Humanism in Medicine Learn, Search, and Serve Notes for the First Year Medical Students at UT Health, Class of 2019 July 30, 2015, 6:30pm 1. Introduction Thank you for the generous introduction. I still feel embarrassed to have received the Humanism in Medicine Award, because normal people do good things quietly. This is an important day for each one of you after years of preparation you will now start Medical School, and in 4 years you will take full responsibility for the care of your patients. The white coat is a symbol of your commitment to learning and serving for the rest of your lives. I do not know most of you, but I love each one of you. Why? Because I love medicine and you are the future of medicine. I would like to share with you some personal reflections. 1) I was born in Germany on February 14, 1941 so it was in my stars to become a cardiologist. 2) My birthdate also gives away that I was also born in the middle of World War II. This means, I spent my early childhood in the middle of the horrors of war, death, and destruction. Exactly the opposite of what we strive for in medicine, which is preserving life and building a better future for our patients. 1
But medicine is more than that. Medicine is a profession in which we are privileged to learn, to search, and to serve, all at the same time. Now comes an inconvenient piece of truth. I am a practicing cardiologist, but I am also a biochemist, and those two worlds do not always mix easily. Those who know me a little better also know that I am not always a nice person. I try to be nice to patients, but, like all doctors, I get paid for being nice. 2. Not a Nice Person But consider this. My small lab has been funded by the NIH since 1976, for almost 40 years. Being a nice person has not helped me to get a single NIH grant. Consider this as well. Being nice has also not helped any of you to obtain your fantastic GPAs and MCAT scores, which got you into medical school. 3. Being Human is More Than Being Nice Did you get it? Entering the medical profession, or any profession for that matter, is more than being nice it s about knowing and understanding, knowing and acting according to what you know. In other words: Being human is more than being nice. It s also about learning, thinking, doing, sharing, and overcoming obstacles. Worst of all, we will make mistakes, and we can only hope that we will not make the same mistakes again. The idea is simple. We go to school to learn and to apply to life what we have learned. We learn not for the sake of learning but the sake of mastering life. The old Romans, already knew. Non scholae sed vitae discimus. 2
4. Examples Let me give you a few examples: - A future lawyer studies the laws to apply it to present day disputes; - A musician practices an instrument or trains the voice to perform at near perfection; - An engineer learns the laws of physics, chemistry or biology to design better machines, compounds, or procedures for present day life; - A historian studies the documents of the past to come to terms with lessons learned and to apply those to the future (example: Nazi Germany); - A theologian studies the breadth and depth religious texts and interprets their meaning; - Philosophers do the same with philosophical texts; - And, closer to home, scientists learn the laws of nature and acquire the tools for an even deeper and better understanding of the world in which we live. Without science there would be no vaccinations, no antibiotics, no heart transplants, and no remission (or even cure) for certain cancers. In short: Without research there is no hope! Patient care and research are like two clapping hands, and I hope that you will learn to clap your hands loudly. Think of it: You cannot clap with one hand alone. 5. Where does Medical School Fit into the Scheme? Learn and Serve Now you may ask: Where does Medical School fit into this scheme? It fits extremely well because today you are entering the first year of Medical School to learn and to serve. 3
Remember: To learn and to serve. These five words have a dual meaning. First, you will continue to learn all the science, all the tools, all the procedures needed to be a competent physician to your patients and that s a lot! Secondly, whether you know it or not, you have entered our school to learn and you will leave it to serve people in need, and you will do this for the rest of your lives. In this respect, doctors are very similar to teachers and to parents, the people who got us here today in the first place. Please let them know, at least every once in a while, how much you owe them. 6. Challenges Not All Will Be Pretty The next four years will be a huge challenge for each one of you. I can tell you that not all you experience will be pretty. You will find yourselves studying whole nights for exams. You will find patients covered with blood and gasping for breath; you will also find patients who are excessively demanding of your time and good will. You will find patients whose disease cannot be cured, you will find patients who cannot even be relieved of their pain, and, yes, you will accompany patients on their final journey on this earth. All this will test the strength of your character. You will also face what Gerald Weissman calls The Doctor Dilemma. For example, there are times when your concerns and commitments at home are in direct competition with the needs of a patient. You will also be annoyed when you receive your first letter starting with Dear Health Care Provider, and you wonder whether 4 years of medical school no longer 4
means anything. Are our patients then health care consumers? You may also have the shock of your life when you realize that your productivity is measured in corporate terms because, today, clinical faculty is a charge-based faculty. The biggest challenge for you and for all of us will be to come to terms with modern medical economics and traditional medical morality, the ethics of humility and compassion. So, please, do not be diverted from the path that brought you here today the path of learning and understanding, the path of learning and serving. Is there a way we can go together in these bewildering times? Of course, there is. Dr. Stoll and your teachers at UT Health will walk with you on this path. My favorite allegory is this: Today s medicine is like taking a flight on a commercial airplane. People fly in first class, or in business class, or in economy class. If you want to get your feet tickled, you fly first class, if you want a gin and tonic before takeoff, you fly business class, if you want to just get from one place to another, you fly economy. Still, everyone gets on the plane at the same time and arrives safely at the same time. Let s make that our goal as well. 7. Concluding Remarks So, to sum up: Learn, to search, and serve. Like a burning candle. Do not be afraid to consume yourself to provide a light in the darkness. And this light is nothing spectacular. It is putting your knowledge to work, or, most often, a very simple act of kindness. 5
I will close with words attributed to the greatest Italian since Julius Caesar, St. Francis of Assisi. An excerpt of his prayer Lord make us instruments of your peace reads: Grant that we may not so much seek to be consoled, as to console; to be understood, as to understand; to be loved, as to love; For it is in the giving that we receive; it is in the pardoning, that we are pardoned, and it is in dying that we are born to eternal life. No matter whether you are a believer or a skeptic, may each and every one of you be blessed on your journey to learn and to serve, recognizing our strengths and weaknesses, our own brokenness and your burning desire to help others. I visited with my friend and mentor in all things Texan, Dr. red Duke, two days ago. I read to him the text of this address. At the end, he said, Don t change a word, followed by I surely always liked taking care of patients. That s what I wish each one of us can say sitting upright in a scrub suit and in a white coat at the age of 87. 6
Addenda 1. Acknowledgement I dedicate my address to Dr. James ( Red ) Duke in gratitude for over 30 years of friendship and inspiration. 2. Notes from David Brooks When Cultures Shift, Op Ed, New York Times, April 17, 2015 In 1952, Norman Vincent Peale published a book The Power of Positive Thinking which rejected a morality of restraint for an upbeat morality of growth love yourself. That book stood atop the bestseller list of the New York Times for a record 98 weeks, and it continues to permeate the academic environment believe in yourself and grow. A more balanced view is that we are splendidly endowed but also broken. You build your career by building on your strengths, but you improve your character by trying to address your weaknesses. We need help with our tendency to screw things up. That great humanistic tradition was tossed aside and is worth revisiting. 7