From time to time, I'm asked to give commencement addresses. They're usually mercifully short, like this one. If you are graduating from medical school or from a residency/fellowship program, I offer you the same thoughts.
William H. Reid, M.D., M.P.H.
What a great occasion! To the graduates: Congratulations! This is the last rant you'll be forced to hear from me. Of course, you can volunteer to listen when we meet in the future, but you don't have to.
And for those who aren't graduating tonight, this is not my last rant: Live with it.
To your families. Be very proud of what you've done to bring these physicians to this day.
To your teachers. These graduates will remember you forever. They thank you. And I thank you for giving them to the world.
Now, I want to talk with each of you in private. Pay no attention to the people around you for the next 8 or 10 minutes. Listen to me, as I simply remind you of what your own heart is saying to you tonight.
Practice Well. You've heard that before. Make it your mantra. "Practicing well" refers to individual patient care and to being an advocate for patients and their families. Occasionally, it refers to social or even political action. Most of the time, though, it means paying attention to patient needs and putting them first. The oath of Hippocrates or Geneva that you took when you finished medical school said that. Our medical ethics say that. State licensing rules say that. And I say that. You decide which of those strikes the most fear in your heart.
Of course, I hope your heart, the heart of a physician, doesn't rely on fear, but fervently wants to do the right thing.
You Can't Shed the Mantle of Physician. You signed up to be a doctor, and you're stuck with it. It's a huge part of your identity. You don't stop being a doctor when you leave the clinic, or when you're on vacation, or when you're doing other things that seem far from the practice of medicine. This great privilege comes with the minor burden of having to behave accordingly.
It's sort of like being the Pope, but you aren't the Pope, so don't let it go to your head. Humility is a virtue.
Don't Ally Yourself with Any Group or Health Care System That Doesn't Put Patients First. You're a doctor. Take that very seriously. When other people are talking about insurance, or resource priorities, or time constraints, you may be the only thing standing between your patient and bad care, You may be the only person in the room who is obligated by oath, ethic, and often law to put the patient first. You write the orders, and though you may work within a team -- and you should be leading that team -- you, not the team or the hospital or the insurance company or the HMO, are held responsible for your orders.
I know we live in the real world, with real limitations, but always take the side of your patient when it comes to clinical need.
Don't Let Anyone Tell You That You Don't Have the "Power" to Stand Up for What Is Right for Patients. No one has more power than a physician who is acting on behalf of his or her patients. That's the way society wants it to be. I'm distressed that many physicians, especially in the public sector, believe they hold little power within their clinical settings, and think they have to compromise what they know is right simply because someone else wants them to. Do not allow yourself to be threatened, overtly or subtly, with some kind of institutional disapproval when you are practicing well.
Once again, you're the doctor. No one else can write the orders, approve admission and discharge, and say "yes" or "no" to most clinical aspects of care.
You're Not Doing This Alone. You have colleagues in your community, and all over the world, who stand willing to help you. You are part of an enormous, international "club" of physicians, and you are a full member, the equal of all others. Use us for personal and professional consultation. Let us help when you're worried about a patient. Let us help when you want a bit of professional advice. Let us help when you want to advocate for good care. And let us help with personal matters when we can.
Take Care of Your Family. The people who depend upon you most closely, every day and into the future; the people for whom you make the biggest difference in the long run, are your family. Your children are the people who will carry your influence farthest, into their adult lives and into their own children. Take care of them; give them your time, and show them your model, your values, and your love.
Finally, Enjoy Your Career and Your Life. I want you to like medical practice, however you decide to pursue it. I want you to enjoy it for a very long time. I don't want your enthusiasm to burn out in mid-career. I don't want you to be sidelined because of some impairment, especially one that can be prevented by taking good care of yourself. I don't want you to be lost to the patients and families who need you, including your own family.
When you grow old, I want you to experience what Erik Erikson called a successful Eighth Stage of development, "Ego integrity" -- a deep sense of fulfillment that you did your best and, looking back, you're pleased with your life.
WHR, Austin, May, 2008