Combining Healing and Humanity

.And both can make you smile. If you don't believe me, just listen to these excerpts from actual medical records-as actually written by real doctors, and sent to me by the Health Care Financing Administration. One exasperated doctor noted, "The patient refused an autopsy." I'm a little concerned with this physician's attitude when he commented, "Discharge Status: Alive.but without permission." Finally, one wrote, "Coming from Philadelphia, the man has no children."

Well, I'm certainly glad that I've come to Philadelphia. Standing in this place that has resonated with the notes of countless great performances, I'm reminded of the legendary conductor of the Philadelphia Orchestra, Eugene Ormandy. Someone once wrote that Ormandy achieved greatness because he always "put the music first." Putting the music first is the trademark of any skilled musician-just as putting the patient first is the hallmark, and the benchmark, of doctors who are both good and great. Putting patients first is what you want.it's what we want.it's what patients want. This ordinary-yet extraordinary- notion lies at the crux of the "White Coat Ceremony," which PCOM held for the very first time this year.

Now it may seem as though I'm preaching to the choir. A patient-based approach is central to osteopathic medicine.it's the approach that helped Alison Leff become a 1999 semi-finalist for my "Secretary's Award for Innovations in Health Promotion and Disease." But for all of you who are graduating today-for all of you who are saying goodbye to your days on "City Avenue".and maybe your nights in Manayunk, the reality is not that simple. In many ways, it was a lot easier for Hippocrates to uphold his oath-to ensure that "the needs of the patient come first"-than it will be for any of you to uphold your osteopathic oath. True, he didn't have the marvels and miracles of modern medicine-but Hippocrates also never encountered the competing choices, the rapid changes and the unlimited challenges you'll face in our current health care system.for that matter, neither did Vesalius, Harvey, Koch, Salk, the brothers Mayo- or Doctor Still.

Just as every orchestra is comprised of four sections, I believe there are four paramount challenges that will test your resolve, your commitment, and your ability to put the needs of your patients first. They are the challenges of technology, interaction, quality, and the patients themselves. These challenges-which are especially important for primary care physicians-are not unfortunate developments-quite the contrary. But like all challenges, you can only meet them if you are fully prepared.

My first challenge is to master technology while mustering the human touch. Certainly, the defining feature of medicine today is the perpetual advance of technology. Long gone are the days when Dr. Quinn's medical bag contained little more than quinine and compassion. Your bag of tricks contains a growing medley of new devices, methods, skills, and practices that are opening new doors to treatment-and new windows to prevention. But unfortunately, today's medical advances can also dehumanize patients-as we come to regard our genes and bodies as microchips and computers to be decoded and debugged-and our personalities and emotions as chemical reactions to be stabilized and normalized. The more we learn about the elements of life-the harder it is to remember that you're treating a life.that it's not a disease that walked into your office-but a patient...and that, in the words of Dr. Still, the goal is "to find health."

This is essential for primary care physicians-who are the major link between patients and our world of high-tech medicine. I know that your osteopathic training has already taught you that-above all-modern medicine isn't just about curing-but about caring. But let me strongly caution you: As you wrestle each day with a crescendo of professional demands and personal obligations, it becomes all too easy to forget to listen to your patients and their health care concerns.to forget to see a patient as a whole person.to forget to be compassionate and concerned. In the words of T.S. Eliot, "Between intention and reality falls the shadow." That's why I hope you never forget that the central principle of the PCOM philosophy is that all physicians must combine healing with humanity.

While you're trying to balance modern medicine, with old-fashioned doctoring, you'll also have to meet my second challenge-the challenge of interaction. Traditionally, medicine was a highly individualist field. It was just a patient and a lone doctor. In 1900, for example, a young laborer was admitted to Pennsylvania Hospital-just a few blocks from here-with a seriously injured leg. Fifty-one days later, he was released-his leg set to heal-without a single test or X-ray-and with a one-page medical report. In all that time, all he saw were the physician assigned his case-and the few nurses assigned his ward.

Times have certainly changed. Today, that young man would be an out-patient. You-his doctor-would be dealing with entire networks of physicians, technicians, nurse specialists, therapists, health insurance executives-and the ever-present feds...that's me. Your interactions with them-how well you function as part of a team-would directly affect how well you serve your patient.

But if you did it with skill-then the health outcome would be better than a lone practitioner-than the doctor of 100 years ago-could ever accomplish. It's like the individual instruments of a symphony orchestra. When they all come together, they produce a sound-a quality-that's more glorious than simply the sum of the parts.

That brings me to my third challenge to putting the patient first. I'm sure you've all heard the old chestnut, "How do you get to Carnegie Hall-or the Academy of Music? Practice, practice, practice." In medicine today, the question: "What do patients want?" has only one answer-quality, quality, quality. They know that our health care system has no equal. They know that we have some of the finest doctors, medical schools, and science in the world. But they also know that it's not always the best for everyone, everywhere, every day.they know that this can't be as good as it gets.

Patients want to see a specialist whenever needed. They want to know all medical options. They want their medical records kept confidential. They want to go to an emergency room when necessary. That's why we're still fighting for a strong, enforceable Patient's Bill of Rights-a Bill of Rights that will ensure access, choice, privacy and recourse against shoddy care for everyone. It's what health care needs-and it's what patients want.

I predict this demand for quality-once we've agreed how to measure it- will fundamentally reshape American health care-and the very crux of the doctor-patient relationship. That leads to my fourth, and final, challenge: The change in the patients themselves. Years ago, an English doctor posted a sign in his waiting room that said, "To speed the process-please have all of your symptoms ready." Back then, patients came to doctors asking, "Please help me." Today, patients can be more like music critics on an opening night. They are not as automatically trusting, not as accepting, not as forgiving as they were when Norman Rockwell painted his famous scene of the kindly town doctor holding his stethoscope to the little girl's doll.

Patient's are more demanding, more vocal, more informed-they get second opinions on the internet. They are no longer willing to settle for less than the best-the best medicine, the best care, the best bedside manner.of course, they don't want to pay for it. They want a doctor with the skills of ER's Dr. Mark Green.the sensitivity of MASH's Dr. Hawkeye Pierce-and perhaps the looks of George Clooney or Jane Seymour thrown in for good measure. All of these are good things. We want patients to demand the best in medicine-to take an active role in their health care and their healing. But let me be clear: I know- because PCOM trains more primary care physicians than any other medical school in the country-that the majority of you will enter primary care. For most patients, you will be the first.longest.and most important interface with health care-so you will be the most affected by this change in patient attitude.

I won't deny that meeting this challenge-or any of my four challenges-will be difficult. But I've no doubt that I can count on each and every one of you.on your healing and humanity.and-most of all- on the tradition and training you've received at the Philadelphia College of Osteopathic Medicine-to ensure that the osteopathic oath you're about to take is never swept out of the halls of medicine.

At the opening of my speech, I said that this place resonates with the past notes of great music. It also seems to resonate with the future notes of great deeds-great deeds that will undoubtedly be accomplished by the Class of 2000 as you embark on your wondrous, joyous, miraculous, journeys as doctors. I can think of few other journeys that will allow you to experience so much of the world's magic, mystery and marvel. Along the way, you will be writing the personal and professional scores of your life. So follow your dreams. Cherish your families. Serve your communities. Laugh often. Love much. Live large.And remember: The work of medicine is like no other. Filled with joy. Occasionally touched by sorrow. And, I'm certain, in your skilled hands-forever noble. Godspeed.