The "welcome to medical school" lecture by the dean.

AStudent

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(Any of you who have seen "Patch Adams" can relate to this question)

Does this "fire and brimstone" speech really occur? Does it occur, but not as "in your face?" My medical school has a temp dean, do you think it will matter?
 

RAwe

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I really need to rent and rewatch that movie, its tough to be in a crowded room be able to cocentrate or even hear with family members yelling

Sorry AStudent this doesn't answer you're question but I needed to rant a little on that.
 

OSUdoc08

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AStudent said:
(Any of you who have seen "Patch Adams" can relate to this question)

Does this "fire and brimstone" speech really occur? Does it occur, but not as "in your face?" My medical school has a temp dean, do you think it will matter?
No. The dean didn't even lecture.
 

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I read a really great "Welcome to Med School" speech from the dean of Medical College of Georgia. I wish I could share it online but I can't find it. You can read it in a December 2004 issue of the "Southern Medical Journal". It's worth your time to read it, IMO.
 

Haybrant

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Pembleton said:
I read a really great "Welcome to Med School" speech from the dean of Medical College of Georgia. I wish I could share it online but I can't find it. You can read it in a December 2004 issue of the "Southern Medical Journal". It's worth your time to read it, IMO.

let us know if you find it; would be interesting
 

Pinkertinkle

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Agent Splat said:
If a med school had a dean like the drill sergeant in Full Metal Jacket, I think that would be the best "welcome to med school" lecture ever.
Haha, golfball through a garden hose!
 

Vomitonme

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I think this is the introduction you were talking about...

Fellow faculty, parents, guests, and young colleagues: I am greatly honored to have been invited to be the guest speaker on the occasion of your initiation into our special fraternity. In case it crossed your mind, our president has very properly vetoed any semblance of hazing for admission to this fraternity, and you will not be asked as part of the ceremony to swallow a live crawdad as sophomores have been lobbying for, spend the night on a slab in the gross anatomy lab, or sing Vesti la Giuba in karaoke, which the faculty thought would be entertaining.

At this ceremony, which is about coats, I am reminded of the Irishman who went up to the clerk in the Men’s Department at Macy’s in New York City looking to find a bargain in a suit. He said, “Show me the cheapest suit in the store,” and the fella said, “You’re wearing it.”

And, brothers and sisters, in a little while, you, too, will be wearing something, and it may not be made of the finest and most expensive fabric—it may be made of ordinary and inexpensive cotton, but it is functional and easy to clean and it symbolizes something of great value. I like to think of it as a garment, which, when donned in the right spirit, changes the person who wears it forever. An analogy would be like that of a piece of cloth cut in a rectangle. It’s just a piece of cloth. But when it is adorned with stars and stripes in red, white, and blue, it can never again be just a piece of cloth. Forevermore, it will be our National ensign—the American flag. Similarly, putting on the garment of a physician should be more than ceremony; it should change the very fiber of the young man or woman called to become a doctor. It is your decision, freely made, to take upon yourself the responsibility of the life and well-being of your fellow man. And, if this is not your motivation—if you are doing this to please your father or your mother—get out!

Many of you come from families rife with high achievers, and it has been expected from the childhood long lost in your subconscious that you, too, will become a successful professional. Your parents saw to it, often at great sacrifice to themselves, that you attended the finest schools in your area, and they demanded excellence from you. In some instances those demands were rather subtly expressed, such as disappointment in your grade of A-minus instead of an A. In others, more overt pressure was applied, and there were severe consequences for mediocrity or bad grades. In the healthiest of circumstances, your parents told you that they would be satisfied with any grade you made if they knew you had done your best. It is almost instinctive in us parents to want our children to succeed, and the love we have for you is indescribable. When you look into the eyes of your own children one day, you will experience what we mean. You are extensions of our very selves, and you are our badges of self worth. We can hardly help wanting you to shine above the rest because then we can shine above the rest, too. When you were kids it might have been in music or dance or in baseball, football, soccer, swimming, golf, or tennis. Your every triumph somehow made us feel superior to other parents and gave some of us that certain confident air and condescending tone. When our eyes were not riveted on you, we might benevolently grant an audience to parents of kids who were not stars, dropping them a few bones of disingenuous encouragement, faint praise, and advice. A few of us have even been quite vicious in our competitiveness by anyone’s standards, and, unintentionally, we may have passed that unfortunate trait on to you. In youth sports, you may have at first cringed when you heard us holler at the ref and then you learned to do it yourself. But it was all about you. As college got closer, we still cared about your sports and so on, but it was your grades in the high school AP courses and your score on the SAT that now mattered most. We were beside ourselves at your success in these areas, and we just couldn’t stop talking about you to our friends. While pretending to listen intently as they talked about their children, we heard not a word and were just waiting for an opening to start in again about you. College sports focused and sharpened that competitive energy and in some, brought out downright hostility. But after the tumult and the shouting and the beer, it was back to the books to put your competitive nature to a more useful purpose. Now it was your GPA or your score on the MCAT that for us filled awkward silences and small talk at cocktail parties. No matter how hard we try, where you are concerned, we just can’t “put a sock in it.” Please forgive us if we have been a little too enthusiastic in our promotion of you. Whether our motives have been reasonable or questionable, all we ever wanted is for you to be a success.

And succeed you did. Your real friends were happy for your academic triumphs. Your fair-weather friends were happy for you too, especially if their grade was slightly higher than yours, but they would never ask. Your acquaintances, however, were full of “friendly” inquiries like, “How’d ya do?”or “What’d ya get?” Their one and only concern was that they scored higher than you. Gore Vidal was pretty insightful, (wasn’t he?) when he said, “Every time a friend succeeds, I die a little.”

I’m reminded of the story about the two guys out in the middle of nowhere on a mountainous trail; they spot a hungry mountain lion running hard after them about a quarter of a mile off. After panicking at first and trying desperately to escape while the mountain lion is steadily gaining on them, one of them stops, sits down on a tree stump, and takes out a pair of running shoes from his backpack and puts them on. His buddy says, “What are you putting those shoes on for? You can’t outrun that mountain lion!” The other guy says, “I know, but I don’t have to outrun him. All I have to do is outrun you.”

And you all outran a lot of people to get to sit in that chair today. And you just got here, and you’re thinking that now you really need to turn it on because you need to outrun about 180 more to land that premier residency you may want three or four years from now. And after you get to Yale or the Mass General or to Stanford for your postgraduate training, you’ll be the best, won’t you? And think of the conversational mileage we parents will get out of your accomplishments at other cocktail parties or in that two-page family update we send to all our relatives and people we barely know along with our holiday greeting cards. And as for you, you will have been trained by some clinicians and scientists who have written 500 or more scientific articles and who have 20 or 30 groupies hanging on them at all the big meetings laughing at all their jokes and hoping for a sentence or even a glance directed their way. They’ll teach you and inspire you to be just like them because that’s what academic medicine is all about. Isn’t it? Admiration? Praise? Recognition?

Or if a career in a teaching institution isn’t your cup of tea, you’ll certainly feel you are more than prepared to enter private practice, and, with your hard-fought credentials, how can you miss being part of the best group practice in any city you choose? You should be able to write your own ticket and be able to pay back all those loans quickly and get your wife or husband out of the rat race they’ve been in putting you through all your training. With your competitive edge over the rest of them and hard-work ethic, you ought to easily be able get that house with the pool, pay the $35,000 initiation fee at the country club, get that silver Jag you’ve always wanted, and put a large down payment on your house at the beach or in the mountains. Furthermore, you’ll have your children perfectly timed and ready for you to live vicariously in them just like we did in you.

Have you noticed what the missing element in all this competitive success I’ve just described is? Yes, it’s the patient. It is the patient who has been left in your wake as you jet ski by.

In the academic medical center there really are some of us physicians (hopefully very few) who use medical knowledge about patients more to publish in esteemed periodicals primarily for self-aggrandizement. Most of the physicians in an academic medical center, whether faculty or house staff, are salaried. If one is salaried, it is only human nature to desire to be well paid while not having to work too hard. Such an attitude is common and usually pretty benign. However, this particular attitudinal tumor can become quite malignant and life-threatening. It can be diagnosed in one’s self easily. Later in your career, if you actually find yourself feeling that you don’t want to see a patient for any reason at any time unless you absolutely have to, you have the full-blown cancer. In other physicians, the symptoms and signs are less obvious. They may be short with you or with the nurses over the phone or critical of the care given to the patients by you or other physicians. They commonly want to transfer patients to other physicians. Translation: They really don’t want to be bothered. Expect the tumor to metastasize around the medical school hospital if doctors with a true calling to help sick people are few in number, inundated with more patients than they can carefully evaluate, or not in key supervisory positions. If those other brand of physicians and trainees become plentiful or gain a good foothold, medical emergencies, hospital admissions, or calls in the middle of the night become viewed as negative interruptions. A good day on-call to these physicians is Mexican food delivered to the hospital and getting to watch television while the beeper and phone remain silent.
 

Vomitonme

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An opposite but equally malignant state can occur in the private practice setting. Motivated by big mortgages on ostentatious houses and driven by a desire for fine clothing, fancy cars, and exotic vacations, some community physicians, again hopefully very few, are rationalizing and justifying expensive procedures on patients for very marginal indications—on insured patients, that is. Indigent patients without a pay source must have unequivocal evidence that a procedure is required and even then are tended to when the doctor gets time. Better still, that patient is transferred to the medical school hospital as “too complex to handle” in the community hospital. Other doctors without an expensive procedure they can charge for are seeing patients in an assembly-line fashion, running them through the turnstiles at warp speed, looking at their watches while their sick or depressed brothers and sisters are trying to explain what’s troubling them, doing cursory examinations, and then sending them out with a preprinted prescription for an antibiotic, a stomach acid blocker, a cholesterol-lowering agent, and an antidepressant. Don’t these patients understand? I’ve got a tee time at 12:45! And, by the way, payment is expected at the time of service and Medicaid has become so complicated that it can no longer be accepted.

These are obviously gross exaggerations and I can only speak with experience about the Medical College of Virginia and the University of Cincinnati where I trained, the military and community hospitals where I have worked, and my beloved Medical College of Georgia, where I have spent most of my 38 years in medicine. At each of these institutions and especially in ours here in Augusta, I have found vastly more of the genuinely dedicated men and women, young and old, with a true vocation to take care of the hurting, the sick, and the dying, than I have that occasional self-centered individual who may possess an MD degree but who will likely never become a doctor. I engage in negative hyperbole only to emphasize something in which I firmly believe: Medicine should be our own unique way of loving and serving the people with whom we share this planet. For some of us in this room, it will also be our way of serving God. The same can and should be said of all honest work. But in our profession, like none other, our fellow human beings may entrust us with intimate and personal details about themselves that they might share with no one else. They permit us to perform sometimes uncomfortable and embarrassing examinations or bravely submit to excruciatingly painful operations just so that we might find a way to help them. Rarely do they check our credentials because they believe in us, many with the faith of children. And that, my dear young colleagues, is a sacred trust for which we must be prepared.

My challenge for you today is to rethink all this. Just for a moment, see if you can feel the sleeves of that white jacket when you put it on as it clings to your arms or the collar as it touches the back of your neck. Let it be the symbol of a new you—a young doctor, a doctor-in-training to be sure, but a young doctor nonetheless—certainly not something called a “health care provider.” Let the donning of that coat be an epiphany for you, starting now. For the rest of your life, promise yourself to learn about the human body, but to learn for a purpose that is pure and good and true. Remain in awe about the body’s complexity, with every human cell a universe in itself. Allow your sense of awe to strengthen your faith if you have one or to at least make you wonder if you have none. Study not because someone’s admiration may depend on what you know, but because someone’s life may depend on it.

You already have many virtues. Be sure that humility is one of the virtues that you are especially known for. Recognize that your bright mind is not your own doing, but it is something that has been given to you. Even with all your intelligence, have the humility to admit that you cannot know it all. Use that humility to ask that “dumb question,” but maybe dramatically enhance your understanding of something important. Use it to say, “I don’t know” when you don’t and then have the curiosity to follow the “I don’t know” with “I’ll find out.” Have the humility to realize that you need the help of all of us who wear the white coat and we need you in return. Humility is not about being full of yourself; it’s about emptying yourself for others. Those physicians from the tuberculosis hospitals of the 19th century knew full well that they could likely die themselves of TB; for they knew it was contagious and had no cure, but, heroically, they kept tending to the sick anyway. So have all those brave doctors on countless battlefields and on-board ships in wartime. They emptied themselves. “Greater love than this no man hath; that he lay down his life for his friend.”

The knowledge of each of us in this room (though in some of us it is dissipating fast) casts a shadow, but our shadows don’t precisely overlap. Each of us has something to share. I implore you to share your knowledge by helping your classmates understand something you do—and rooting for them all. Humility is making Gore Vidal eat his words by changing them into “every time a friend succeeds, so do I.”

I’ve asked you to think about that white coat changing you. Now think for a moment what it means when your sick or hurting patient sees you in it. It changes him; for when you walk in the room in that coat, whether you deserve it or not, he sees a person with wisdom and vast knowledge, with compassion and hope and relief from his suffering and from his fear of the unknown. It’s quite a pedestal he has placed you on before you even introduce yourself. That is the legacy that the great physicians who have worn a white coat before you have led him to believe. It’s as if they’ve put that coat on you themselves. You cannot let your patient down. You cannot let those wonderful physicians in our fraternity who came before you down. You’ve got to live up to those great expectations.

Start with a friendly handshake and a kind word or two and then just listen. There’s an old adage that remains sage diagnostic advice today, “Listen to the patient; he is telling you the diagnosis.” You can’t listen if your mind is already made up or if you’re looking at the clock or if you are constantly in a rush. Then, examine your brother or sister with care and with sensitivity. Be sure you know what’s normal and when you are not sure, don’t gloss over it and call it normal like so many of us do. Get your physical diagnosis book out and look it up or ask for help. Read about your patient’s symptoms and findings if you need to and enjoy the challenge of figuring out exactly what’s wrong—kind of like Lieutenant Columbo. Once you’ve got the problem solved, choose the best treatment for your special patient. If you’re not sure what you are treating, stop treating it! Get some help. And if you seem to always be in a rush, ask yourself why and fix it.

There are those outside our hallowed halls, our hospital wards, and our examination rooms who look at medicine today as a business that can be made more profitable to themselves and their shareholders by slashing overhead and giving us android voices who answer the telephone and drag us and our patients through a maze of endless menus with minimal hope of talking to a human, let alone a doctor or a nurse. These tycoons or the federal “G-Men” want us seeing as many patients who can pay as rapidly as possible and seeing a minimum of patients who can’t pay. They expect us to justify in writing why we have prescribed certain expensive medications. They are skeptical about certain imaging studies we order and will not pay for a day in the hospital beyond what their black book says is the statistical average length of stay for a given diagnosis. If we are willing to hack our way through the thicket of their company’s telephone version of “Where’s Waldo” or visit their web site, that is, if we can remember our user ID and password (they are “kind enough” to e-mail our password back to us soon, if we’ve forgotten it) or fill out a confusing array of forms written in double-speak, they might condescend to permit us to care for patients as we see fit. They are very poor stewards of our time. I wonder—could it be on purpose? Are they simply trying to wear us down? These business executives only think they know medicine, and they see us in the white coats, not as allies, but as adversaries—as part of the liabilities of their ideal profit centers. In reality, some of them are lay people practicing medicine without a license on patients they’ve never seen. Ironically, when the tables are turned, and they or their loved ones are sick or hurting, they expect of us the most detailed histories, the most careful examinations, and the latest and best laboratory studies and x-rays that money can buy. Don Quixote de la Mancha was trying to joust with windmills that he imagined were monsters to save his beloved Dulcinea. In this case, our beloved profession is under assault by very real monsters, and those of us who understand what the white coat is all about must keep tilting at them whenever we get the chance.

I will leave you with an open letter to patients. Something like this, only maybe your own version, should be on proud display in your office one day:
 

Vomitonme

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My dear patients:
Thank you for the privilege of allowing me to participate in your care. I am deeply concerned for your well-being and want to relieve your suffering if I am able. To do that, I will try my best to ascertain the cause of your trouble. If the cause is not immediately obvious, I will ask you to carefully describe your discomfort until I am certain I understand what you mean. I may need to ask many other questions about you and your family to try to determine what might be wrong.

For minor problems, I may do only a limited examination. If I believe you do not truly need prescription medications, I will not prescribe them, especially when I am uncertain what is wrong. Only if I believe prescription medications will hasten your recovery or relieve your symptoms, will I prescribe them.

If I suspect a serious problem, I will do a detailed examination and spend whatever time with you that you need until it is safe to turn my attention elsewhere. Those of you who are waiting to see me, will simply have to wait, but most of you will understand that I would do the same for you. I can only hope that those who pay me for my time will also understand, but you, my brothers and sisters, come first. And if you become seriously ill, I will endeavor to be as certain about the cause as I am able, so that I may limit the medications to only those you truly need. When I am uncertain of your diagnosis, I will get help from colleagues who share my philosophy. If I cannot cure your disease, I will try my best to ease your suffering and to do you no harm. I believe that somehow our interaction was intended by God, sometimes for the positive influence I may have on you, but often for the positive influence you may have on me. For this reason, I am willing to participate in your care regardless of whether you share my views and regardless of how you got sick, your social standing, your race, your religious beliefs, or your ability to pay me or my employer. I am honored that you have chosen me to try to help you and I will try to be worthy of that confidence.

Sincerely,
Your devoted doctor of the Class of 2007
Fisher, John F. MD, FACP
------------------------------------------------------------------------

If the forums are still a little screwed up, I can post the pdf or .doc form of the text to download.
 

flash

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Wow...the most inspiring thing I have read in a long time.
 

Pembleton

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Nice job, Vomitonme!

That's the one.
 

MzzMisty

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Wow that was a great speech.. I am speechless.. BRAVO :D
 

erin682

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Oh wow, that makes me glad to go to mcg. That must have been at the white coat ceremony before mine. I need to copy that whole thing on to my computer and read it whenever I get frustrated with this whole process.
 

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Do I need to tell you all that the movie Patch Adams is a fantasy (although based on a real guy) that has absolutely no relation to the the reality of medical school?

I imagine that faculty, students, and even most patients would grow to cordially dislike anybody like the Patch Adams portrayed in the movie.

Just for an experiment, watch Patch Adams before you start first year and write down your impressions. Then watch it during the last two months of fourth year and compare your impressions.

The "Welcome to Medical School Lectures" exist but they are only meaningful because you will be so intimidated on the first day of medical school. Give the same lecture to a bunch of fourth years and they'll roll their eyes, not because they are cynical but because by then they have encountered patients who even Patch Adams would want to slap.

Like I always say, medical school is not a cult. You are not entering a sacred priesthood. It is not awe-inspiring. It is just a challenging and useful profession like a lot of other professions.
 

AF_PedsBoy

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I saw like ten minutes of Patch Adams when I was a third year and all I could think was, "what a tool."
 

dsblaha

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All we got was a lecture on how to use PubMed and some demographic information on our class.
 

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Agent Splat said:
If a med school had a dean like the drill sergeant in Full Metal Jacket, I think that would be the best "welcome to med school" lecture ever.
Go to Uniformed Services University. Most of the faculty are active duty military.