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Presentation at theWhite Coat CeremonyUniversity of IowaRoy J. and Lucille A. Carver College of Medicine
Friday August 21, 2009
byRichard D. Williams, M.D.Professor and Head, Department of Urology
Good afternoon and welcome, new students, your families and friends, to the University of Iowa and the Roy J. and Lucille A. Carver College of Medicine. It is a great honor and a privilege to speak to you today about the White Coat Legacy.
Just what does wearing the white coat mean? It means both great opportunities and great responsibilities. Student physicians, you are about to embark on a fantastic voyage that will allow you to become a physician and a full member of an honored profession. Make no mistake that while sometimes we are led to believe that the American people are dubious about "doctors" in general, they very highly respect and appreciate their own personal physician.
Some of you may be stepping into this new arena with trepidation, wondering if you have what it takes to learn all that is required to be a competent physician. Let me assure you, as you begin, that each of you have been carefully chosen because you have the exact abilities and characteristics to succeed in medical school. All of you have done well in your undergraduate studies. Some of you have obtained advanced degrees, others have been involved in research or industry, and you all have the capacity to complete the entire curriculum offered here at the University of Iowa.
As you begin medical school it is worthwhile to reflect upon why you have chosen medicine as your career. Each of you have been influenced by family, friends and role models and encouraged to pursue this path. Do not forget these people as you get involved in the daily activities of student life and later as a graduate physician - they deserve your lasting gratitude. For me, I was adopted shortly after birth and have my adoptive parents to thank for creating the environment that allowed me to grow up healthy, loved and guided. When I was in grade school I had meningitis (a spinal cord infection) and I was in the hospital for an extended time during which I began to dream that I wanted to be a physician just like the caring, wonderful doctor that took care of me - a dream from which I never woke up.
Many of you have as a goal to increase the understanding of disease and devise new treatments through research that will someday improve the lives of our fellow human beings. Others of you will become treating physicians and surgeons on the front line, providing care to patients every day. I have had the opportunity to do both and I can tell you that there is nothing more satisfying than seeing a patient recover from illness by virtue of your intervention, or watching a new method of treatment devised in our own laboratory improve the lives of patients in a clinical trial.
There will be other times, however, when your treatment doesn't work or you have to decide when to stop treatment in consultation with the patient and their family - these times are difficult, but you must not shrink from your duty to be a complete physician. A painful example for me is a 10-month-old boy I encountered in Haiti on my annual medical mission a couple of years ago. He had a large mass in his bladder and had poor kidney function. I had hoped he had a simple ureterocele (or swelling in the tube that drains the kidney) that we could remove and he would completely recover. At surgery I found a large tumor in his prostate and bladder that would require total removal and formation of a new bladder and a life-long external drainage bag and finally extensive chemotherapy and radiation - neither of which was available in Haiti - and even if he received optimal treatment he would have a very limited prognosis. I had to make the decision at surgery not to proceed and then to sit and discuss the eventual outcome with his 16-year-old mother and his grandmother. As a grandfather myself, I found this most difficult. Upon my return to the U.S. his biopsy was read as a highly malignant cancer, which confirmed my clinical decision, but did not begin to relieve my distress.
There are numerous paths within medicine you might pursue, but you can be certain that if you successfully complete medical school and whatever training you decide upon afterward, you will have a life-time career and be a respected member of your community. One word of advice as you traverse through the various disciplines in medical school - look at your instructors and their trainees carefully. Interact closely with them and try to discover what you may choose to do as a physician from day one. Note that, as I indicated before, most of us make these decisions based on role models - observing a physician who embodies the personal characteristics, practice patterns and skills that catch and maintain our interest. For me, I met a pediatric surgeon in medical school who was a superb technical surgeon and was also incredibly caring and nurturing to his patients and families. Again, I wanted to be just like him. When I was in my surgery residency, I met the opposite pediatric surgery role model. But, fortunately, soon thereafter I met the urology chief and his residents, and found my clinical calling, as these physicians were happy, competent and caring, and they made a profound, positive impact on their patients' lives. You can begin forming these opinions regarding your chosen field of medicine very soon but try to get a wide array of experiences before making your final decision.
Along with the great opportunities to improve patients' lives, research new discoveries, and determine your own career path, wearing the white coat also means great responsibilities. These include:
1. Integrity and honesty: Put the concerns of patients ahead of personal concerns with regard to choice of treatment or your financial gain.
2. Life-long learning: Keep up with new developments in your chosen field of medicine in order to provide your patients the most current management available.
3. Listen to the patient: When interacting with patients, focus on them, listen carefully to what they say and answer their questions. Don't let how busy you are or the new computer record-keeping systems become a barrier between you and the patient.
4. Teaching: Become a teacher of fellow medical students, undergraduate students and, of course, your patients.
5. Teamwork: Remember that teamwork in medicine is essential and provides the most comprehensive care for patients. Your "teams" will include other physicians, nurses and nurse practitioners, physician assistants, technicians and all health care workers. Work collaboratively together.
6. Community service or medical volunteerism: Consider giving back to your community or other communities as they have given to you. For example, the state of Iowa provides financial support to the University for your education, and the patients you encounter here will graciously allow you to be involved in their care.
In all of this, remember: the patient is our primary focus and we must be cautious not to believe that we, as individual physicians, are the most important aspect of their care. Dr. Allan Berger once wrote, and I strongly believe, "We are but an instrument of healing and not its source."1
One last issue - we are witnessing a major debate on the future of health care in the United States, and I expect there will be some changes in the near future. While it is not true, as some have said, that "we have inferior care in the U.S.," it is true that it is the most expensive in the world and that it is not readily available to every American. Responsible interaction by all individual parties, including patients, physicians, lawmakers, health insurance companies and industry, will hopefully lead to workable solutions for us as physicians and our patients. The most important point, however, is that as American health care changes, the basic fundamental principles of why we wear the white coat and became physicians will not change - we are there to provide competent and compassionate care to our patients.
Now you are about to put on the white coat, signifying the beginning of your medical education and career. What then exactly is the White Coat Legacy? It is each and every one of you as an individual. You are the future of American Health Care. You are the next leg in the medicine relay. Your teachers are going to hand you the baton with great expectations. I encourage you to take up the challenges and meet them with great resolve and enthusiasm. You will never regret what you will gain here at the University of Iowa. We are very proud that you are here and wish you every success in your training and in your life as a physician.
1. Berger A. Arrogance among physicians. Acad Med 77:145-7, 2002.
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