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Wong outlines qualities for COM
students
Editor’s note: On Aug. 20, Jeffrey Wong,
M.D., associate dean for Medical Education, College of Medicine (COM)
presented a speech commemorating the annual White Coat Ceremony to COM
students, faculty and guests.
It is my pleasure and distinct honor to formally address and welcome
you as our newest group of colleagues. You, the class of 2010 have come
from a wide variety of backgrounds and interests from 44 different
colleges and universities. Some of you are science majors, some of you
are not. Some of you have very recently received your undergraduate
degree; others of you have already worked in another field. And all of
you are extremely bright, highly self-motivated and have enjoyed
tremendous success in your respective life-journeys thus far––for if
you had not, you would not be sitting here listening to my words.
The other similarity that you all share is your desire to become
physicians and I suspect that you all are excited, and your family and
loved ones very proud, of this wonderful opportunity being given to
you. I also suspect that many of you are a little apprehensive—a little
nervous, perhaps even a little scared—about what awaits you. Therefore,
I wish to spend the next several minutes providing you with some of my
perspectives of what this next step entails. Whether my words will
allay your fears or heighten your apprehensions still remains to be
seen.
What image comes to mind when you think of the word “physician?” Unless
you have a family member who is in the profession, it is likely that
your impression of who a physician is or what a physician does is a
compilation of your own experiences as a patient or a family member of
a patient, or perhaps even from the movies or TV. Some of those images
include:
The honest trustworthiness and remarkable availability of Marcus Welby;
The cavalier, wise-cracking rebelliousness but impeccable surgical
technique and poise under-fire of Hawkeye Pierce; The intuitiveness,
dedication, and healing ability despite little-to-no technology of Dr.
Quinn, Medicine Woman. And, in what might be construed as a total slap
to plastic surgeons everywhere, the hot-shot, up-and-coming superstar
“Doc Hollywood,” who “sees the light” and changes his career
goals forsaking an extremely competitive cosmetic surgery fellowship in
order to care for the people living in a rural Southern town. No, I
don’t believe that town was Charleston.
All of these physicians were dedicated to their profession in the way
the public wishes us to be. Smart, incredibly skilled, poised,
competent.
And that’s the first part. The academic school work. These are the
long, long hours of dedicated study that all await you (whether you’re
ready or not) starting just about 48 hours from now. The white coat,
shown here with an accompanying stethoscope, is an important symbol of
our profession. It tells the outside world that you are “student
physicians” and are devoting the next several years of your life to
learning and understanding the subjects of biomedical science. The
structure, the function, and the dysfunction of human systems—from the
necessary interactions between submicroscopic molecules of life all the
way up to the macro-systems of diverse populations and cultures—and
what opportunities you, as a physician have at your disposal to
intervene in, hopefully, a positive fashion. This is an area of study
so vast that no one can ever hope to learn it all. The good news is
that you’ll never be bored as the opportunities for learning will never
cease, and not all of it will be on the test. The somewhat sobering
news is that it is remarkably easy to get behind; once you do, it is
incredibly hard to catch-up, and in a relatively short period of time,
written tests and grades won’t really matter—your competence will
instead be tested with every single patient for whom you treat. Are you
scared yet?
These items you will receive today, your white coat and your
stethoscope, in addition to a pin provided by The Arnold P. Gold
Foundation, a public foundation dedicated to fostering humanism in
medicine, symbolize each student’s and physician’s commitment to
providing competent and compassionate patient care. And this is the
second part. Not only are you coming to medical school to enhance your
knowledge of disease and refine your diagnostic and therapeutic acumen,
you must also learn what it means, professionally, to be a physician.
Medicine is a career. Patients want a physician for whom medicine is
“not just a job,” but rather a passion, a calling, a reason for being.
An important reason why it must be a passion, a calling, or a reason
for being is the recognition that being a physician is not a “sometimes
thing.” It is a 24-hours-a-day, 7-days-a-week thing. What I mean by
this is not that you will never leave the hospital or have time off for
yourself or for your loved ones—don’t worry, you’ll still have
vacations! What I mean is that the demarcation between who you are
personally and what you do “at work,” perhaps more so than any other
profession, will become increasingly blurred. This is due I believe, to
the nature of our work—the extremely high level of confidential
intimacy and trust that our fellow human beings grant us during each
and every interaction, is so profound as to be unlike any other
profession. It follows accordingly that their expectations for ethical
and professional behavior are similarly extremely high. And those
expectations do not stop once the work day is over. Some of these new
“expectations” upon which all of your actions will soon be judged are
important aspects of medical professionalism that I will briefly
outline. In doing so, I refer back to Friday, at the GIFT program
orientation, where we spoke of respect.
As physicians, you will be granted a high level of respect initially
just by virtue of your title and degree. But as with most things,
ultimately, the respect a physician receives from others must be
earned. Additionally, a professional physician conducts all affairs in
a manner that is respectful of patients, of patients’ families, of
colleagues, of your teachers and your subsequent learners, of society
at large, and of the profession of medicine itself. Lastly, you must
also learn to know and to respect yourself—to accurately recognize
those things that you presently do well and those that you’re still
working on improving. The word respect might also serve as a mnemonic
for reminding us of other important aspects of professionalism to which
successful physicians aspire.
A physician aspires to develop equanimity – Webster’s dictionary
defines this term as “evenness of mind especially under stress.” Sir
William Osler, in his valedictory address entitled “Aequanimitas,” at
the University of Pennsylvania in 1889 noted, “In the first place, in
the physician or surgeon no quality takes rank with imperturbability,”
He goes on to note that “Imperturbability means coolness and presence
of mind under all circumstances, calmness amid storm, [and] clearness
of judgment in moments of grave peril.” Physicians are expected to be
leaders, and equanimity is crucial for success.
A professional physician demonstrates sincerity in thought, action,
word, and deed. An ethical standard in medicine involves truth-telling,
informed decision-making and full disclosure in communications between
physicians and their patients, as well as physicians and their
colleagues. The privileged stature that society bestows upon the
medical profession is contingent upon full and honest dealings by all
its members in all aspects of clinical care, research and academia.
Conflicts of interest must be avoided when at all possible and fully
acknowledged when they exist.
A professional physician practices perseverance. It is not necessary to
be really smart to succeed in medicine. However, it is extraordinarily
difficult to succeed without working hard. Not giving up when work
becomes challenging, not just settling for a diagnosis when some of the
history just doesn’t fit, not acquiescing to, but instead working to
improve a system of care that fails to meet your patient’’s needs—those
are some of the persevering traits that define professionalism.
A professional physician aspires to excellence. It is perhaps
unnecessary to say this to you as you all have enjoyed excellence all
of your lives thus far. However, there may come a time in your future
medical career, maybe even within the next year, when the going gets a
little tough, or the task is a little harder than you thought, or the
obstacles seem a bit too daunting––and you may be tempted to coast, or
not do your best, or do just enough to get by. Strive your hardest to
resist this temptation! If you’re not trying your best, you’re cheating
your patients and you’re cheating yourself. You wouldn’t want to send
your family member to a physician who just “scrapes by” ––and you
don’’t want to become one of those kinds of physicians yourself. Don’t
be satisfied with mediocrity.
A professional physician displays compassion. This compassion is
demonstrated through empathetic communication and through one’s
humanistic and altruistic actions —acting for the good of patients and
placing this good of patients over one’’s own self-interest. Francis
Peabody’s oft quoted line applies here, “. . . For the secret of the
care of the patient is in caring for the patient.” Osler, in the
aforementioned address Aequanimitas urges physicians to, “Cultivate,
then, such a judicious measure of obtuseness as will enable you to meet
the exigencies of practice with firmness and courage, without, at the
same time, hardening “thuman heart by which we live”.
And lastly, a professional physician inspires trust. This is not always
an easy thing for physicians to inspire. The medical knowledge that we
as physicians have and the subject matter with which we deal, places
patients in an extremely vulnerable and difficult situation—a situation
that could easily be exploited by a physician lacking in
professionalism.
It is a truly awesome responsibility, this trust that is given us. Dr.
Faith Fitzgerald, professor of medicine at the University of California
at Davis places the enormity of this responsibility in this context.
Imagine what a patients thinks when you prescribe a medication, a pill
or an elixir, a secret potion, a foreign chemical substance –– about
which you say, “I believe this medication will help to make you well
and I want you to take it. However, there is a chance for side effects
to occur, this drug might create new problems that don’t presently
exist, it might even kill you.” The patient says, “I’ll take the
medicine you prescribe, doctor, because I trust you.”
Or how about the patient, whom you believe requires an operation. You
say, “We wish to give you chemicals through a small sharp needle placed
in a vein in your arm. Then we plan to have you breathe a vapor that
will entirely “knock-you-out.” While you are sleeping, we’re going to
cut you open, take out part of your organ that is diseased, sew you
back up and, in order to wake you up, we will give you other chemicals
in your veins that will reverse the first chemicals that we gave you.
We believe that all this is safe, in fact, we don’t even think it will
cause you much pain, however, there is the potential for things to go
wrong, it might even kill you.” And, remarkably, the patient says,
“I’ll undergo the surgery, doctor, because I trust you.”
Or even more remarkable still, imagine parents bringing you a sick
child perhaps their only child, perhaps the most important,
irreplaceable thing in their lives. They come to you and willingly hand
over their son or daughter—to ply with medicine, to anesthetize and cut
open for surgery, or even to perform other treatments while the child
is fully awake—treatments that cause obvious pain and emotional
distress. They do it, doctor, because they trust you.
You all are on the threshold of an incredible life journey — one full
of excitement and hard work. Some of your past experiences may provide
you with insight into the socialization of your new profession but
personally incorporating the lessons of your medical school experience,
these seven items outlined by the word, respect is by far more
important. Just as the skyline over the Cooper River has been
irrevocably changed, so has the nature of your previous pre-medical-
school life. That which is expected of you now is much different than
what was the case previously.
There dawns a new beginning as you join this most distinguished and
noble of all professions. Please never forget the amazing privilege
bestowed upon you as a physician, in caring for another human being. Be
mindful of the incredible trust that is placed in you, and our
profession, and strive mightily to maintain it.
On behalf of those of us in the dean’s office, as well as the faculty
and staff of the medical school, I warmly welcome you all to the
Medical University of South Carolina.
Friday, June 23, 2006
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