MD Program

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    Reflections on Becoming a Physician

    Presentation at the
    White Coat Ceremony
    University of Iowa
    Roy J. and Lucille A. Carver College of Medicine

    Friday August 20, 2010

    by
    Jennifer R. Niebyl, M.D.
    Professor, Department of Obstetrics and Gynecology 

    Welcome to the University of Iowa Roy J. and Lucille A. Carver College of Medicine.  It is an honor to be invited to address you today.  Welcome to you and your families to the University of Iowa.  Let me tell you a little about it.  It was founded in 1847 and was the first public university in the nation to admit men and women on an equal basis.  The University of Iowa Writers Workshop is world renowned with its staff and graduates winning 17 Pulitzer prizes.  In the mid fifties Professor Lindquist of the College of Education created the ACT test.  The College of Pharmacy faculty invented the world's first buffered aspirin.  In 2008 the U.N. Educational, Scientific, and Cultural organization designated Iowa City as the U.S. First City of Literature.  Last but not least, the University of Iowa Carver College of Medicine is nationally highly recognized.  University of Iowa Hospitals and Clinics opened with 50 beds in 1898, and now has 680 beds.  It is ranked very high nationally in U.S. News & World Report.   Ten specialties are ranked in the top 50 out of 5,000 hospitals, 267 physicians are in the Best Doctors in America database, and the nurses have received Magnet designation for excellence in nursing.  UI Children's Hospital is ranked in the nation's top 25 Children's Hospitals.  We are proud that you talented individuals have chosen to come here, as I did when I moved here 22 years ago (to be chair of obstetrics and gynecology).

    I look at this class and realize that 43% are women.  My class was 5% women.  It wasn't until 1972, five years after I finished medical school, that Title IX was passed ending discrimination against women in education.  Now 75% of residents in obstetrics and gynecology are women.   Your class is also geographically well represented from 21 states across the country from Florida and New York to California.

    Student physicians, you have a wonderful adventure ahead of you, as well as great responsibilities.  You will need to learn to balance your personal and professional lives.  You will work hard, but if you love your work as I have loved mine, it will not seem like work.  You will have the thrill of hearing patients say "you changed my life."  In my case it was by caring for a high risk pregnancy when others have told the patient she should not be pregnant or by helping an infertile couple get pregnant.

    You will need to take breaks and spend time with your family.  It is important to take care of yourself, to be able to take care of others properly.  You also need to seek mentors to help you through the myriad of experiences you will have.  All of us on the faculty are happy to talk with students, as are our residents.

    You will be part of a large group of healthcare providers including nurses, dieticians, physical therapists, and pharmacists.  The white coat does not give you permission to set yourself above anyone else, but you must be a team player with all of these people. 

    From Warren Buffet:  "You need these three qualities:  integrity, intelligence, and energy.  But, if you do not have the first, the other two will kill you."  Integrity is extremely important.

    You will learn a lot of facts in medical school, but you will need to become a life  long learner, as many things will change as you practice.  You will need to consult the medical literature frequently and teach yourself, to stay on the cutting edge.

    For many years we did Pap smears every year and we know that that has prevented many cases of cervical cancer.  Now we know the frequency of screening can be decreased to every three years in healthy women over age 30 who have had three consecutive negative Pap smears.  It is difficult to change our practice habits, even while saving some health care costs, and it is also hard to educate patients that the frequency of Pap smears can be safely decreased.  However, physicians who do not keep up with new guidelines are not practicing state-of-the-art medicine.

    Five years ago the University of Iowa lost a world renowned space scientist, Professor James Van Allen, after whom the Van Allen space belts are named.  He continued to go to work every day until his late 80's and was quoted as saying he still had much to learn and people were still asking him questions.  What a wonderful example of life long learning and teaching!

    As an obstetrician-gynecologist I want to talk to you about reproduction.  Have your children while you are young!  It is biologically easier, you are more likely to succeed in having a pregnancy, and you have a lower risk of a Cesarean section.  I am not saying during medical school or necessarily during residency, but don't wait until age 40 to start trying.  There is never a convenient time during your career.  An amazing number of otherwise well-educated people do not know how much a woman's fertility decreases in her thirties, especially after age 35.  Of course, we can help you with assisted reproductive technology and donor eggs, but it is very sad for couples when these technologies fail, and adoption is difficult.

    Let me address you also about child care.  This applies to all of you, as increasingly men are family caregivers.  My mother was ill after my sister and I were born and my father had to hire a nanny to help take care of us, and she stayed for seven years.  I still see my nanny to this day and we recently celebrated her 90th birthday.  What did I learn from her?  She let me do things that my mother wouldn't let me do, like make a mess cooking in the kitchen.  I learned that it was okay to have children cared for by people other than their parents and that has helped me with the guilt of being a working mother and working long hours as a physician.  You need a care giver and a back up plan with your spouse and family.  So, hire help!  My husband once said to me that, " just because you don't want to do something doesn't mean I want to do it." 

    After I had a child as a second year resident, I felt that my own nanny was a part of my extended family.  She was an experienced mother and taught me how to deal with children, which made all of our lives easier.

    Why did I choose obstetrics and gynecology?  My mother had five pregnancy losses, including two stillbirths in her 20's, and was told never to get pregnant again by her doctor.  Then she moved to Montreal and heard of obstetric research at McGill University where they were doing urine tests in pregnant women of pregnanediol, the metabolite of the pregnancy hormone progesterone, to prevent stillbirths.  My father carried the urine specimens up the hill, in the snow to the hospital every day.  When the level fell, my mother was called in to be delivered five weeks early.  So, I am a product of a research project in obstetrics.  (We have better tests now, by the way.)   You will all have different interests and different mentors, but some personal experiences may also help you choose your area of specialty.

    I will conclude with part of the poem "If" by Rudyard Kipling, written in 1895 for his son, but still motivational today for both men and women.      

    "If you can keep your head when all about you
    Are losing theirs and blaming it on you,
    If you can trust yourself when all men doubt you
    But make allowance for their doubting too,
    If you can wait and not be tired by waiting,
    Or being lied about, don't deal in lies,
    Or being hated, don't give way to hating,
    And yet don't look too good, nor talk too wise:

    If you can dream--and not make dreams your master,
    If you can think--and not make thoughts your aim;
    If you can meet with Triumph and Disaster
    And treat those two impostors just the same;

    If you can talk with crowds and keep your virtue,
    Or walk with kings-nor lose the common touch,
    If neither foes nor loving friends can hurt you;
    If all men count with you, but none too much,
    If you can fill the unforgiving minute
    With sixty seconds' worth of distance run,
    Yours is the Earth and everything that's in it,
    And-which is more-you'll be a Man, my son!"

    Now you will be donning the white coat with its legacy for you to become extraordinarily well-trained, culturally sensitive, clinically expert, and scientifically inquisitive young men and women.  You are the future of health care.

    I very much look forward to meeting all of you in the classroom and on labor and delivery, when you do your clinical rotations.  I wish you all the best.

    Thank you very much.