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Harold P. Adams, M.D.
Professor and Director
Cerebrovascular Diseases Division
Department of Neurology
Provost Whitmore, Dean Kelch,
Mr. Howell, Dean Nelson, Dean Densen, faculty, students, and members of
the University of Iowa College of Medicine Class of 2005 and their
families and friends. I welcome you. Congratulations to the new members
of our academic community. I thank Dean Densen for the very warm and
kind introduction. I am truly honored to give this lecture. Although I
have spoken in many places around the world, I doubt that I have
addressed any audience that is more important to me than is this one.
The students represent the future of American medicine.
When Dean Densen asked me to address you, I was uncertain as to the
topic and the scope. After considerable deliberation and several false
starts, I picked the theme of love for this lecture. I believe most
members of the audience will readily recall that All You Need is Love is
the name of a popular song first performed by the Beatles in 1967. Some
may wonder why I picked the theme of love and the title of a Beatles
song for a lecture to be given to a group of young men and women who are
at the beginning of their medical careers. However, I would argue that
love is fundamental for your success as a physician.
The word love has special meanings for each member of this huge
audience. Love invokes a broad gamut of emotions, feelings and memories.
Still, there are aspects of love that form the very core of our
humanity. As a result, it is hard for me to define love. The most
eloquent definition of the type of love that I wish to discuss was
written almost 2000 years ago. It was penned by the Apostle Paul in his
first letter to the Corinthians. And I quote:
Love is patient, love is kind.
It does not envy, it does not boast, it is not proud.
It is not rude, it is not self-seeking.
It is not easily angered, it keeps no record of wrongs.
Love does not delight in evil but rejoices with the truth.
It always protects, always hopes, always perseveres.
Love never fails.
Besides this truly eloquent description of the core of love, I
would like to append some additional components of love, which are
fundamental to all human endeavors and are especially important for a
I would propose that these aspects of love are fundamental to your
success. Even if you accumulate a vast fund of knowledge and become
technically skilled in the practice of medicine, you will not be a
physician-healer unless you have, show, and share love. Love is the core
of medicine. It is truly what you need.
A critical aspect of success is having a real enthusiasm or love for
what you are doing. If you do not enjoy medicine or do not find
happiness and excitement in its study and practice, you cannot be
fulfilled or content. I can assure you that you will not find happiness
in all that you will do in medicine. You are embarking on a very
rigorous course of study and a very demanding career. All medical
students and physicians have times when they are frustrated,
disheartened or overwhelmed. Physical, mental, and emotional exhaustion
are real occupational hazards. I do not have easy answers for how you
should address these stresses. All I can advise is that you must, and
will, develop your own coping skills that will make you a better
person-and a better physician.
Next week, you will take your first step in medicine. In many ways,
you will find that the first two years of medical school do not differ
markedly from your previous educational experiences. You will attend
lectures, do laboratory work, study and take examinations. However, the
first and second years are truly a time of transition into another type
of study. The first two years are not easy. In fact, most students find
them to be very stressful. You will learn very quickly that the amount
of information is massive and that the hours of study are very long. In
short, most medical students do not describe the first two years as
being fun. Most physicians do not remember this part of their medical
education with fond affection. Still, do not allow the intensity of
these two years to overcome your enthusiasm for your chosen career.
Remember, your goal is to be a physician.
These basic science courses truly are basic-they provide the
foundation for your medical career. Medical students often muse about
the relevance of much of the material that is studied in the first two
years. I surely did. As a medical student, I could not fathom any reason
to learn the biochemistry of the glycosaminoglycans. I would have never
guessed that 20 years later I would be using (and relearning) this
information when I began doing research on the utility of the
glycosaminoglycans for treating patients with stroke. The contents of
the first two years, which many of you will not love, are designed to
give you the scientific infrastructure for your successful clinical
practice. You are building a storehouse of basic science knowledge that
you will use every day and with every patient.
Most medical students are far more enthusiastic about the third and
fourth years. You are actually interacting with patients who become
your most effective and important teachers. You are learning clinical
skills and the fundamentals of treatment. You are truly starting to
become a physician. Your fund of clinical knowledge will grow
tremendously. You will be amazed about the amount of trivia that you
will learn. While you will be taught a mountain of presumably isolated
facts that seem to be of uncertain utility, this information really is
not trivial. These odd pieces of information will help you in the care
of your patients. These pieces of trivia provide a clear understanding
of the nuances of a patient's history and examination and the subtle
nature of medical decision-making process that is fundamental to a
At the time you graduate, less than four years from now, you will
have just begun your training in how to be a physician. I must emphasize
the word-begun. Even though you will be addressed as doctor, you still
will be a student. Even though you might not be a medical student, you
will be a student of medicine for the rest of your life. While you might
be earning a salary rather than paying tuition, your education is
continuing. You will be acquiring new information about a dramatically
changing profession on a continuous basis. You will learn something new
every day. This is one of the aspects of medicine that I hope you will
The second key definition for love is summarized by the word-care, or
as Dr. Francis Peabody, one of the giants of American medicine in the
early part of the 20th Century, stated, One of the essential qualities
is interest in humanity, for the secret of the care of the patient is
caring for the patient. You cannot treat patients or manage their
illnesses effectively unless you do care.
The practice of medicine truly revolves around the care of the
patient. You need to recognize that the patient, not you, is the most
important person in the patient-doctor relationship. You will need to be
as aware of your patients' needs and well being as you are
knowledgeable about their illness. You must recognize that the desires
and emotions of the patient in the patient-doctor relationship differ
from yours. Having been both a physician and a patient, I know. I would
like to share a personal experience with you. This summer, I am
celebrating my 10th anniversary as a cancer survivor. I consider myself
to be very lucky. By the grace of God, the fruits of modern medical
research, wonderful care, and much love, I survived my illness. I will
always be grateful for the care at the University of Iowa. I am also
lucky because I learned what it was to be a patient and this experience
has affected my outlook as a physician. As a patient, I was frightened
because I knew I had a life-threatening disease. I knew enough to be
scared and I knew that I needed my physicians to make critical decisions
about my care for me. I was dependent upon them - I needed their
treatment and their care. I also learned that I wanted my physicians not
only to provide care but to care. I needed both their knowledge and their compassion.
You must be able to give such compassion to your patients. At
times, this may be difficult because some patients are not easy to love.
For example, it is difficult to show compassion to an intoxicated
patient who is combative and yelling obscenities-especially if it is two
o'clock in the morning. Similarly, you will encounter patients or
patients' families or relatives who are unpleasant and aggressive. Some
people are obnoxious and it is difficult to show empathy or concern when
you are feeling threatened or angry. We are all entitled to react
emotionally when we deal with disagreeable people. Still, we must
control our emotions and act in a manner that is both careful and full
Caring involves attributes that cannot be learned from a book or
taught in a lecture. You will need to show warmth and empathy. Your
empathy must be real. This is not an emotion, or a facet of our
humanity, that can be faked. You cannot be an actor. You cannot fake
empathy. Many patients are sufficiently sophisticated to recognize
compassion that is false or contrived. The attributes of warmth,
compassion, concern, caring, honesty, and humility must come from within
During your career, you will make very tough decisions-sometimes in
a matter of seconds. Some of these decisions can truly mean life or
death for your patient. These are awesome responsibilities that your
patient and society entrust to you as a physician. These
responsibilities must be assumed with thoughtfulness, care, and love.
Fortunately, your education and training permit you to evolve into these
decision-making roles. Take time to observe the skills of the seasoned
physicians with whom you work-watch how they respond when they are faced
with really tough decisions. These teachers can be your mentors in
their actions as well as their words.
Providing care is associated an endless series of highs. As one
medical student stated, It's really wonderful to be doing something
worthwhile and that makes a difference. It is extremely gratifying to
know that you have helped someone. The range of positive experiences is
broad and varies, from your reassurance to an anxious parent of a sick
child to your successful treatment of a critically ill patient. These
positive experiences not only help you be a caring physician, they will
sustain your sense of enthusiasm and love for medicine. Still, while
your care and love of your patients are fundamental to your role as a
physician, you also must achieve an element of detachment. In many
cases, this is not easy. You will see countless tragedies and some of
them will scar you. As a caring person, your heart will go out to
patients and their loved ones. If you did not feel emotional distress in
these situations, you would not be a caring physician or a humane
person. However, you must separate this sense of compassion from your
duties. You must control your emotional reactions because decisions
based on emotion likely will be incorrect. Sometimes, controlling your
feelings can be extraordinarily hard. There will be instances when your
knowledge and skills will not be sufficient. There are patients who
cannot be helped. You may need to advise a patient or family that no
treatment is available and that the disease is terminal. At other times
your focus might not be the patient. Your primary role will be to
understand and support a devastated family. These are situations that
will test your mettle. They come with the oath that you will take soon.
During the coming years, you need to formulate ways to handle these
extraordinarily difficult times with kindness and compassion. These
truly are the times that you can show the most love to your patients.
You are at the beginning of a career that is marked by intense
competition. Physicians and medical students, by their very nature, are
competitive. You would not be here if you were not eager to compete. You
will be interacting or competing with other medical students and
physicians for the rest of your life-whether the competition is for
grades, residencies, honors, or patients. While competition cannot and
should not be avoided because it challenges us to excellence, we must
recognize the potential for the destructive nature of excessive
competition. The task is to channel our competitiveness to be
constructive. We must strive for excellence, but at the same time,
maintain our humility. We need to recognize our fellow medical students
and physicians as colleagues. Value them. They have earned our respect
Because they will understand your frustrations, your fellow medical
students and physicians soon will become your closest friends. These
colleagues will be the ones to whom you will turn when you have
professional or personal crises. Your colleagues will be the source of
help when you are in trouble. Conversely, there will be times when you
will be asked to help your fellow physicians and their patients. While
the timing of cries for help might not be great, a physician who
respects and values his colleagues should and must respond willingly and
agreeably. Do not be hypercritical or arrogant. Do not develop an
exaggerated sense of self worth. Be cautious of your criticism. Treat
your colleagues in a way that you would want to be treated.
Finally, and most importantly, the fourth attribute of love involves
affection. I want to talk about love of the persons who are the most
important to you-your family. I look at this audience of proud parents,
grandparents, spouses, children, and friends. Your choice of medicine as
a career affects all them. They are sharing your educational experience
and your new profession. Medical school and medicine are expensive.
While the financial burdens of a medical education are tremendous, the
other costs are even greater. You and your loved ones are making huge
sacrifices in time and commitment. You will be preoccupied with your
studies. You will be distracted by your care of your patients. Remember
that your family will be making sacrifices so that you can be the type
of physician that you will want to be. They deserve your affection and
love. Make time in your schedule so that you can show your love to them -
they are the most important people in your life. Do not ignore them.
Hopefully, I leave you with some thoughts about love-love of
medicine as a science and art, love of your patients, love of your
colleagues, and love of your family. With enthusiasm you can become an
excellent student of medicine. With caring, you can be a skilled
physician. With respect, you will be a valued colleague. With affection,
you will be a loving person. In closing, I would like to return to the
Beatles' song with which I began:
Nothing you can make that can't be made
No one you can save that can't be saved
Nothing you can do but you can learn how to be you in time
All you need is love.
All you need is love.
All you need is love.
Love is all you need.
I look forward to your success. I know you will not fail-because love never fails.
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