Dr. Google and others in the long line of snake oil salesmen who will tell your patients that vaccines are harmful or the potion they have on offer is better than evidence-based treatment. You’ll need to learn who to include on the team, and how to deal with partners as well as competitors.
Another concept that the White Coat ceremony encompasses is that joining this profession of medicine is a privilege, and that along with that privilege comes responsibility. To students and also to you families, friends, and supporters, please realize what my family had to learn, as have others who send the first of their family into this profession, that the obligation
to the patient is sacred. Know that holidays and family events will happen without your daughter, son, wife, husband, or partner being present because they are at the hospital, that they will sometimes miss you and the family traditions, but that, during those times, they will be holding the hand of a new mother and baby, or a lonely elder, or supporting a family who fear they may lose one of their own. So when the doctor you love comes home, please know they will need even more support and kindness from you, because they’ve missed out on your fellowship, but have also given a part of their own heart to their patient.
This profession brings the responsibility to be, like Caesar’s wife, above reproach. You are entering a closely regulated profession. At every level of government - local, state/territorial, and federal - there are laws and rules that we must agree to follow, and you must know that there will be consequences if we don’t. You will be under scrutiny. We’ve just seen in the news that a very senior physician with a national office in the US has disgraced the profession and lost his cabinet position by abusing his privilege and the public’s trust. We have a fiduciary responsibility to our patients, and to the public, to prescribe, to order tests, and to make decisions in a way that provides the best medical care at the least financial impact, and to advocate for our patients to policy-makers so that everyone is able to access needed medical care without jeopardizing the ability to afford food, shelter, and education.
Starting now, you have a reputation to cherish and protect. Your daily activities, your social media presence, your financial decisions, and your interactions with patients and their families must be pursued with integrity, honesty, common sense, and courage. When you speak with the authority that this profession affords you, credit your sources and cite appropriate references, be precise, and be accurate.
I’d like to ask all of us to think back to who we were just six weeks ago, and the traumas we’ve all faced in this short time – unprecedented natural disasters, mass shootings, near and still potential loss of the nation’s health care system, and escalations of nuclear war threats. In this short period of time we’ve lost, learned, argued with airline and airport employees about travel, and with banks about availability of funds, helped and donated, worried, cried, held someone, been held, and given and accepted support, compassion, and assistance. You and your fellow students, organized by Med4You, sent donations and your visible support to Puerto Rico. You gave to Go-fund-me’s and to organizations to help people hurt by Hurricanes Harvey, Irma, and Maria, and you learned to wake up and breathe before checking the news and twitter for what new worries you may have to add to your list. Then you got up and got to work on your studies. You all show your faculty every day your resilience and your strength.
But you may still wonder, as we all do:
What can I do, what should I do, now, in this seemingly non-stop series of crises happening in the world we now live in?
As a first step, you should learn about how medical students and physicians fit into the existing health care system structures and especially those structures that arise during a crisis. Many of you will figure out how to improve those structures and build new ones, soon and in the future.
Focus, and concentrate on excellence in basic science, and its applications for improved medical care. What you learn in the basic sciences are the things that you need to bring with you to work every day of your professional life, but they are also necessary to work at on an ongoing basis so that you keep up to date with new knowledge and professional practices throughout your career, so that you avoid professional obsolescence, and you are able to improvise in novel circumstances – like how to work in a medical shelter after a disaster, or at the site of a mass casualty event like the Boston marathon bombings or the Las Vegas or Orlando shootings.
Learn the science and language of emergency management – take Incident Command Structure courses, volunteer to help in crises when you can.
Learn basic and, if possible, advanced life support skills, and stay current – you may need these skills at an event, on an airplane, at a mall – so that you can respond immediately while Emergency Medical Services and other first responders are on the way.
And, learn about trauma informed care and how to recognize in a patient, whose behavior is challenging, that past or recent trauma may be manifest and that evidence-based interventions will help the patient and enhance your effectiveness.
In closing, I’m reminded of the letter given to my 4-student team just before our first cadaver anatomy laboratory session, written by the person who her donated body to my medical school’s anatomy program and assigned to our team.
“I don’t want you to think of me when you are in anatomy lab. Focus, then, rather, on what you can learn that will help your patients. Instead, think of me when you are helping someone, as a physician in your practice, and also in your daily life. When you are kind to someone who is afraid, when you are patient with someone who is angry, when you share your good fortune with someone who is in need. Remember that giving to others will be who you are as a physician, but it is also who you can be as a person.”
It may seem selfish with all the challenges we face today for you to focus on your studies, to look inward and keep the world out, to limit the time you spend with, and talk with family and friends. But it is not. It is generous to excel at your studies, to prepare to step into this wonderful profession. When you have performed this work that is so important now, the work of study and preparation for a wonderful, challenging, difficult, valuable career ahead, you’ll be welcome as a colleague. Please accept my best wishes for your time with us here at UMHS and for all of your life as a physician.
Copyright Julie Graves, MD, MPH, PhD, FAAFP 2017
Comments
Post a Comment