Seek to Become, Not to Acquire

Posted on | August 21, 2008 | Comments Off on Seek to Become, Not to Acquire

Today’s doctors need to do more than just ‘walk the walk’. They must look and speak as professionals to gain patient trust.

Every year a new group of college graduates assemble in medical school auditoriums across the United States to begin their four year metamorphoses. A short “White Coat Ceremony” serves as a transitional introduction for excited parents and apprehensive students alike to hear from faculty and deans about what the next steps toward becoming a physician will entail. These young adults walk in as fresh ’savants’ only to be humbled by the collective brain trust of their fellow first year colleagues. Like sports, medical school is the next level of intellectual competition for these graduates – the big leagues – where the competitor can ‘size’ himself or herself up against some of the brightest students in the country.

The thirst for new knowledge wells up inside each medical school novice knowing that they have a clean slate to achieve perfection during this next iteration of training. In an attempt to negotiate 30 hours per semester of science and medicine courses, however, these new students can experience high levels of stress, frustration, depression and self-doubt.

After two rigorous years of scientific lectures seasoned with clinical sessions examining ‘professional patients’, these third-year students start their clinical rotations. They sample six the core medical specialties to develop their styles and skills for converting their amassed medical knowledge into the clinical care of patients.

At the very heart of these interactions lies the mystical “doctor-patient” relationship. It’s supposed to be a human bond beyond the perfunctory “client-merchant” interchange. Patients often entrust their deepest secrets to learned professionals whom they barely know. They must feel confident that these intensely personal facts will abet in effective treatments for their maladies. Patients, however, must feel a sense of trust that the physician will compassionately deal with the intimate information to their benefit. Thus, young physicians not only need to learn how to ‘walk the walk’ but, more importantly, how to ‘talk the talk’ and even ‘look the look’. This package of ‘walk-talk-look’ is the embodiment of professionalism, a topic, now being emphasized throughout U.S. medical schools. Medical students are beginning to realize that it’s not just how to say something to a patient but how you look when you say it, and how to follow through with what you promised.

In a recent study of 400 outpatients, photos of physicians in different styles of dress were shown.¹ The subjects were asked which doctors they would trust more when sharing sensitive personal information or discussing difficult issues. This group’s demographics were representative of the general population (age 52, men 54%, white 58%, some college 43%).

The group clearly selected professional clothing with a white coat (76%) or scrubs (10%) regardless of the doctor’s gender. Not surprisingly, business dress (9%) and casual dress (5%) ranked the lowest – the former being too slick looking and the latter being too ‘laid back’. Clearly, looking the look matters.

I was invited to deliver the keynote lecture for the University at Buffalo’s White Coat Ceremony this August and took the opportunity to instill the concept of professionalism at the very outset of their training – with parents present. In my mind, we dress for our patients and our colleagues who refer to us, not for our own inner sense of comfort.

The following paragraphs are a text of my comments which I believe could benefit twenty-year medical professionals as much as the new medical school recruits:

White Coat Ceremony Speech

30 years ago, I was sitting in the auditorium at Downstate Medical School and my soon-to-be anatomy professor said,

“Welcome to Downstate Medical School. Statistically you represent the top 2% of your college’s graduating classes. Over the next four years, we will determine who are in the top 2% and who are in the bottom 2% of this elite group.”

This declaration is the essence of what your future endeavors will be throughout this next phase of your education. Medical school educators also have an awesome and serious obligation to you. They will challenge your capacity to learn about, and to diagnose disease processes. You will measure your progress by your test scores, how well your answers are received on clinical rounds, and by how well your fellow students answer their questions. These assessments will drive you to become the very best physician you can be.

Only your parents could have raised you to be the high achieving and responsible women and men that you are, sitting here on the first day of your medical career. Similarly, only the UB faculty can change you from bright graduate students into the future doctors that will lead medicine to its next paradigm.

And so goes your next four years of education.

Well, it’s not that simple, so let me give to you an unofficial survival guide for successful completion of medical school and proper selection of your medical specialty.

The UB scientists and physicians will challenge your capacity to understand complex medical systems and your ability to treat patients emergently, by exposing you to the core elements necessary to become a well-rounded physician.

First, you will learn the ‘science’ of medicine. These are the thousands of facts essential for you to make critical diagnoses and life-saving treatments.

Second, you will learn the ‘practice’ of medicine. This phase will teach you how to apply your fresh medical knowledge for the betterment of your patient’s care.

Third, you will learn the ‘art’ of medicine. This phase is difficult in that it uses your innate senses of compassion and service to ease human suffering, while always caring for those you treat. It involves effective communication and empathy, especially when delivering bad news to those who anxiously wait for hopeful news of a return to normal life.

Finally, you will eventually learn the ‘intuition’ of medicine. This stage comes after years of practicing your specialty. It is the sense that you feel when all the scans and lab values are normal but your gut tells you that something is still wrong with this patient.

I recently attended a medical symposium where Dr. Charles Denham, CEO of the Texas Medical Institute of Technology, discussed the characteristics of a successful professional personality.² He proposed that our intrinsic core values are like the ‘genetic code’ for our professional behavior in hospitals and clinics. The common traits and values most often cited by respected corporate leaders for fostering successful hospital work environments are described as follows. I believe every physician should endeavor to incorporate these characteristics into their daily interactions if they wish to have a successful medical career.

First, Humility is the defining personality trait. It’s the ability to share your glory with others and to be self-effacing. As David Packard, Hewlett Packard founder and former CEO, once said,

“You shouldn’t gloat about anything you’ve done; you ought to keep going and find something better to do.”

Courage is the ability to take a bullet for the team…or for your patient, if it’s the right thing to do.

Integrity is knowing what you stand behind, or stand for, when making tough medical and ethical decisions.

Passion is why you are sitting here today. If you don’t have this attribute after four years of medical school, you shouldn’t be caring for patients.

Inspiration is a quality of your personal style that will make others line up behind you because they believe in your passion for patient care.

Dedication is the selfless desire to improve the quality of your care, with each and every patient, so as to make it a little better for the next patient.

Compassion is understanding the needs of your patients and their caregivers. Your future skills must be to “To cure sometimes. To relieve often. To comfort and support always”.³Never juxtapose these qualities of your healing art.

Generosity is the giving of your time and resources freely when those, who are in need the most, require your gifts of caring and healing.

Discipline is the perseverance to deliver the kind of changes necessary to make the next iteration of health care accessible and affordable to all Americans.

Dedication to Continued Learning will require that you place a high priority on learning throughout your career. You owe it to your patients not to treat with stale medical knowledge.

Collaboration is the concept of ‘us’ and not ‘them’ or ‘me’. We are all part of a health care team that must work efficiently and effectively for our patients to get the very best care.

And finally, Competitiveness is actually a sense of self-awareness and self-management that will breed success in what you do. It is the ability to perceive, assess and manage one’s emotions and impulses. Don’t worry about the other guy… and don’t overpromise but underdeliver.

I would like to provide you with a few considerations… professional pearls, so to speak… as you embark on the first day of the rest of your professional life. It’s been my road map for traveling through a career that’s provided personal satisfaction and fulfilled my social obligation to help the most vulnerable.

1. Things are never as bad as they seem, nor as good as you believe. You will get through it.

2. “Seek to become, not to acquire” – Confucius said these words 2500 years ago and it still applies today.

3. Take responsibility for the care of your patient. Dr. Francis Moore, Surgeon-in-Chief Emeritus at The Brigham, stated it perfectly when he wrote;

“The fundamental act of medical care is ASSUMPTION OF RESPONSIBILTY …complete responsibility for the welfare of the patient.”⁴

4. Before deciding on a career, evaluate each medical specialty for its most mundane aspects. Because, when the excitement fades, you’re left with the routine tasks and they’re the drivers for a satisfying career.

5. Extrapolate and ask, “How will this specialty fit my future lifestyle choices in 20 years?

6. Make the mental commitment to lifelong learning. Medical practice changes on average every 5 years so don’t think that graduation day is the end of your studying.

7. Always think, “How will I leave my chosen specialty a little better than I found it?”

8. Try to support or engage in research and resident education – both are essential for your specialty to thrive.

9. Remember to keep an honorable professional image – look the look, talk the talk, walk the walk. Your patients deserve it.

10. Strive to say that, “After 25 years, this specialty has been rewarding and self-satisfying and I would recommend it to a medical student.”

I would like to end by quoting one of Buffalo’s favorite sons. Tim Russert penned a letter to his son, Luke, as he was about to go off to college and printed it in his first book, Big Russ and Me.⁵

He wrote “…along the way you’ll hit some hurdles and experience some setbacks. I will always be there for you…But remember, while you are always, always loved, you are never, never entitled. As Grandpa likes to say, “The world doesn’t owe you a favor.”

You do, however, owe this world something. To live a good and decent and meaningful life would be the ultimate affirmation of Grandpa’s lessons and values.

The wisest commencement speech I ever heard was all of fifteen words:

“The best exercise of the human heart is reaching down and picking someone else up”.”

You are all loved. Your parents’ sacrifice, dedication and support of your goals are a testimony to that love. Heed these words written by Tim Russert.
Seek to become the next Nobel Laureate, the next National Academy of Science inductee, the next medical school professor, or the next compassionate physician.

Remember, four years from today after you receive the title of “doctor” and are on your way to a new career, your alma mater, UB Medical School, will always be there for you, too.

Good luck in your studies and God bless America.

Delivered August 15, 2008
UB School of Medicine

To learn more, visit this blog site: http://www.hypnosmd.com/

References
1. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. S. Rehman, P. Nietert, D. Cope, A. Kilpatrick, The American Journal of Medicine, 2005 Nov; Volume 118, Issue 11, pp. 1279-1286

2. Values Genetics: Who are the Real Smartest Guys in the Room? C.R. Denham, Journal of Patient Safety, 2007 Dec; Volume 3, Number 4, pp. 214-226

3. Aphorism attributed to Edward Livingston Trudeau M.D. c.f. Cerletty, J.M., Journal of Palliative Medicine 3(4):483-485, 2000

4. A Miracle and a Privilege: Recounting a Half-Century of Surgical Advance. By Frances D. Moore, M.D. National Academy Press, 1995

5. Big Russ and Me: Father and Son–Lessons of Life. By Tim Russert Miramax, 2004