MD Program

  • All You Need Is Love

    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 Meaning of Love

    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 physician.

    • First, you must love what you are doing, that is, you must have enthusiasm for medicine.
    • Second, you must love and care for your patients.
    • Third, love of your colleagues, you must respect and appreciate your fellow students and physicians.
    • Finally, but as important, you must have affection for and appreciation of your family-love of your truly loved ones.

    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.

    Love of What You Are Doing

    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 skilled physician.

    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 cherish.

    Love of Your Patients

    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 of care.

    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 you

    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.

    Love of Your Colleagues

    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 and love.

    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.

    Love of Your Family

    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
    It's easy
    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.