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COLLEGE OF MEDICINE DEAN DR. JOHN FOGARTY REMARKS
WHITE COAT CEREMONY, CLASS OF 2012
FRIDAY, AUGUST 15, 2008, 6:00 P.M.
OGLESBY UNION BALLROOMS
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Dr. John Fogarty |
Thank you - it is a great honor to address the Class of 2012 on
this, YOUR day, acknowledging this significant transition in your
professional life as you get ready to incorporate clinical care into
your training. The white coat, along with the stethoscope, is one of
the most recognizable symbols of medicine. You should wear it with
great pride. It is interesting to note that physicians first adopted
it at a time of great cynicism about medicine and its craft and
practices, many people associating doctors with quackery and
charlatans. Physicians needed to ally themselves with science, so
they took on the frock of the laboratory scientists. So we today
will hopefully symbolize the best of the blend of science and
clinical care.
The color white is also significant since it symbolizes hope and
health in contrast to the old hospitals where only the very poor
went for care and conditions were not conducive to recovery.
But I wonder why I am the one who was asked to address you today
since I hardly ever wear a white coat and had to purchase one for
this day. And what do I have to say to you as you sit excited about
your future as you are at your most enthusiastic and idealistic
stage of your career. Over the years, many physicians --
particularly psychiatrists, pediatricians, and family physicians --
have given up the white coat, perhaps thinking that as a symbol of
authority, it might create a barrier for effective patient care.
My hope today is that you will take on the best of the symbolism
of the white coat and be the kind of physicians we all aspire to be.
I come from a military career steeped in oaths and traditions, a
wearing of uniforms and symbols of status and hierarchy. I wore a
uniform for over 28 years (perhaps that's why I hardly ever wore a
white coat). I have attended or participated in countless change of
command ceremonies, promotion, awards and decorations programs, and
Army school graduations and retirements. Each is a reflection of
traditions of service and passages to new stages of careers.
Your excitement today reminds me of the pride and excitement I
would see in the soldiers at Fort Benning (the home of the Infantry
not too far from here) as they completed basic training. The
trainees had been tested to new levels of physical, emotional, and
mental fitness; some of them had to dig down and find reserves of
strength and commitment that they did not know they had. I know many
of you have been tested and challenged this first semester. Many of
you questioned whether you had what it took to be a doctor. The
basic training graduation signified entry from the basic trainee to
a real soldier. As you put on the white coat, this ceremony
signifies your passage to the essence of doctoring -- which is
caring for patients.
The art and history of medicine provides an interesting view into
the essence of being a doctor and how medicine has changed in the
last 100 years. One of the most enduring works of art is 'The
Doctor" by Sir Lewis Fields, showing the caring doctor at the
bedside of an ill child, concerned but helpless.
There was little to offer the child and family other than
compassion and watchful waiting to see if the crisis would pass and
the child recover, or not and the child would die. There are equally
compelling pictures of Sir William Osler, considered by many to be
the epitome of the modern teaching physician, on bedside rounds with
his students in the early part of the 20th century, engaged in the
discovery of the elusive diagnosis. Neither of these physicians had
the antibiotics, diagnostic tools, or heroic procedures we have
today; some would even say that they were equally ineffective in
their cure of their patients. But if Osler were alive today, the
trait he would most likely wish to see endure in all physicians in
the 21st Century would be compassion. As he said it so well, “It is
more important to know what patient has the disease than what
disease the patient has.”
I am very excited to be here at the FSU College of Medicine
because this is a special and unique place – your mission “to
develop exemplary physicians who practice patient-centered health
care, discover and advance knowledge, and who are responsive to
community needs” attracted me to this opportunity. Many schools,
including the one I just left, have redesigned their curriculums in
the past 10 years. Most have had as one of their guiding principles
to be “patient focused.” This medical school was founded on and has
as one of its cores, that principle. Much of your teaching -- in
lectures, small groups or self-study -- focuses on the diagnosis of
disease or maintenance of health around the care of patients and
patient and family case studies. But what does it mean to be
“Patient focused?”
I believe it requires:
- The capacity to listen and communicate;
- A comprehensive focus on prevention;
- Consideration of health and illness of individuals in the
context of their families, cultures, and their communities;
- Understanding of individual professional and societal values
and how they affect clinical decision making;
- An awareness of and ability to analyze ethical issues in the
context of the patient’s illness and values.
Starting a new medical school allowed your faculty to design from
the ground up a curriculum that was comprehensive, integrated, and
patient focused. Integrating the basic and clinical sciences by
focusing on the patient and systems rather than specialties or
disciplines places the emphasis directly on why most of you are here
– to take care of patients.
Because of the explosion in medical knowledge and technology in
the past 50 years, many students have become more disease focused to
survive, rather than patient focused. Perhaps we are here today to
make an effort to avoid that. Lewis Thomas expressed his concern
about the widening gap between the doctor and the patient when he
said: “Medicine is no longer about the laying on of the hands, it is
more like reading the signals from machines.” And “if I were a
medical student today, I would be apprehensive that my real job,
caring for sick people, might soon be taken away, leaving me a
different occupation, looking after machines.”
These are not new ideas. At ceremonies such as this, we recall
the words of the ages to remind us of the values, guiding
principles, and tenets of our profession. The white coat reminds
physicians of their professional duties, as prescribed by
Hippocrates, “to lead their lives and practice their art in
uprightness and honor.” Maimonides in the 12th Century said: “May I
never see in a patient anything but a fellow creature in pain. May I
never consider him a vessel of disease.” Unfortunately today, we
know that pain is inadequately managed even in our best hospitals
and there are far too many errors in this complex world of medicine
that you are entering which leads to suffering, prolonged hospital
stays, and loss of life.
Mark Twain was suspicious of doctors – once when he was awarded
an honorary degree he said, “I am glad to be among my own kind
tonight. I once was a sharpshooter, but now I practice a much higher
and equally as deadly a profession.”
Today, in many ways, we have a disease cure system, not a health
care system – a recent survey of average citizens suggested that
most believed that physicians do not care about their patients as
much as they used to and are too interested in making money. What do
they see in the doctors who care for them that make them feel this
way?
The special profession you are entering is a wonderful mosaic of
stories, people, and experiences of the human existence. As you
learned in your medical interviewing course, you will do well if you
just remember one thing: Listen!
Osler said, “Listening, not imitation, is the sincerest form of
flattery, it is unspoken caring” and advised “Look wise, say nothing
and grunt. Speech was given to conceal thought.”
Epictetus said, “We have two ears and one mouth and should use
them in that proportion.”
As you listen, you will have the kind of wonderful experiences
that I have had in the past 30 years in sharing the thoughts, fears,
joys and ills of your patients, to understand them in the context of
their families, and their illness. I would like to share just a few
with you.
The young - the child during a routine office visit who brings me
a picture she did in class for me --for her doctor -- and hopes I
display it on my office wall.
The old - The 93 year old retired MC General who called me after
he was discharged from the hospital with a complicated pneumonia,
thanking me for not giving up on him and pushing him to recover.
The sick - the older gentleman knowing he was dying from bladder
cancer who bought his wife a puppy so she would have a companion
after he died. A special friend who I actually lit his cigarette for
him in his final days.
The well - the middle aged woman scheduled for a routine health
maintenance exam who really did not want to go into all that but
just wanted to discuss and get advice on how to train for a
marathon.
The fearful - the 50 year old man returning to the office after a
5 vessel coronary bypass operation. I had seen him for the first
time a month before and we were beginning to address his risk
factors and lifestyle when he had his heart attack. Needless to say,
he was scared and shaken by his experience. He remembers little of
his hospitalization, but does remember my visit to the ICU after the
operation.
The joyful - the Christmas cards I still get with pictures of the
children I helped deliver.
The newborn - helping a young family deal with an unexpected
congenital defect after a normal delivery.
The dying - all of the patients who have taught me so much about
the gift of life and their faith in dying.
What are the attitudes and skills that I would recommend that you
develop as you go forward?
- Be a doctor – listen, care, and communicate with your
patients.
- Talk to your patient in the way that best fits for them –
all patients are not alike.
They have unique cultures, fears, and needs. It is up to the
doctor to adapt to the patient not the other way around.
- Be accessible, be available, and give the patient the time
they need.\
- Know your science and your limitations. Compassion without
competence is mistaken kindness. Be a lifelong learner and learn
with your patients and from your patients.
- Care for yourselves and your families – enjoy the journey
and don’t always focus on the destination. As a group of people
who pay homage daily to the concept of delayed gratification, it
is critical for you to enjoy the trip along the way. The station
is only a dream – it outdistances us constantly.
As Francis Peabody in his famous essay “The Care of the Patient,”
delivered at Harvard Medical School in 1926 said, “the essence of
the practice of medicine is that it is an intensely personal matter…
the treatment of a disease may be entirely impersonal, the care of a
patient must be completely personal.” He noted that the most common
criticism by older physicians of young graduates was that they had
been taught a great deal about the mechanisms of disease but very
little about the practice of medicine, or that they were “too
scientific” and did not know how to care for patients. His essay and
a commentary was republished in JAMA in 1984 and his words are just
as true today as they were in the 1920s when he spoke them. “The
secret of the care of the patient is in caring for the patient.”
If you simply remember that in medicine, the goal is, “To cure
sometimes, to relieve often, to comfort always,” you will do well.
I congratulate you on your passage to clinical experiences and
wish you well in your journey.
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