Transcriber: Emma Gon Reviewer: Tanya Cushman
Medicine's future must preserve its noble past.
You see, the heart and soul of medicine
finds its expression
through the caring hands
of those whose privilege it is to look after others.
And as one who has the responsibility
to steward the education of those who'll become behind me in my profession,
it's important that we remember those principles.
Now, let me let you in on a little secret.
In second grade, I had a crush on my teacher.
(Laughter)
She announced to the class one day that she was going to get married.
And I was heartbroken.
(Laughter)
So I decided that I would do a little report,
a report to try to get her attention
and to let her know that I had a future as a physician.
(Laughter)
And here, in a Time magazine article
that appeared towards the end of my second grade,
there was a story about an arthritic hand
and how doctors were able to -
through a procedure where they released the constrictions -
able to put the hand back into a form where it was once again usable.
And my little book report -
I can still remember it in black paper with silver ink -
I turned in to my teacher, and said,
"You may be marrying this other guy, but I'm going to be a doctor."
(Laughter)
Many years later, during medical school,
I had the privilege for the first time to walk into the anatomy lab.
And there I met
my first, and among my best, teachers.
This woman had donated her body
so that my anatomy lab partners and I could learn the structures of the body,
the anatomical findings that you would have
to learn that there were 206 bones in the body.
And in that moment that I met our donor,
I can remember back to that report.
And I held her hand with the greatest of esteem.
And shortly thereafter, when we dissected the hand,
I remember hands intertwined with hands.
In fact, it was a bit difficult to discern which was the hand of our cadaver
because our hands are so alike.
Yet that profound moment
of recognizing a covenant that exists
between those who care for patients and the patients of the covenant
is that the hands of others will be in the hands of their caregivers.
And then there was the epiphany.
One day, those hands would be mine.
Fast forward to today.
There's great concern in our profession about the wave of data and information
that all clinicians must utilize in their care for patients.
There's concern
that artificial intelligence and technological developments
and new treatment modalities
will actually come, come between the caregivers and their patients -
make it more difficult to hold their hands.
Now, let's just think about this for a minute.
Think about the phone in your hand or the watch on your wrist
or the glasses on your eyes.
Today, those devices record what we eat.
By touching them, we can know what our pulse and our blood pressure is.
We can assess our blood sugar.
We can schedule and have an appointment,
and every now and then, we can make a phone call or check the time.
(Laughter)
And if you think that this can't happen to medicine,
just think for a moment about banks.
When was the last time you went to a bank?
But when you need money,
you can take your card, go to a machine, put it in,
and out will come your money.
Think about your airline number; most of you know your airline numbers.
Think about your hotel, your hotel loyalty numbers;
you know those as well.
It wasn't until just recently
that you could know your medical record number.
Now, let's think about it in the future.
When you utilize your phone - just that passive experience -
by holding it to your head,
we'll be able to know your temperature,
know your pulse, assess your blood pressure
and do so many other things that we can't even envision today,
and that information will go directly to your medical record.
Think for a moment about the daily experience in the bathroom.
By sitting down,
almost immediately, we'll be able to know the temperature of your body,
the weight,
the electrolyte makeup of your urine
and whether or not blood exists in your urine or your stool
and whether or not it's necessary for you to have a cystoscopy or a colonoscopy -
all before you flush.
(Laughter)
Now, this torrent of information is before us,
and in fact,
there is great concern now in our profession
about the amount of data
and how we can analyze it and utilize it to make things better for patients.
Think about another moment,
think about playing doctor.
I can remember when I played doctor the first time with my brothers.
I wore my father's white shirt,
I had a little plastic stethoscope,
a little hammer and a fake mirror.
And I held my brother's hand,
and I took my stethoscope and I put it on his heart,
and I gave him a good rap of the knee
with my hammer,
watched his reflex.
It wasn't too different than Rockwell
when he depicted the doctor
and had the doctor
actually using the stethoscope to listen to the little girl's dolly's heartbeat.
You know how children play doctor today?
They sit with their back to their little friend,
they hold a computer,
they say, "What brought you in today?"
And as the child talks, they start to type.
I can tell from the reaction that you've been there.
(Laughter)
In many instances, I've sat in on patient visits with their clinician,
and I wonder
about whether it is the patient or the computer that we're caring for.
In fact, we're trained to care for patients.
We're trained that the doctor-patient relationship
is what's most important to us.
But now, we focus on the doctor-computer relationship.
Now, think about it for the moment.
Who are the students in this picture?
To American medical schools today,
we admit humans,
and these humans will have the responsibility to care for others.
But it's a very complex time in medicine.
Are you aware that each day in America,
a doctor commits suicide?
Are you aware to the extent that clinician burnout
is causing us to lose a legion of professionals
on a monthly basis?
Are you aware that 40% of women,
six years after their training has concluded,
will reduce their practice hours
or leave the profession?
40%.
Now,
the data that we have,
the therapeutic possibilities that have been discovered,
the treatment regiments that we can utilize today -
these are outstanding.
The face of medicine has changed for the better.
But we must now think and return - think about and return to
the importance of the doctor-patient relationship.
Sir Henry Tate, in the late 1890s,
asked Sir Luke Fildes
to paint an idealized picture of the doctor-patient relationship.
Here is that painting.
You'll see a child outstretched on a chair.
The child is thought to be Sir Luke's one-year-old son
who had died a few years earlier from tuberculosis.
The doctor's name was Murray,
but the face depicted on the doctor in this painting
is thought to be that of Sir Luke himself.
Many people missed the background,
where the mother and father are anguished over the illness of their child.
All that existed was the caring relationship
between doctor and patient.
There is no computer.
Honestly, there's no medicine; there's no X-ray machine.
There's certainly no biologics,
because in those days there was nothing to treat tuberculosis,
which is why the child died.
But what there is,
is a caring relationship that exists between doctor and patient.
Now, as we look to the future
and all the wonderful things that are occurring in medicine,
it feels to me like it's important
that we bring together the caring relationship
with the new biologics, diagnostics
and technological regiments that exist.
It will only be through that humanistic approach
that we can once again revitalize our profession
and again bring to our patients
that caring relationship that they so desperately want.
Think about the humanism that exists
when a caregiver promotes their patient's human dignity.
Think about the humanism that exists
that when a patient faces fear,
their clinician will hold their hand.
Think about the final moments of a person's life,
when all therapeutic possibility has been exhausted,
when there are no more treatments to provide,
when all is left is time for caring.
Think about in those moments,
if those who care for us will take the time to hold our hand.
And when I talk with our students about their futures in medicine,
I reflect with them about the hands I've held throughout my career.
I remember holding the hand of a neonate:
my outstretched finger and their grasp of it.
But as I held that baby's hand,
what was as poignant
was that my arm was around the parents,
who were shaking
because the love of their life might not make it.
I can remember holding the hand of a young girl
whose outstretched hand on the soccer field
had been kicked by an opponent.
And a few hours later, as we sat in the emergency room,
while her cast was being applied,
she turned to me and said,
"Doc, what's this cast going to look like tomorrow night
when I'm in my prom dress?"
I remember holding the hand of an early-twenties young man
who had been involved in a motor vehicle accident,
in a car going at a high rate of speed,
and as I held his hand in the emergency room,
he said to me,
"Doc, I'm going to die, Doc.
Don't let me die, Doc."
And a few moments later,
I brought his parents in to say goodbye.
They held his hand for the final time.
I remember holding the hand of a patient
the first time I made a diagnosis of breast cancer,
the first time I made a diagnosis of HIV infection,
the first time I made a diagnosis of dementia.
And I remember caring for a titan of business,
a man who, in a million years,
would never have thought that at the end of his life,
I would be there to hold his hand.
But as I did,
I knew that I brought comfort to him at this incredible moment.
Now, I often wonder
when it might be that someone will hold my hand.
Will it be when a grandchild is sick?
Will it be when they hold the hand of one of my children or of my wife?
Perhaps if might be when they hold my hand.
I wonder if I'll remember
who it is that holds my hand.
Perhaps it will be when it's my hand at the anatomy table.
But in that moment,
I hope my caregiver will realize the privilege it is
to care for me.
And in so doing, recognize
that the future of medicine can be assured
if we preserve its noble past.
I want you to know it was a privilege for me
to have the opportunity to share these thoughts with you.
(Applause)