Keynote Address given at the White Coat Ceremony at UMHS on May 12, 2012
A pleasant good morning to everyone.
It is a pleasure and an honour to be invited here today and to be asked to give the Keynote address. It was only 20 years ago that I started my medical training at the Mona Campus at the University of the West Indies in Jamaica. And seeing you all here today, I can well imagine what is going through your mind, as believe it or not, I was once a medical student just like you. Although I was naive, insecure, and unsure of my skills and the challenges that lay ahead, I had many mentors along the way who reassured me that although the journey would be a difficult one, I would eventually succeed and that my dream of becoming a doctor, would one day become a reality. They were fond of telling me that, “medicine is easy”, (which I did not believe at the time, but now I do), and that “the only difference between them and I was time.”
What I hope to do in the next ten minutes or so is to share with you some of the insights gained, and words of wisdom given, that have shaped me, and that have allowed me to stand before you today.
First of all, we must understand that medicine is a privileged and sacred profession, in that we deal with patients at their most vulnerable, as many will be suffering from chronic illnesses and some even with terminal diseases. From the onset, we must realize that our calling is not just to save lives, as inevitably we all have to die, but our calling must be to prevent and even decrease the suffering in our patients’ lives. Although we may accurately define life as “a sexually transmitted disease with terminal prognosis”, I want to reassure you that this is not a problem with life or suffering itself, but our perception of our role in it.
Secondly, we must appreciate that our medical training is modelled on the scientific method. When we formulate a diagnosis, we are actually putting forward a hypothesis that may explain a patient’s complaint. If we are to serve our patients well, we have to first have an excellent grasp of the basic sciences so we can appreciate where the abnormal structure in the anatomy or the abnormal function in the physiology of the patient lie. Having become well grounded in the basic sciences, we then proceed to the bedside or clinic where we interact with the patients and develop our clinical skills in applying what we have learnt from the basic sciences to our patients’ health needs. This skill involves us interacting with the patients by interviewing them and dissecting their symptoms (which we call history taking) and examining them using our senses of sight, hearing and touch, sometimes smell, and rarely taste, looking for clues which may be consistent with or help rule out a given list of hypotheses (which we call differential diagnoses). If at this point we have not made a diagnosis, we then augment our senses by using the tools of modern medicine such as microscopes, cameras, Xrays, chromatography and spectroscopy, to pinpoint the structural or functional lesion that is the source of our patient’s complaint.
I fervently hope that at this point you can fully appreciate that a good grounding in the fundamentals plus developing critical thinking skills in pattern recognition is the key to becoming a successful practitioner. Please remember this truism that medicine is an apprenticeship, where our unwritten motto is, “See one, do one, and then teach one,” and that we progress and “we see further by standing on the shoulders of Giants”. We should thus heed the advice of one of those giants, Sir William Osler, who teaches us; “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”
To be a successful doctor, we should develop in ourselves the five Cs. First of all, we should be compassionate, this goes without saying. Secondly, we should be competent, and this competence is developed from understanding the fundamentals in the basic sciences and developing our clinical skills to the best of our abilities. Thirdly, we should be confident in our skills, as this is important in nurturing the relationship between our patients and ourselves, and also of us in ourselves, as confidence in our knowledge and skills, is the antidote for anxiety and indecisiveness in our professional and personal lives. Fourthly, we have to be of sound character, as believe it or not, we are role models for our patients. In order to earn the trust of our patients, we need to “practice what we preach.” It was a wakeup call for me, that when I told my third patient that she needed to lose weight as part of her treatment plan, she turned around and asked me what I was doing to lose weight myself, as at the time, I was also obese with a BMI of 31kg/m2. Like all great leaders, and being leaders in our fields, we also have to apply the tenets of accountability, transparency, and good governance in our professional and personal lives, and to appreciate that respect and trust from our patients, is something that is not granted, but earned.
And the last C, which I feel is the most important quality, is that we need to become efficient catalysts of change by fostering healthy behavioural change in the lives of our patients. As you know, a catalyst is a substance that speeds up a reaction without being consumed in the process. So as efficient catalysts, we should bring the right knowledge, the right treatment plan, the right specialist, to the right patient at the right time, to speed up the rate at which our patient recovers from sickness to health, or help our patients who are healthy remain healthy. Thus our goal in our professional and personal lives, as we grow and develop and evolve, should be to become more compassionate, more competent, more confident, of sound character and also more efficient as we catalyse the recovery of our patients, and better yet, empower our patients to maximize their wellbeing.
It would be remiss of me at this point not to throw some light on a major shortcoming of our medical profession, and it is my fervent hope that your generation would be the ones to help us in remedying this suboptimal situation. Believe it or not, we have spent much time and energy and research in discovering skills, medications and technologies to save lives. However, we must wake up to the realization that as medicine is practiced today, which is based on the sickness model, medical research is taking us where we cannot afford to go, as our health care model as it stands today, is without a doubt unsustainable. It has been said that “an ounce of prevention is worth a pound of cure.” Better yet, we say to you, that putting more time, energy, and research into prevention IS the cure for the unsustainable sickness model within which we find ourselves immersed today. During your training, you will discover that most of today’s diseases are lifestyle related and hence preventable, and I hope one day that in addition to the patient’s bill of rights, we can by consensus formulate a social contract or a covenant with each other and our patients called a patient’s bill of responsibilities. As Arun Ghandi, grandson of Mohandas Ghandi has said, we commit one of our greatest human blunders when we divorce human responsibilities from human rights. Gone should be those days when we amass great wealth and fortune by profiting from human suffering by capitalizing on the physical, cognitive and emotional frailties of our patients. I yearn for the day when we as a profession are not perceived as human mechanics, eagerly waiting for our patients to break down, but are seen as sincere health coaches eagerly reaching out to our patients to guide them and encourage them to partake in wholesome healthy living. In so doing, we would become partners with our patients in helping them become more empowered and more responsible, and helping them decrease suffering in their lives and those around them. We need to be our patients’ advocates and help convince our policy leaders that that their number one priority should be in helping shape the rules of society where the healthier choices, become as a matter of fact, the easier or cheaper choices.
And finally, we would like to share with you the secret to our being here today, what motivates us and inspires us in the difficult times and what keeps us grounded in the good times. As you can guess, this apprenticeship is not only a professional journey, but also a spiritual one. And when we say spiritual, we mean one in which we endeavour to develop in ourselves a sense of connection to all that there is in time and space. To be one with each other and with the whole universe, we endeavour everyday to cultivate in ourselves to the best of our awareness, a sense of infinite gratitude for all things past, a sense of infinite responsibility for all things future, and ultimately a sense of infinite service for all things present. (Some of you here would recognize at once that this is basically the heart of Buddhist philosophy.)
So thanks again for lending me your ears. Good luck on your journey as you not only fill your mind with information, knowledge and wisdom as it pertains to the practice of medicine, but also as you fill you heart, soul and spirit, with faith, hope and love for your profession and above all for your patients you are ultimately called to serve.