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Lighting
the Fire of the Future
Randolph D. Smoak Jr., M.D.
President-elect, American Medical Association
In just a few minutes you’ll be graduates of the oldest medical school
in the South. And I think, one of the finest medical institutions
in America.
 Dr.
Smoak gives his commencement address to the MUSC graduating class of 2000.
Following graduation, I hope you’ll be students of your chosen discipline
forever.
I’ve been to top medical schools across the U.S. and around the world
—and I have to tell you—the education you have received here is absolutely
second to none.
I can’t improve on that learning this morning. But I do have
a role in helping you make that leap—from education to experience.
Experiences so exciting that anyone who hasn’t already known the privilege
of a lifetime in health care – might actually envy you them.
My aim today is to give you two things.
First—congratulations. Each and every one of you heartily deserves
it— as well as your families.
Please join me in giving these graduates a hand. . . .
Each and every one of you truly has my deep respect this morning.
You are here for this celebration today because you have persevered—through
the long days and nights of studying, through lectures, labs and exams.
And what you have achieved here in Charleston as a result—what you
have learned at MUSC—is not only going to shape your life and your career
in the years to come . . . .
It is going to change the lives of literally millions of patients for
the better as you go out and practice the skills you have learned here.
My second purpose this morning is a bit harder. It’s to give you food
for thought that will help you succeed in the world.
And I’m going to try to do that this morning. But nothing I can tell
you that will ever be as important as the actual work that you will do
in the months and the years ahead.
I’ve been around the globe on behalf of the medical profession.
In fact, I’m here this morning fresh off the plane from Geneva yesterday,
and the meeting of the World Health Organization.
In this country, I’ve lobbied on behalf of thousands of physicians
and their patients in various state capitols and in Washington—everything
from health system reform and patient protections to anti-tobacco efforts.
But I would be less than truthful if I didn’t tell you this—that nothing
I have done has ever been as rewarding as caring for my patients one-on-one.
Treating their ills and sharing their lives. The work I trained for
right here—at MUSC.
It’s been a long time since I sat in the seats you’re sitting in today.
 MUSC
graduates receive their diploma on Friday, May 19.
And I don’t have to tell you—in many ways, health care was different
then. Even this university was different. And I didn’t walk two miles in
the snow to school.
Here at MUSC in those days, the Administration Building and portico
behind me, and even the Basic Sciences Center, hadn’t yet been built.
In fact, only the Colleges of Medicine, Nursing and Pharmacy existed,
along with a basic program in the sciences.
But what was here—was the Horseshoe. Although even that was a little
different—the Horseshoe faced the other direction back then.
But this site still had the same important function on the third Friday
in May that it does today—to be a place where student achievements were
acknowledged.
And the place where MUSC graduates stepped out—into the future of health
care.
What is that future going to look like? What is ahead for you—as
physicians and nurses, pharmacists and dentists, medical and cytotechnologists
and researchers and administrators?
As pharmacists, you will become more and more a part of the medical
team.
Preventing medical error by checking prescriptions. Helping to monitor
the effects of therapy for chronic conditions like high blood pressure,
diabetes and asthma.
And using the Internet in your daily communications with doctors. In
the even shorter term, many are predicting that you will soon—perhaps within
five years—see paper prescriptions go the way of the old-time chemist,
as electronic prescribing becomes a reality.
As dentists, your world is filled with possibilities, too. You are
entering a marketplace where your older colleagues are retiring faster
than new dentists can take their place. There is enormous demand for your
presence—in South Carolina, across the nation—as well as in the Armed Forces.
At the same time, you’re going to be able to do so much more than your
predecessors.
Digital radiography. Lasers for removing decay and soft tissue lesions.
Conscious sedation, to help those who have been afraid to go to dentists
in the past.
Even more and more comprehensive third-party and Medicaid coverage
for your services.
All are going to mean that you will be able to help more people who
need you than ever before.
Not only filling cavities. But the full picture of oral health, from
periodontal health to better and better implant technologies for dental
reconstruction. Along with greater opportunities for post-graduate training
and to participate in dental research.
As nurses, your future is equally bright. The demand for your
services, too, is already great—and only predicted to grow.
And unlike generations before you, you’ll be providing care not only
in the hospital and clinic setting, but will be expanding the marvelous
tradition of bedside nursing into highly technical work and patient care
management as well.
Critical care. Ambulatory care. Primary care. Different disciplines
and different settings. In home health, and schools, and worksites. And
in long-term care.
The kind of work you’ve been training to do right here at MUSC, in
primary care for the elderly, in hypertension and diabetes management,
nurse midwifery and pediatric care.
You couldn’t be better prepared for the opportunities ahead than you
are as a graduate of MUSC nursing.
And as graduates of the College of Health Professions—you have unlimited
new opportunities as well.
A marketplace clamoring for your skills as administrators, as therapists,
in clinical laboratories and as so many other essential members of the
health care team.
Your horizons are vast as you work hand in hand with your colleagues
to shape the health care system of tomorrow.
And even with all of this—what I can conceive and predict for each
of you today—physicians, nurses, dentists and health professions—is only
the tip of the iceberg in terms of what you’ll really achieve.
When you’re sitting where I’m sitting someday, you’re going to be amazed
at all you’ve done.
In the past two generations, I’ve seen health care professionals take
what they have learned and push back the horizons.
From today’s new pharmaceuticals that achieve wonders we once only
dreamed of—in treating depression, high blood pressure, asthma—even controlling
the advance of HIV.
To unlocking the secrets of the human genome. We can now count the
days until we truly know what’s inside the DNA helix.
And as a surgeon, especially, I’ve seen advances we would never have
thought possible. Transplants. Heart catheterization.
MRIs, PET scans and harmonic ultrasound mean we often don’t even have
to make an incision any more to see a patient’s vital organs.
While minimally-invasive surgery has literally changed the course of
recovery as we know it.
Once, gall-bladder surgery meant six to eight weeks of recovery time.
Yet just a few weeks ago, one of the surgical nurses I work with had
an emergency gall bladder operation.
She was back on the surgical rotation with us—just a few days later.
Medicine and all of health care have come so far in the past 30 to
40 years. And the future you will practice in promises even greater advances
in technology, in the information revolution and the globalization of medicine.
For you in your careers, as it has been in my practice, technology
is going to be the greatest gift. And many of you will be there to test
and to use and develop it.
Growth in telemedicine, allowing you to reach rural areas from large
medical centers. Or even your home.
New—and smaller—surgical tools and techniques. New ways of bonding
and filling and restoring the teeth without the amalgams of the past.
And new medications, certainly, that will require us all to keep learning.
But along with all of this—fantastic scientific advances—that will
require us to continue to examine and adhere to our standards of ethics.
Research into stem cells and cloning. Greater advances in transplantation,
an area that just now is truly beginning to come into its own.
In today’s quality and cost-conscious climate—you’re also going to
need to do the outcomes research to evaluate those novel and exciting treatments
– and to justify their costs and benefits.
You’ll need to know how to counsel patients who are receiving genetic
information for the first time—how to protect them from discrimination
for insurance coverage and guide them to early treatment options.
Including a whole new set of treatment options that don’t even exist
today.
All fantastically exciting new arenas.
At the same time, you’re going to be in the very heart of the information
revolution. Your patients, thanks to the Internet, are going to know more
about potential treatments than ever before.
And this is going to create whole new opportunities in your relationships
with them. You’ll be counseling them as informed users of the health care
system.
While those patients on the other side of the digital divide—and there
still will be many of them—will need your counsel and your guidance even
more.
Because the leading causes of death in this country have changed today.
It’s not just heart disease or cancer anymore. But tobacco. Obesity. Alcohol
abuse. Infectious diseases. Toxins. Firearms. Drug abuse. Things that you
can help prevent.
You’ll be working with patients to educate them. To inspire them
to work for their good health just as hard as you will.
And—more and more as professionals, you’ll be working together.
Health care in the 21st Century is going to be work that is done by
teams of professionals.
Americans are getting older. In fact, unless you’re a pediatrician,
you’ll spend half of your time in your professional lives treating patients
over age 65.
And they will need you to coordinate care for chronic or multiple conditions.
But even outside the context of research and large academic centers—you’re
going to find that you’re sharing the load with each other.
So much so—that many of you will find yourselves working not only in
multi-specialty practices. But multi-disciplinary ones.
And as you do, you’ll be bringing good health to Americans in ways
we never have before. Options for patient care that will only exist the
day your practices start the trend.
And finally, of course, there’s the globalization of medicine.
In the past few years, physicians around the world have begun to work together
like never before toward international standards of practice, such as in
the World Medical Association’s Declaration of Helsinki, an endeavor I
was proud to be a part of, which sets guidelines for clinical trials.
Towards internationally-understood codings for disease and the procedures
to treat it.
And a vast, international exchange of medical information that is growing
and will just continue to do so in the months and years and decades to
come.
These aren’t my predictions. They’re what the futurists and the experts
are saying.
And knowing what they do now, I would give a great deal to be back
in those seats where you are today—starting my career all over again in
these wondrous, exciting, fast-paced times filled with possibilities.
I hope you’re as excited today as I am for you. You have chosen one
of the finest, most interesting and rewarding work in the world.
Outside of my wife and my four daughters—and their husbands and children—my
career in medicine has been the greatest thing I could ever have imagined
doing with my life.
Every single day has been an adventure. And—it still is.
Now, it’s your turn. You are the Class of 2000. With all the right
to shape and mold the future that that title portends. And the whole world
of health care is waiting to meet you.
So in this Horseshoe today, I wish for you good fortune. Good fortune
for the future that will never run out.
This place gave me good fortune that has taken me around the world,
and into worlds of human healing we only dreamed of when I first studied
here.
And, most fortunate of all, it has provided me with a lifetime of working
with and caring for patients, which are the real reason we’ve all chosen
our professions in the first place.
But more than good fortune today—I wish you for you the sense of pride
in the professions you have chosen. The same pride that I feel for you
this morning, along with everyone else on this dais, and all of your friends
and family sitting with you in this bright Carolina sunshine.
The same honor I have always felt in being a physician—and in knowing
that the work I do can actually be of great benefit to others.
And last but not least this morning—I wish you happiness. Satisfaction
in knowing that the work you have chosen will make a difference in people’s
lives.
And that you will always keep learning and growing, and every ending
will lead to a new beginning—as you keep solving the mysteries and making
the miracles of our medical future.
That’s what your MUSC experience has been all about.
You’ve got the knowledge and the opportunities for experience—go for
it!
William Butler Yeats once said that “Education is not the filling of
a pail—but the lighting of a fire.”
The torch is in your hands now. I can hardly wait to see how you’ll
shine.
Go out—seize this day and this time in your lives.
Light the fire of your future. And show us what you can do!
We’re so very proud of you. One and all.
Thank you for letting us share this moment. And congratulations—graduates!
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