Lewis R. Goldfrank, MD
(June 12, 2019)
Congratulations on your graduation. This milestone and the commencement of your increased independence are a tribute to your fine work. Your future accomplishments will be substantial.
You as a class will have developed immensely profound bonds. Being a physician is a creative task. Stay undaunted, nurture inspiration in each other. Recognition of the importance of creating a quality healthcare team allows “’us” to succeed in rendering care to patients, ensuring our success as physician advocates and social activists. Each patient needs more analysis, attention and devotion than any of us can accomplish as individuals, no matter how hard we strive.
Fast vs. Slow medicine
You must always try to improve your understanding of your patients’ needs and the complexity of their problems. Your commitment to your patients can only achieve an improvement in health when you understand your patients. There are phases of your work when procrastination might be lethal for your patients, when fast medicine is essential. There are also phases of your work when rushing will limit your understanding, your creativity, and your devotion to your patients. Technology offers to speed our efforts and although it can be efficient for emergency physicians, it may not be effective and may even be counterproductive.
Attempting to accomplish a task is often done too quickly—which deprives you of wholly understanding the patient’s needs and limits your potential to achieve excellent care. It is under those circumstances that slow medicine is essential.
Remember: All the essential questions should be asked and all of the patient’s queries, addressed. As well, remind yourself each day that there are no inconsequential questions. When thought about in depth, questions or problems that seem inconsequential at first, often actually represent matters of great consequence.
Humanism and science
Your equal devotion to humanism and scientific rigor will be essential. Your skills, expertise and commitment should lead to research, innovation, and team development. To maintain your creativity and integrity you must recognize the unique importance of your role, while never distancing yourself from those aspects of your tasks that are often considered routine. Your patients’ lives will be in your hands each day. Your students’ careers will be in your hands each day. Your acts will heal, innovate and educate. Experiences with those patients whose lives you impact will stay with you not silent and still as photographs but as noisy, fraught, poignant videos—shared and replayed by your patients and coworkers.
Indeed, these experiences will create memories for many. Make sure that you have done the best you can do. Be a model of good leadership—independent of hierarchy and continuously demonstrating significant respect for all.
Teaching and mentoring
The simple approach to learning is that the more we learn, indeed the more we know BUT—the less certain we are and therefore the more we need to study. Make opportunities to share your immense knowledge and wisdom, as that will be very useful to others and will continue to expand the breadth and depth of your knowledge. Take your roles as mentors very seriously. You will learn as much from your mentees as I have from you. Some relationships will be transient, and others will continue development over a lifetime. Both types of experiences are immensely valuable and are often remembered as important and even foundational for your entire career.
You now understand the emergency department work environment. Each of you must find a reasonable approach to patients and peers that allows you to retain the humanistic values all must search for in medicine. Pessimism in medicine will become a self-inflicted wound, diminishing your vision, resilience and commitment. There is no place for pessimism or the faint hearted in emergency medicine.
Your skills are too great, your roles too important to allow an error, a criticism, or uncertainty to lessen your enthusiasm, your creativity or your integrity and belief in humanity. A powerful debate continues among the historic optimists, the new optimists and the possibilists. Voltaire, as an optimist, could not have written “Candide” had he not believed that most people in the world were quite good. Bill Gates, as a new optimist, would say you need to be inspired by people and that you must proclaim discontent with the world and demand progress. Hans Rosling, a Swedish Physician/Statistician as a “possibilist,” might say that “he neither hopes without reason nor fears without reason” and acts to achieve that which is possible. Each of these important thinkers chose a divergent pathway to advance societal good through humanism. I believe that your patient care experiences and your patients’ stories will preserve your love of medicine.
Our nation is a theoretical champion of individual rights, which have only been achieved by sacrificing the principle of a common good. That sacrifice is unacceptable. I believe that you have the curiosity and wisdom to meet the great challenges of our society. I believe that you—now with your skills and training—have the obligation to use your knowledge, your positions of power and privilege, your capacity to understand and empathize and your strong voices to protect those abused because of race, religion, gender—or their otherness.
You now must speak up and speak out against the injustices and inequalities inherent in our communities, here and elsewhere. You must speak out against xenophobia, isolationism and the fear of destruction by others. Your task is complicated and enriched by caring for a large number of people with extreme heterogeneity of cultures, social determinants and health needs making the achievement of excellence remarkably valuable, and often seeming just out of reach. Your task is to do what is right, which is often, neither the convenient, nor the profitable. Your roles will be those of big vision physician activists who will be intelligent, courageous physician advocates and leaders. Your task for the foreseeable future will be to achieve healthcare rights for all.
You have been privileged to study at the bedside of many, you have been exposed to innumerable problems and now you must choose to correct the problems and to search for or create the essential solutions. My experience here at New York University and Bellevue Hospital in New York City has shown me that nothing is impossible. One often thinks of these problems as the intractable social determinants, but you have been at work every day with faculty who have successfully devoted their careers to addressing social determinants previously considered insoluble. Certainly, this approach has personal risks—you will recognize, however, that if your patients are suffering injustices, and you timidly do nothing, or not enough, your suffering will be greater.
Setting out/stepping forth now, you surely have many goals, but the energy that allows you to achieve a goal or dream—usually leads to satisfaction—often not elation—because by the time success arrives you will already be preparing for the next dream or project. The destination we physicians have in emergency medicine is uncertain. It is often determined by a series of patients, a family or one memorable individual human being.
The almost infinite variety of human experiences which we have in common with our patients forces us to delve into and analyze all of medicine, anthropology, ethics, public policy, population health and much more. It is these patients and our experiences in the service of their needs, our research and ongoing learning that sustains us and offers us an antidote to burnout.
We are truly doctors without borders. You will have unlimited opportunities to express your immense potentials. Enjoy the experience! Recognize the opportunity! You and I and our profession will be judged by the progress we make in addressing the needs of those who have been neglected, discriminated against, or abused—the uninsured, the undocumented, and many more.
It is unconscionable that healthcare in America is considered a privilege. It must be our goal to achieve equity for all in healthcare. We must meet the health needs of every single person. Universal health care is fundamental, if our values are to be realized. In the future people will ask: Where were you and what did you do when the homeless, the opioid users, the uninsured and the newest immigrants were neglected?
Your first response should be—I was trained and worked at Bellevue Hospital.
We count on you to make remarkable contributions to address these issues as the future leaders of medicine.
Congratulations—your advocacy and activism will be essential.