MD Program

  • The Kind Of Doctor You Want To Be

    Presentation at the
    White Coat Ceremony
    University of Iowa

    Roy J. and Lucille A. Carver College of Medicine

    Friday August 18, 2006

    by
    Jeffrey S. Wilson
    Clinical Professor, Department of Internal Medicine

    It is a privilege for me to be asked to speak with you today. As you will learn during your medical school training I generally do not have difficulty finding enough to say during lectures or small group sessions. I must admit, however, that I struggled a bit thinking about what I might say to you today. To help me decide I talked with some senior medical students about their experience as entering freshmen at the White Coat Ceremony. They all agreed it was a special day. The first student I spoke with had proud memories of having the Dean help him put on his white coat. The second student fondly recalled standing with her new class to recite the Hippocratic Oath. The third remembered sharing dinner with his family after the ceremony. When I asked about the speaker, they looked at me blankly. I began to feel anxious. Sensing my distress, they discussed and agreed on one point: Dr. Wilson – be a doctor who keeps it brief. I thanked them for their input.

    And so, it is with this advice in mind that I greet my colleagues, the new members of the Gold Humanism Honor Society from the class of 2007, the class of 2010, your family and friends. Class - you have worked extremely hard throughout your schooling and have been very successful. You now enter medical school with great enthusiasm and excitement. Your parents are undoubtedly also excited as they are now reasonably certain that in your future you will have steady work, a decent income, and that perhaps you will be able to take them on a vacation someday. I recommend that you do this, considering all they have done for you.

    I believe the White Coat Ceremony is a time to recognize and celebrate the wonderful human attributes associated with the medical profession. As a way to do this I would like to ask you to reflect with me over the next 10 minutes, about the kind of doctor you want to be. By this I do not mean the specialty - such as internal medicine, surgery, or family practice - that you may eventually enter, but rather the humanistic qualities and attributes you would like to have as a practicing physician. Today, I would like to give you a few ideas to consider.

    As you enter your first medical school classes this fall you will be acutely aware of how much there is to learn. Over the next four years your brain will be filled, often to overflowing, with medical information. We will teach you as much as we possibly can, and you will learn to teach each other. But medical knowledge is rapidly changing. Most of what you learn during medical school will have changed, even by the time you graduate. Because of this, one of the most important skills you will learn is how to teach yourself. This is an essential skill for all practicing physicians to have. Nearly everyday that I see patients; questions arise that require me to return to the medical literature. When you are seeing patients 10 years from now they will expect that you are practicing according to 2016 guidelines, not the 2006 guidelines you learned in medical school. So you are entering a profession of life long learning – this is part of what makes medicine stimulating and so much fun. Be a doctor who is committed to intellectual curiosity and the pursuit of life long learning.

    As you progress through medical school, you will have the opportunity to learn from your classmates, residents, fellows, and attending physicians. And, if you are really smart, you will realize how much you can learn from other health care professionals – nurses, respiratory therapists, pharmacists and physical therapists, to name just a few. Respect and take advantage of their special expertise and remember that optimal care of patients is a team effort.

    Be a doctor who learns from and respects all members of the health care team.

    When you are finished with your formal medical training you will be knowledgeable and skilled in your chosen field of study. Remember however, that the body of medical information you have learned, is and always will be, a tiny fraction of all medical knowledge. This is an important concept to remember – there is an old saying that has been adapted to medicine that goes like this - it’s not what you don’t know that hurts the patient, it’s what you think you know, that ain’t so.

    Be a doctor who understands and is proud of what you know, but perhaps more importantly, recognizes and is humbled by what you don’t know.

    During your career you will be involved in the care of thousands of ill patients. They will come seeking your help for their medical problems. Set the highest standard for the medical care you deliver to each of them, from the most down and out members of society to those considered to be VIPs. Most of you have received medical care, or have a close family member or friend who has. You have a sense of what separates excellent medical care – medical expertise, reasoned judgment, a gentle bed side manner – from average medical care.

    Be a doctor who consistently gives the kind of medical care you would want a member of your own family to receive.

    While you will cure many patients during the course of your career, you will also be in involved in the care of patients with illnesses you cannot cure, those who are terminally ill. Remember that even in these situations there is always something positive you can do for every patient. Be honest with them, hold their hand and always give them hope.

    Jerome Groopman, an oncologist at Harvard Medical School, in his book The Anatomy of Hope, defines hope as, “The elevating feeling we experience when we see – in the mind’s eye – a path to a better future. Hope acknowledges the significant obstacles and deep pitfalls along that path. True hope has no room for delusion.”

    Every person needs hope. Be a doctor who always gives patients true hope.

    As healers we sometimes do not fully appreciate the importance of human touch. The power of human contact was re-enforced to me when as a young faculty member, our team saw a man with the human immunodeficiency virus (HIV) and AIDS. He had developed a lung infection and we were asked by colleagues to find out what type of infection he had, to help guide his antibiotic treatment. We recommended performing a procedure called bronchoscopy – where a thin, flexible tube is introduced through the trachea, into the more distal airways, and cultures are obtained from the infected area. We discussed this procedure with him and he agreed to have it done as he also wanted to find the cause of his infection. For patient comfort we first numb the airways with topical medication and then give intravenous medicine to help relax the patient and prevent pain. Our patient was anxious about his illness, anxious about being in the hospital and anxious about having this procedure. And despite increasing amounts of medication to help him relax he remained uncomfortable during the procedure. I was supervising another physician who was performing the bronchoscopy and therefore my hands were free - I reached down and took his hand in mine and held it. He grasped my hand tightly but then, the rest of his body relaxed, and he was able to finish the procedure without difficulty. When we checked in on him later in the day, he thanked me multiple times for holding his hand during the bronchoscopy. This simple gesture had meant a great deal to him. He told us that since he had been diagnosed with AIDS, the people who took care of him avoided physical contact and he had come to feel quite isolated. I learned from this experience how important the human touch can be and that holding a patient’s hand can sometimes be more effective than anti-anxiety medication.

    Be a doctor who can hold your patient’s hand.

    Although difficult to imagine during your medical school training, you will only become busier as you enter residency and then your chosen field of medical practice. The time pressure placed on physicians in our society is severe and unrelenting. The average return office visit in many primary care practices is 15 minutes, and sometimes less. One of our patients’ greatest concerns about the care they receive revolves around the lack of time they are able to spend talking to their physician. In a profession where listening is a crucial skill – we often fail to listen. You will learn soon that taking a thorough, accurate medical history is the single most important tool we have in making a diagnosis. As a profession we must do better to give time to our patients, listening to their medical stories and answering their questions.

    But there will always be situations where you are hurried and the time you have to spend with a patient is short. One of my most influential mentors during my own medical school training, Dr. Jim Clifton, taught me that the quality of the time you spend with a patient is just as important as the quantity. A patient will perceive a five minute conversation spent sitting down, relaxed, and face to face very differently from the same five minutes spent standing in the doorway, looking at your watch every minute or two. I have found this to be true. The term – quality time – is often used in child rearing, but it is just as germane to patient care.

    Be a doctor who is generous with your time and who listens more than talks.

    Medicine is a demanding profession. Be sure that you make time for yourself and your family. You will be a better physician if you are rested, fit, and maintain a varied and interesting life outside of medicine. Continue to pursue outside interests such as music, reading, sports and travel. Most importantly, make time for your family. As your parents will surely attest, children grow up rapidly and you will want to be there for each milestone along the way. This can be a difficult balancing act – and one that is crucial to learn. Be a doctor who is devoted to both family and profession.

    Ten years from now most of you will be finished with your formal training – hopefully - and be practicing medicine. The practice setting will be varied – community based practice, academic medicine, government health agency and others. But common to all of these settings will be the opportunity to teach and share your knowledge and expertise with other physicians, students and allied health care professionals; and the responsibility to teach your patients about ways to prevent and treat illness. After all, the word – doctor – comes from the Latin word “docere” - meaning to teach. Being a teacher has many benefits. Teaching your patients helps them follow your treatment plan and participate in decision making. Teaching your peers keeps you professionally sharp because it requires the highest level of understanding. Teaching promotes humility as you realize how difficult it is to impart knowledge to others. Teaching is a great way to give back to your profession. A secret that you should also know about teaching is that teachers usually learn as much from their students, as their students learn from them. Teaching and learning are truly two way streets.

    Be a doctor who shares what they have learned with others.

    At the start of this talk I spoke about the opportunity you will have to learn from many great teachers and role models over the next four years, in many different forums – some unexpected. Recently, the University of Iowa community lost one of its most respected members – Professor James Van Allen – the renowned space scientist. Several years ago I was privileged to see Professor Van Allen in my clinic. He was in his late eighties at the time. As part of my history taking I asked Dr. Van Allen how he spent his days. He looked at me with a grin on his face and replied – “I go to work everyday. People are still asking me questions and there is so much still to learn”. What a wonderful example of lifelong learning and teaching! I realized then I might have another forty years of work in front of me.

    Please consider the ideas I have shared with you today on some of the human attributes I believe are important to our profession. While you will be immersed over the next four years in learning the nuts and bolts of being a physician – do so with a view towards the kind of doctor you want to be - firmly in your sights.

    Be a doctor:
    Who is committed to life long learning.
    Who learns from and respects all members of the health care team.
    Who understands what you know and what you don’t know.

    Be a doctor:
    Who is honest with your patients, gives them hope and can hold their hand.
    Who is generous with their time and is a good listener.
    Who is devoted to both family and profession.

    For my part, I hope today I have been a doctor who has kept it brief. Class of 2010, on behalf of my colleagues I welcome you to the medical profession, and I welcome continuing to learn with you in the years ahead. Congratulations.

    References

    Groopman, Jerome MD; The Anatomy of Hope – How People Prevail in the Face of Illness Random House Publishing 2004

    Acknowledgements

    Special thanks to Dr. Peter Densen, Margaret LeMay, and Charlotte Wilson for their advice in preparing this address, and to Dr. Jim Clifton for all that he taught me during my medical school years.