Good afternoon, everyone.
It’s great to see you all again—I hope you feel galvanized by the experiences of your first week of medical school!
For me, this ceremony is one of the highlights of the entire academic year, because it offers all of us the chance to pause and reflect on the meaning of this extraordinary journey you’ve embarked upon.
As you begin that journey, medicine is entering a new era, shaped by accelerating discovery and armed with capabilities that our predecessors probably could not even have dreamed of.
Where once the "great diagnostician" would stride into the room…touch the patient’s belly… and announce, "Aha! An enlarged spleen!" (whether out of genuine brilliance or mere bravado, no one knew for sure!)… today, we have ultrasound at the bedside.
Where—even when I started out—interventions required the trial and error of exploratory surgery…they can now be mapped to the millimeter, before the patient ever gets to the OR. Where procedures used to leave foot-long scars, they now often leave traces measured in centimeters. And where hospital stays dragged on for days, they’ve shrunk in many cases to mere hours.
And all this, of course, has redefined the kinds of skills you’ll have to master.
Fortunately, you’ll have tools at your disposal that even science fiction may not have envisioned when I was a medical student. Computer simulation. Patient records appearing instantly on your i-Phone. Up-to-the-minute information streaming at you from so many directions that your biggest job will be…not to get overwhelmed!
The confluence of all these forces has taken much of the guesswork out of medicine.
But that doesn’t mean it’s made things easier.
I’d like to spend just a few minutes examining with you some of the emerging challenges and what I think they’ll require of you.
Let me start with the least immediate, but by far the most serious: the rationing of health care.
Historically, if something could be done to help the patient, the doctor’s job was to do it. End of story.
Tomorrow, the economic consequences of progress are likely to create extraordinarily difficult dilemmas. If society cannot afford to support everything that can medically be done to save someone, what happens? Who lives and who dies? And on what basis can a terrible decision like that get made?
I always hope that scientists will discover ways to spare us decisions like those. Already, we know that procedures like joint replacements-- which allow patients to retain their independence and ability to function far beyond what would otherwise be possible—are both life-changers for the individuals afflicted AND huge cost-savers for society.
And the same is true for every advance that delays—even without avoiding—the onset of a degenerative disease like Alzheimer’s or Parkinson’s.
Nonetheless—to the extent that we may find ourselves medically able to provide solutions that, for society as a whole, prove financially unsustainable for everyone who might benefit— doctors will clearly need to have a stronger moral compass than ever before. They will need a profound sense of humility and compassion…a solid grounding in ethics…and the ability to gauge factors as disparate as quality of life…family impact…and the tradeoffs between cost to society and patient benefit.
The second issue I’d like to mention pales by comparison, but already has significant ramifications for the practice of medicine.
Heightened treatment capabilities have brought with them higher patient expectations and far less regulatory tolerance for error.
Even less than a decade ago, medicine was still a pretty closed world. What happened in the OR stayed in the OR. Today, driven by the federal government, what happens in the OR shows up in publicly posted statistics, as do measures of the quality of care…or incidents like hospital-acquired infections and patient falls.
The work that doctors do, in other words, is now objectively graded. And as I’m sure you can relate to as students—there’s something a little daunting about having "report cards" get published for all the world to see!
Yet obviously, from the patient and public health perspective, transparency and accountability are crucial, salutary concepts. And for sure, they are driving healthcare providers to keep making necessary improvements.
I don’t think that public reporting of outcomes is making most physicians any more anxious to do the best they can for their patients than they always have been. But I do think it’s shedding a strong light on the importance of collaboration.
Keeping patients safe from infection…from falls…and from any other untoward hospital incident ...depends as much on the contribution of the person who empties the trash in the hospital room…or the person who transports the patient from one test to another…as it does on the chairman of surgery.
Respecting the part that every team member plays is, in my eyes, as decisive to excellent patient care as a physician’s finest professional skills. So if –as I’m sure you have not!—you’ve come to medical school with some image in your mind of the "Great Doctor" supported by a cast of "awe-struck underlings,"…my advice is …to think again!
The final point I’d like to explore with you is the impressive precision that today’s technology affords us, and that in many ways seems to have shifted medicine from an art to a science.
If you define art as creativity in the face of the unknown, that’s certainly true. But if you define it in terms of the magic and mystery that inspire one person to trust another, medicine remains –and always will—an art of unparalleled power.
You have before you a choice that will define not only the lives of your patients, but your own. And that choice is: whether to become a "data-driven" doctor in the sense of someone who studies the chart rather than listening to the person…or whether to devote the time that technology saves you…to becoming a better ally to someone who needs your help.
Each of you is here because we’re pretty sure we know which road you’ll choose!
I wish you all the wonderful discoveries…unique opportunities for personal growth…and forever friendships…that make medical school such a defining time of one’s life.
Thank you very much.