Our President and CEO, Dr. Richard I. Levin, recently presented the keynote speech at the American Medical Student Association (AMSA) Convention & Exposition on February 23, 2017 in Washington, DC. He addressed premedical and medical students: “You are part of a 2400 year-old tradition of caring and it is one of the greatest things you could have chosen to do.”
Please see below for Dr. Levin’s full speech.
The Practice of Medicine in 2050. Back to the future.
I can’t tell you how honored I am to be here today. I’ve spent a good part of my life trying to understand how students and faculty thrive and so I humbly thank AMSA and Dr. Kelly Thibert for inviting me. Dr. Thibert, you are a true humanist and it is wonderful that you have been able to use your role at AMSA to not only guide future physicians but also to expand and share your own visions of humanism in healthcare.
Some of you know about the Gold Foundation. We’re almost 30 years old. We invented the White Coat Ceremony – which most of you participated in – and in a generation changed how academic medicine teaches about the critical, safe, delicate space between patient and doctor. I have a great job and one of its highest benefits, is being able to interact with medical students across the country. To be with so many of you today is a real privilege. You are part of a 2400 year-old tradition of caring and it is one of the greatest things you could have chosen to do.
You know, one of the problems for us tonight is my age. I’ve been doing this for over 45 years. [Graduation slide, describe] I’ve seen a few things. But just recently, I saw something completely unfamiliar. I saw a young woman, positioning her iPhone camera, her mouth wide open, as a dog face and tongue appeared on the screen. I watched as she did this several times, and then when satisfied, she snapped a photo. Yup, that was my introduction to Snap Chat filters. And it may have been more distressing than anything I ever witnessed in medicine.
I do not have a Snap Chat for you all to add me, but I’ll let AMSA know when I do. In the meantime, if you like, let’s continue this conversation on Twitter, or LinkedIn or email me.
What have I seen? Babies being born in good health; the chief pilot for Pan Am – the leading airline in the early 70s which no longer exists – admitted to Bellevue in cardiogenic shock and surviving because there was never a minute of his six-week hospitalization when there wasn’t a doctor or student sitting at his bedside; a cardiovascular surgery resident in her late 20s having a stroke because of an undetected malformation of her carotid, a young Afghani immigrant who flew to JFK and took a taxi directly to Bellevue because of the worst rheumatic heart disease most of us had ever seen, cared for without question, valves replaced again and again, transplanted after 30 years of traditional care, wonderful things, uplifting joyous things, [pause] and terrible things, arrogance replacing humility in a small fraction of our corps. This said best by a medical student writing in the e-journal Aeon.
Ilana Yurkiewicz “ He comes to the operating room late, greets no one, and berates the nurse for not setting up the step stools the way he likes. He tells the resident she doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the medical student when she reaches for the retractor to pull back skin for a clearer view. The operating room is tense for hours. ‘I need a different clamp,’ he says at one point, ‘this one is too dull.’ ‘I’m on it,’ says the scrub nurse. ‘You’re not,’ he retorts, ‘or else it would already be in my hand.’ All of us adorned in blue scrubs and surgical caps stand on edge, braced against the next wrathful outburst. ‘I want to see the tip of my blades,’ the resident explains, staring intently at the monitors where her laparoscopic instruments have not quite come into view. ‘Just cut,’ the lead surgeon barks at her. By the end of the operation, the intern’s hand shakes as he sutures the wounds closed, to the beat of the running condescending commentary on his halting speed and less-than-perfect stitches.
This type, this arrogant bully is not a style, we used to say “He’s a great surgeon but isn’t very nice to his patients.” In research just published in JAMA Surgery, investigators found that post surgery problems were 14% more common in patients whose surgeons were in the top quartile of filed complaints in the last two years, compared to those whose surgeons had little to no complaints.
My medical school experience, decades ago, would look as unfamiliar to you as Snap Chat did to me. When I started, Medicare and Medicaid had just been passed a few years prior and the profession was still adjusting to the new terms. Less than 10% of medical students were women. We didn’t have MRIs. Smallpox had had yet to be eradicated. Marcus Welby and MASH were the hit medical dramas of the time. We had nothing close to the Electronic Medical Record, but our notes were in the chart and they often told beautiful narratives.
So there are times when I wonder if my experiences, my wisdom, are even relevant at all to you.
And then, I think about Parker Palmer, a teacher, an educational philosopher, founder of the Center for Courage and Renewal and his words:
“Mentors and apprentices are partners in an ancient human dance, and one of teaching’s great rewards is the daily chance it gives us to get back on the dance floor. It is the dance of the spiraling generations, in which the old empower the young with their experience and the young empower the old with new life, reweaving the fabric of the human community as they both touch and turn. “
If there is something which the generations before yours can do, it is to demand that we have the time and the opportunity to have this dance.
So, you have the advantages of technology and modern scientific approaches that I never had as a student. But there are essential elements of medicine from decades and centuries ago that have been lost and it is up to you to give them new life.
There was a time, even before my time, when compassion was the only tool doctors had to heal. They sat at bedsides and listened. They made house calls and supported patients and their families. They didn’t come with drugs or a surgeon’s knife. They came with a gentle touch and an empathetic ear.
As a resident, I was free to go back after a shift and check on a patient. I could sit and talk with families. I had “midnight meals” with resident mentors where I could discuss a tricky case and learn from those above me.
But over the years, healthcare became more corporate and efficiency became the overriding concern. There was a lot less leeway given to extra time with patients. And, our excitement with scientific and technological discovery had the unintended consequence of turning our attention away from the patient. Let’s look at this for a moment.
According to researchers at John Hopkins and the University Maryland, the amount of time interns now spend face to face with patients is about 8 minutes per patient. And about half of their days are spent in front of a screen instead of with patients.
In fact, humanism has taken such a backseat in healthcare and our society in general, that the Dalai Lama has proclaimed “Compassion is the radicalism of our time.”
Imagine that — what was once all we had in medicine is now so lacking, but so necessary, that it is considered radical.
It’s your generation that needs to lead this radicalism, and push to keep healthcare human. As a group, you are no less compassionate than med students decades ago.
For how many of you, by show of hands, was caring, helping, making a difference the #1 reason you came to medicine?
That’s what I thought.
And it was for me too. And I’d like to pass on some of the best advice I ever got, from an unlikely mentor. We didn’t have a White Coat Ceremony back then to mark our entrance into the field of medicine. So when my rotations on the wards were about to start , I was told to visit the Bellevue seamstress. To get my white coat, I had to walk through a maze of drab green corridors to a coat room. The seamstress was the only person there. She looked up over her glasses and said “Hi doc, here for your coat?” She looked at me, quickly assessed my size and shape, grabbed a starched coat from a pile, and asked me to try it on. She said “Doc, you’re gonna see some things; some things, doc.” The coat fit, of course, I was probably the 10,000th student she had sized up.
We talked a bit – (slowly) I wanted to talk, and then, to usher me out, she said “Listen, you take care of our patients now, Doc. You do a good job, okay?” I promised her I would and left.
There’s no doubt, as you move through your career, you’re “gonna see some things.” In fact, you already have. But you will see more. Much more. And my advice to you today is that when you see it, allow yourself to feel it too. We have been taught to shut our feelings down, to not think too hard about the suffering we see, to remain clinically detached and emotionally isolated. In the face of human pain, it was thought to be emotionally economical to be a stoic. But your feelings are not trivial. It is those feelings, and the deep reflection on those feelings, that will make you a better, stronger, more resilient doctor.
“Take care of our patients,” my mentor, the seamstress said. Such a simple, obvious request. That’s what medicine is all about, right? It’s why you all raised your hand for why you chose the profession in the first place. But what does that really mean? As a new doctor, how do you really “take care”? You will probably be quick to apply all the scientifically-excellent methods you’ve learned –your clinical knowledge and skills — use Up to Date and the most modern of technology available to you in the quest for diagnosis and treatment. And there’s no doubt if you do that, you will succeed.
But medicine should be — must be — more than that. The human element — the connection between patient and physician — must not be lost in our race to cure more and do more in less time and with less interaction.
I hope you will be the physicians who understand that while you will be practicing, a high, precision, technology-based medicine, there can be immensely more value when technology is joined to compassion and empathy. As the Gold Foundation Research Institute has proven, by lowering the rates of readmission and litigation and increasing the rates of adherence and understanding through humanism you can save the country 30% of its impossible healthcare bill.
You can make big changes with simple solutions. One of the most exciting programs of the Gold Foundation is called Tell Me More. And it was started by med students, just like all of you, from the Icahn School of Medicine. They came up with the idea that if they could ask patients a few questions, and post the answers on the wall by their bed, that it would be a simple way for every person that enters to room from doctors, to nurses, to those who provide meals, to learn just a few personal things about the patient.
In doing so, the patient becomes more than just a disease — they are human beings.
So don’t underestimate what you can do, what changes you can make as students. You can, and must be the leaders who bring humanism back into medicine by organizing, by demanding not for us alone, but for your patients. It will be difficult to work within the requirements of today’s systems with limited time for communication and relationship building. But listening well to your patients is the start of great care. And who knows, maybe there’s a way that Snap Chat filters can be a game changer for doctor-patient interaction. That’s for you all to figure out.
The truth of the opportunity was recently described by the Director of the CDC under Obama, Tom Frieden. He said “It is not that the patient is always right. It’s not that the doctor is always right. It’s that it is always right to have a conversation, to listen. It’s always right to understand and have empathy.”
So I ask you today, as you go forward in your training and in your careers, take time to turn away from the screens, develop that incredible space between you and the patient – whether in the ER, cyberspace or your office – And… “You take care of our patients now, You do a good job, okay?”
Richard I Levin, MD, FACP, FACC, FAHA
President & CEO, The Arnold P Gold Foundation