MD Program

  • The Healing Hand

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

    Friday August 19, 2011

    by
    Michael B. Cohen, M.D.
    Professor and Head, Department of Pathology

    “Medicine, that subdivision of the humanities.” -Thomas Mann

    I am delighted to be here today. It is truly an honor and a privilege to share some thoughts with you this afternoon. But the honor comes with the expectations of erudite, insightful, and humorous comments. So, let me lower your expectations--I may not have any of those.

    At the outset, let me also quickly dispel three important myths. First, contrary to the views of some of my physician colleagues, pathologists can be humanists. Second, perhaps contrary to administrators’ views (some of who are on this stage), department chairs are capable of compassion. And, last, New Yorkers can be respectful.

    That being said, I would like to sincerely congratulate you. My hat goes off to you for your hard work and what you have achieved! I share the pride of all of those who have gathered here today: your families and friends, as well as the broader UI community.

    I’m quite sure that I could not get into medical school now, so I’m lucky it happened more than 30 years ago. When you applied to medical school I suspect all of you stated, in some form, like I did, that you had an interest in science and a desire to help people. There are of course many ways of helping people but being a physician is a very special and important one. Helping people is about service, and to be overly obvious about it, it is about being a servant, a servant to your patients, to their families, and to their communities. So, to follow on the title of this address’s metaphor…you will get to touch people, both literally and figuratively. And in turn, your patients will touch you. Cherish this.

    This ceremony is, of course, symbolic. The Gold Foundation describes it as a psychological contract linking Scientific AND Humanistic patient care, similar to what you articulated during your application process to medical school. The physician-patient relationship is at the core and it should be readily apparent that you are beginning your apprenticeship in the caring and curing of people.

    This is also an auspicious experience. Think of Janus, the Roman god of transitions, who is typically represented with two faces—one looking to the past and the other looking to the future. I am not aware of any other profession, not in law, not in business, not in engineering, where the incoming are inducted into their chosen field, in your case the profession of medicine. There certainly was no such ceremony for me in 1978.

    The OED, the Oxford English Dictionary, defines the kind of humanism we are talking about today as a “sympathetic concern with human needs, interests, and welfare.” Surprisingly its first usage was in 1836, less than 200 years ago. Humanism is much about empathy (which is a vicarious experience of feeling of another) and, at times, about sympathy (which is sharing of the feelings of another). Empathy is also the basis of emotional intelligence, championed by Daniel Goleman in the business world and its literature. In fact, many believe, as I do, that emotional intelligence is a better predictor of success than intellectual intelligence, and this goes for department chairs at medical schools too. I suppose most of you think that this is all common sense. But I would caution you with the words of Voltaire: “common sense is not so common”. In reality, empathy, respect, compassion, etc. are best viewed as muscles. I would therefore urge you to develop these with regular, rigorous workouts.

    I presume all of you heard about Rep. Gabrielle Giffords. But what you might not know is how Dr. Randall Friese, the trauma surgeon in charge when Giffords arrived in the Tucson ER, treated her. He recounted that the most important thing he did was to hold her hand while he was giving orders. What a powerful message this is…holding her hand, reassuring her that she would be well cared for. This is precisely the type of humanism I expect from all of you. Another example of humanism comes from the book Cutting for Stone by Abraham Verghese, well known to this campus. He describes a senior surgeon who asks a trainee, “in an emergency, what is administered by ear?” He answers correctly, “words of comfort”. Be the doctor who will hold the person’s hand and listens.

    I am also asking you to treat the patient as a person. I am as guilty as any physician in thinking of the patient as the one with…pick your disease: the diabetic foot in the ER, the kid with Wilm’s tumor, the woman with lupus in RCP, the dementia patient. Be acutely aware of your own reactions. Heal the person not the disease. Too often physicians think in even worse scenarios where the person is not even a patient, she is a set of numbers, such as a patient in the ICU. Verghese, who I just mentioned, has talked about the iPatient. What a depressing concept. The permission a person grants you to let you do a Pap smear or a testicular exam is unique and special. Learn to do an excellent physical exam. Do not think just about the process or the outcome.

    I wish to inspire authentic humanism in you. An important piece of advice I can give you is to pick a role model, or role models. Which attending physician, which resident, which student would you select to care for a loved one? Perhaps more importantly then choosing a role model, is being that role model for others. In addition, I would urge you to revisit those experiences that were instrumental in your decision to pursue a career in medicine. Whatever or whoever feeds your spirit and keeps you from being cynical is important.

    You can’t be perfect but you can certainly strive for excellence. In my first semester of medical school I failed my mid-term in histology. To prepare for the final exam, a classmate in the same predicament, and I must have reviewed almost 800 slides with different tissues. I passed with high marks. As I look back, it’s bit ironic that as a pathologist I am now fundamentally a morphologist. The broader lesson is that to be a good doctor you will need to study hard and understand the scientific basis of medicine. But to be a great physician you will need to incorporate humanism into your practice.

    The role of the physician is critically important, but it is also very tenuous. As I slowly come to the end of these remarks let me confess that I’m actually feeling tired today. As some of you know, I had chemotherapy on Tuesday…for metastatic lung cancer. My cancer was incidentally diagnosed in 2006 when I went to our ER for chest pain, which in retrospect was likely due to an esophageal spasm. I had about an 85% chance of cure at that time but recurrence was diagnosed last October. A tenuous role…You will not just be physicians but also patients. How will you expect to be treated? Doesn’t the Golden Rule (treat others as one would like others to treat oneself) apply to all the people you will take care of? I can tell you from personal experience that even our great hospital is not in Lake Wobegon, where the entire medical staff is above average.

    Let me note that there is a bright future for all of you. There is no need to despair about the future of medicine. Yes, we are at the onset of a necessary series of changes in medicine… from only those with insurance to all, from generalized medicine to personalized medicine, and from medical care to health care. It was only about 100 years ago that seeing a physician was better than not seeing one. I believe we are at the cusp of another such revolution.

    Let me offer you two quotes from my role models. The first is by the physician and Nobel Laureate Albert Schweitzer:
    “The purpose of human life is to serve and to show compassion and the will to help others.”
    The second is from Francis Peabody, a physician who worked at Boston City Hospital:
    “One of the essential qualities of the clinician is an interest in humanity, for the secret of the care of the patient is in caring for the patient.”

    Medicine is a both science and an art. As you become healers and develop both sides of this same face, be mindful of the privilege and responsibility that has been entrusted to you to touch others.

    Thank you.

    Acknowledgements
    I am grateful for critical comments from my daughters Isabella and Rianna Cohen, and my friends Margaret LeMay-Lewis and Ginnie Woodard.

    References
    T Mann. The Magic Mountain. (Originally published in 1924)
    FW Peabody. The Care of the Patient. JAMA 1927; 88:877-882.
    A Schweitzer. On the Edge of the Primeval Forest. (Originally published in 1922)
    A Verghese. Cutting for Stone. New York: Knopf. 2009.
    Voltaire (François-Marie Arouet). Dictionnaire philosophique portatif. 1765.