At more than 130 medical schools across the country 16,000 medical students this spring have received their diplomas, taken the Hippocratic Oath, and heard inspirational words from a commencement speaker.
No one tracks who speaks at medical school graduations so we made a few calls, sent some e-mails and rounded up excerpts from the best ones we found. Some are poignant and some are funny, but there is no denying the overarching message: healthcare and the practice of medicine are at a crossroads.
Atul Gawande, M.D., HMS professor and author of The Checklist Manifesto: How to Get Things Right
"We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn't choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting balance in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine's complexity has exceeded our individual capabilities as doctors.
"….No one person can work up a patient's back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don't even know what it means to "protocol" the MRI.
"The public's experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it's pit crews people need."
John Hopkins University School of Medicine
Henry Brem, M.D., Director of the Department of Neurosurgery at The Johns Hopkins Hospital
"…never neglect or deny your own family. You can focus on different aspects of your career but your family is a constant and will always need you and be with you. In your work choose activities that will have the highest impact. But realize that as important as your work is, your impact on your own family is irreplaceable and immeasurably important. No one can substitute for you, as a son or daughter, sister or brother, spouse, friend, or most critically as a parent.
"My best advice is to learn to be passionate about each of the roles that you are embarking on. My privilege in life has been to find that I am always pulling myself away from one passionate and exciting activity to another that needs to be done and that I love doing. The balance between these forces is dynamic; and it constantly needs to be reassessed and changed at different stages of your career."
Washington University School of Medicine
Matthew C. Spitzer, M.D., president of the board of directors for Médecins Sans Frontières/Doctors Without Borders USA
"Refuse what is unacceptable to our humanity; refuse what contradicts the physician's oath you will take today. Sooner rather than later, you will be asked if you will see a patient who doesn't have insurance and can't pay. Will you give the same time and dedicated care? Will you accept or will you push and break through the limits of where you are and what you do? See what is around you; choose to act and raise your voice. Refuse to accept that in this country the poor get worse care, many vets don't get adequate care for physical and mental trauma, and that the homeless are not brought inside the walls of the office. Determine what you do by what needs you see, what you are moved by, bring all of what you know to bear, and when you see that isn't enough, question what you know and demand something more."
Michigan State University College of Human Medicine
Ann C. Bonham, Ph.D., chief scientific officer for the Association of American Medical Colleges
"I come from a world of science – my passion is to improve health through discovery. My plea to you is to recognize your role and your social contract with patients by integrating research into your clinical care. Some of you may actively engage in designing medical research, others may participate – either in multi-site clinical research networks or in other ways – but all of you can advance medical care by embracing research as good for your patients and your practice."
University of Florida College of Medicine
Peter Small, M.D., an expert on tuberculosis and a senior program officer for the Bill & Melinda Gates Foundation
".. medicine is not only humbling because of the mass of information you are expected to know, medicine is humbling because of the way it will confront you with the really big questions you will never answer. As an intern in the San Francisco General Hospital Emergency Room, it was my responsibility during shock trauma codes to perform open chest cardiac massage - to put my gloved hand inside the chest of a patient and manually squeeze their heart in a desperate last ditch attempt to keep blood flowing to their brain. I'll never forget the day I did this for a man who happened to be about my age who had the simple bad luck to be struck by a bus. To hold the heart and feel the last beat of life of a man who, but for the grace of god, could have been me, has posed questions that humble me to this day.
Penn State College of Medicine
Elizabeth G. Nabel, M.D., president, Brigham and Women's/Faulkner Hospitals in Boston
"Therapies mean nothing unless a 60-year-old patient can play with his grandchildren or a six-year-old leukemia patient gets to play on her jungle gym. Keep people first. One size does not fit all when it comes to patient care."
University of Connecticut School of Medicine
Henry Lee, M.D., forensic scientist and endowed professor at the University of New Haven
"You might expect me to talk to you about who killed Jon Bennet Ramsey. Did Vincent Foster commit suicide? Was Lee Harvey Oswald the lone assassin of JFK or was it conspiracy? Or how did the jury reach the verdict in the OJ Simpson case? No, I am not; I am here to share with you some my life experiences and to give you some simple advice on how to be successful in life.
"Once you have your success, you should share you success with others, share your knowledge, your strength, and your passion with others. Just think about how many people in the future will come to you for comfort, healing, and hope. Just think about all those medical and scientific breakthroughs that will be uncovered by you. Because of you this world will be a much better place to live.
John A. Burns School of Medicine at the University of Hawaii
Darrell G. Kirch, M.D., president and CEO of the Association of American Medical Colleges
"Cling tenaciously to the bedrock professional values of compassion, integrity, and service that lie at the heart of the Hippocratic tradition. And please, find the courage to join your generation with mine in addressing this fundamental imbalance in our ethics by taking on the lack of fairness in our healthcare system. Despite all our knowledge and all our skills, we should make each other a promise today that we will never lose the sense of doing good and creating a better society that brought each of us to our careers in the first place."
Perelman School of Medicine at the University of Pennsylvania
Arthur H. Rubinstein, M.D., retiring dean of the Penn medical school and retiring executive vice president of the University of Pennsylvania Health System
"All of us in medicine, young and old, are facing rapid and enormous changes that can be difficult to handle. However, the major challenge, in my opinion, is mainly a generational issue. What is difficult and stressful for older generations may be much less so to the young degree recipients of today. For one thing, you may value autonomy less than those of us who went into solo or small-group practice in the 20th century.
"In our Perelman School of Medicine our recent classes have been organized into teams, which we believe will position our students to work in the changing, new healthcare system now under development. At the same time, our recent graduates place a higher value on a balanced lifestyle, with more time for their families. They are able to deal with the profusion of new knowledge because they are adept at evaluating it with the help of new information technologies. They are certainly more proficient at using newer electronic devices. To think that playing video games could help prepare a doctor to perform delicate robotic surgery!"
University of Southern California Keck School of Medicine
Drew Pinsky, M.D., host of the nationally syndicated radio show "Loveline" and assistant clinical professor of psychiatry at the Keck School
"This ceremony is one of the few degrees that once conferred changes who you are and what you can do and your relationship to the world forever. So, my esteemed colleagues to be, I welcome you to this profession."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
