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Students of Our Patients

I am very privileged to have spoken at the White Coat Ceremony for the SIU Medicine Class of 2022(!).

Here is my speech:

First of all, I would like to thank you, my students, for this great privilege of speaking before you.  I would like to congratulate you for your late nights and concerted efforts to excel, and thank your parents, partners, friends, and families for encouraging and supporting you through this initial phase as you venture to begin to learn the art and craft of becoming a doctor.

And what does that mean?  The root of the word docere means: to teach.  And who do we aim to teach?  Our patients.  As you embark on this calling, you may hear others warn you about issues with reimbursement and medicolegal liability, of changes to the prestige, compensation, and authority claimed by practitioners of the healing arts.  But yours is a noble profession.

Improvements in public health, technology, and scientific inquiry have left their mark on the practice of medicine over the last century, but we have also continued to be humbled by our assumptions and are always learning more.  You will be reminded that half of everything you learned in medical school will be changed or obsolete in ten years.  Are you open enough to continue to learn?  Do you have the humility to understand the uncertain?  Can you communicate that with your patients?  Will you sit at a beach, overwhelmed by counting grains of sand, or will you take it all in and communicate something as simple and complex and abstract as a series of waves?

Many here have been ill before, and have felt vulnerability, loss of control, or even existential angst.  Did you need an advocate?  Can you provide strength to those in need of support?

A little over 90 years ago, Francis Peabody’s classic oration, originally presented before students of Harvard Medical School, was published in the Journal of the American Medical Association, entitled “The Care of the Patient”.  I am going to skip over a few mentions of tonics to read you some of the interesting parts:

“Hospitals… are apt to deteriorate into dehumanized machines…. When a patient enters a hospital, one of the first things that commonly happens to him is that he loses his personal identity.  He is generally referred to, not as Henry Jones, but as 'that case of mitral stenosis in the second bed on the left'.

He implored to his new doctors: "Medicine is not a trade to be learned but a profession to be entered."

In his speech, Peabody also comments on the "amazing progress of science in its relation to medicine during the last thirty years, and the enormous mass of scientific material which must be made available to the modern physician."  I ask you, since 1927, has anything changed?  Besides Google?

You will find that you as the medical student, the lowly medical student hanging out in the wards of the hospital, it is you who can give the most to a patient.  It is you who is the best equipped, not with your smart phone, but with time and curiosity to make that connection and do some detective-work in the process.

Here is another quote from Peabody:

"The good physician knows his patients through and through, and his knowledge is bought dearly.  Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine.  One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."

You may hear some people tell you to guard your heart in the process, to spare your emotions, but I will underline that you will never learn to understand the big picture without making that effort.  How a person’s homelife or socioeconomic condition will influence their medication compliance or the progression of their disease.  How cancer prevention and screening cannot happen without access to care.  How the keystone to the doctor-patient relationship is built on trust, and without connection to others, you will not learn and they will not learn and you will not impact. 

Do not be discouraged.  We need you in our ranks!  And I know you can take the challenge!

But, remember who your teachers are – not your attendings or faculty, or residents.  They will help guide and counsel you, they will mentor you through this process.

Remember, student doctors, you are now students of your patients, of how to be a good teacher.  Remember that the doctor-patient relationship requires establishment of a relationship.  

On this day, as you stand proud in your Coat of White, as you recite oaths of eras past, you have become part of a noble profession, and as a doctor, you will become a student of our patients... and that the secret of the care of the patient is in caring for the patient.

Thank you.

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