President Robertson, Dean Richardson, Dr. Keenan, distinguished faculty, family, friends partners, spouses, children and of course you the graduates of 2011. Welcome to one of the most incredible turning points in your life, a truly momentous occasion. As you sit here surrounded by this much love, pride and joy know that you have accomplished an amazing thing in your life and are now entering into one of the greatest professions. Congratulations.
I am truly grateful for the opportunity to speak to you today. You have given me a gift that is actually immeasurable and for that I thank you.
I have been told that great speeches should be like a skirt. Short enough to be interesting but long enough to cover the topic. I am not sure what this will mean for me since I have not worn a skirt since I was 7 years old.
I had the privilege on Friday of being with the graduating third year residents from our internal medicine residency program. We listened to stories of fear, failure, joy, loss, companionship and relationships starting from the first day of residency until now-the same journey you are embarking upon. In those stories there were lessons, which will allow us to know our patients and ourselves better; to navigate the complexity of our healthcare system and to do right. I will share those lessons in a moment. For now I would like to share a story with you of a patient I recently cared for.
When I entered the room, he was laying in the bed on his right side, hood over his head, eyes down, a bed too short for his long legs. His wife present at his bedside, anxious yet giving words of encouragement. The team moved in with precision, asking scripted questions. How long have you had the shoulder pain? When did it start? Where does it go? Does anything make it better? Some quick nodding, a suggestion of what might be wrong. A quick statement of what would happen next. Onto the next patient. Many more patients to see of equal complexity, all with tremendous medical needs.
Medicine is now a very complex endeavor and system. No longer will you find the patient admitted for a “simple condition” or being treated for only one or two diseases. They now come in with a medication list to fill a small book, a list of diagnoses, sometimes a page long and specialist whom you consult, who are sub-subspecialist of a field. So how do we discover who our patients are in the midst of this complexity and responsibility? How do I get to know my patients better?
You see when you are given the title of physician society allows you to enter into the most trusted and sacred profession. Society will give you the authority to ask questions that people who have been together for 40 years may not ask each other; to do things no one else can do. As physicians you will ask questions to understand the underlying questions, to hopefully answer the seemingly unanswerable, to give life saving treatments, and to hopefully diminish suffering. Each of you individually and collectively attempting to enhance the quality of each person’s life you encounter.
So what are those lessons that allow us to be as good as we can possibly be? The first lesson is to listen to your patient and to be curious about your patient. Hearing is passive act but listening requires effort. You might hear a patient’s story while proceeding through your differential diagnosis, ordering and interpreting tests and providing a treatment plan. But what makes this interaction effective, potentially life saving? Is it the test you ordered, the treatment you gave? Not entirely. What actually matters the most is your ability to listen. You will be more in touch with your decisions and those of your patients when you ask the unscripted questions. Who are they? Where did they come from? What is significant in their life? It is only when you ask these questions that you gain a full understanding of the patient. This will allow you to hear the story under the story-the one that may light the way to the correct diagnosis and more importantly the one that will create the unbreakable and immeasurable bond between you and the patient.
The second lesson is remembering your humanity. It is the human dimension of care that matters most. Look at your patient; listen to his or her story. Humanism is not about doing something extra. It is about being more than just providing care to someone; it is about being a healer.
The next day I asked the young couple, “How long have you the two of you been together?” Smiling the wife said, “For a while. I knew he had this disease but you take the person as they are and I love him for him, not his illness.” As our discussion progressed only over a few minutes, his wife said, “You know, doctor, the only difference between regret and gratitude is the outcome. But, more importantly it is the way you decide to view the outcome. I choose to view the outcome of all of this with gratitude not regret.” In that moment, time nearly stood still for me. I no longer saw just a sick patient and his wife at the bedside. They were more than just the collections of a hospital room. They are the young married couple facing decisions and outcomes of enormous responsibility; the kind many of us have never known at this age and hopefully never have to. The loss of his job, the stress of hers, the insurance company demands, and the unspoken fear of death at such a young age, lingering like an unwanted guest in their room.
You might ask how did this knowledge change his management, his treatment. It forever changed it for me. He was no longer the patient in the last room down the hall. He has a name, a face, a past, a present and hopefully a future. He has dreams and fears, the same as all of us. I listen even more actively to him, to his wife, to the nurses and every other person on his healthcare team. Because of it I believe together we will provide even better care for him.
You see, we are given the unique opportunity to inject humanity into the frailty of life. To listen and be curious about that life. To not only provide thoughtful care but to provide it with compassion and dignity. This will become the most important part of your work.
Now you may be saying this is the right thing to do but how can I do this when I don’t even know how to take care of someone with this disease or that disease. The third lesson is to learn with humility and curiosity and to do it collaboratively. As you move along in your training and career, the first encounter of any disease will be hard but then it will become the second encounter, and the third, and the fourth until the first encounters become fewer and fewer and you learn with more ease and not stress. A learning that if done with humility and understanding will progress exponentially for the lifetime of your career. You must be curious about everything-ask the why constantly? Do not settle for less. To navigate the complexities of healthcare you must also collaborate. Collaborate with the nurses, the therapists, the pharmacists, the secretary, the nursing assistant, and the housekeepers. Without them, you will not be able to fully care for the patient and you will not learn. We may each be knowledgeable in our own domain but it is only collectively that we can become expert in caring for the patient.
The last lesson is finding personal balance. There are times you will feel alone but you are not alone. You will be buoyed by people who care about you and your growth. They will watch out for you, mentor you, care for you, and be there for you. These people are your colleagues, friends, family, and mentors.
Look around you right now-the people who are sitting next to you, your friends and colleagues. They are the ones who understood the long hours of endless studying, the fear on the first day of your clerkship. This camaraderie will continue into your career and will become even more meaningful than you will ever know of or conceive of. You will create a lifetime of unbelievable memories and relationships with everyone around you. But remember just like your professional life, your personal life also requires active work. Do not forget to pick up the phone and call your mother. She will be worried about you. Make that date night with your partner or spouse and look into that person’s eyes. Take joy in the laughter of your children. Cherish dinner with your friends. Do all the things you can to preserve the balance in your life. Not only will you be richer, this abundance will flow into all aspects of your life both professionally and personally.
I feel so privileged and grateful to be in this profession. I hope you too will find the joy I have found in medicine, the joy so many of us have found. There will be no other experiences like it in your life. Treasure the moments; find the good in all that you do. Be curious. Always ask why. Be a healer. Stay balanced. Congratulations to you the graduating class of 2011.
- Sima Desai, MD
Associate Professor, Department of Medicine