Good afternoon, everyone.
I’m so pleased to see you all again. Congratulations on making it through your first week!
This ceremony is a very important milestone. Donning the white coat for the first time is a tangible symbol of the extraordinary journey you’ve embarked upon, and I suspect you will carry the image with you for the rest of your days.
I want to spend the next few minutes reflecting with you on the nature of the journey ahead, especially as it relates to the next four years.
You’re here because you’re exceptional. But you have before you a life-defining choice as to what you will do with your gifts.
If you want to make a real difference in the world—whether it’s in the lab, the classroom, a small rural practice or the chairmanship of a department—there is simply no shortcut. To rise to the best that is in you, you have to embrace—or at least commit to—all the demands…all the doubts…and all the discouragements of intensive training.
Now, in many fields that’s obvious. You don’t win Wimbledon if you’re still worrying about your forehand or your backhand. You don’t wind up as a lead dancer if you’re still wondering exactly what to do with your feet. And you don’t get to play at Carnegie Hall if you’re still sorting out your fingers on the keyboard.
The people who do things like that have worked at it until their skills are as engrained as breathing. They’ve put themselves through relentless practice—Malcolm Gladwell, as you probably know, argued in his book Outliers that the “magic number” is 10,000 hours of it. And as a result, their artistry seems to flow from them…as if they were just “born with it.”
The essence of excellence in athletics or the performing arts, in other words, is making what’s difficult look easy.
In medicine, it’s different. Medicine is not about becoming a star. And making what you do look effortless to other people is not the point. Nonetheless, the same fundamental principle applies: however much talent you start out with, the real key to achievement lies in long, hard work.
I have no idea how many miles of film I studied as a resident and fellow in neuroradiology. All I know—and I say this as life-long runner—is that it was a marathon.
Anyway, it’s not the actual quantity of images I slogged through that matters. What matters is that ultimately, abnormalities just popped out at me. I knew in an instant—as if by instinct.
But of course, it wasn’t instinct. It was a vast, internalized database of scans that had worked its way into my unconscious… my reflexes…and maybe even embedded itself in my DNA!
And that’s the payoff. If you stay the course, suddenly things fit together differently. Reaching the other side of all the details and the mechanics of your discipline is sort of the intellectual equivalent of breaking the sound barrier. Your relationship to knowledge shifts to a new plane. It frees you.
Now, many, many people never “get there.” Not because they couldn’t, but because they gave up along the way.
Some start out with strong confidence in their abilities and expect that, because they’re smart, it will be easy. And then they hit a rough patch, and it throws them off course.
Others start out riddled with self-doubt, and when the going gets really steep, see that as confirmation that they’re not up to the task.
And still others simply conclude that “good enough” is … well … good enough.
Perhaps the trickiest part of all of this is that we’re not talking about a one-time choice.
There is no one fork in the road. The decision to give it your all… or just do enough to “get by”… presents itself again and again and again.
And that’s due to the nature of the learning curve, which actually isn’t a “curve” at all. Rather than following a steady, upward trajectory, it comes in fits and starts. It zigzags… it backslides… it pauses on what can seem like endless plateaus.
And while you’re on one of those plateaus, the effort you’re investing of