SPEECH
BROWN UNIVERSITY MEDICAL SCHOOL
COMMENCEMENT
PROVIDENCE, RI

MAY 29, 1990

C. EVERETT KOOP, MD

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GREETINGS, ETC.
I AM DELIGHTED AND HONORED TO BE INVITED TO SHARE WITH
YOU THIS SPECIAL DAY, THE DAY YOU RECEIVE YOUR
DOCTORATE IN MEDICINE, THE DAY WHEN ....AT LONG

LAST... YOU GET TO BE CALLED "DOCTOR".

ICAN RECALL THAT FEELING AS THOUGH IT WERE ONLY
YESTERDAY--INSTEAD OF 49 YEARS AGO-- THE DAY PEOPLE FIRST
CALLED ME "DOCTOR KOOP". AND IT WAS ESPECIALLY FITTING
THAT THE FIRST PEOPLE WHO CALLED ME "DOCTOR KOOP" WERE

MY PARENTS AND MY WIFE.
MY HOPE FOR YOU IS THAT WHEN YOU ARE AT MY END OF YOUR
MEDICAL CAREER, YOUR MEMORIES WILL BE AS REWARDING AS

MINE.

AND LET THE PLACE OF HONOR IN YOUR MEMORY BE FILLED

WITH THE PEOPLE WHO HAVE MADE IT ALL POSSIBLE:

YOUR PARENTS... REMEMBER THEIR ENCOURAGEMENT AND
SACRIFICE, THEIR LOYALTY AND COMFORT...DON’T EVER FORGET

THEM.
YOUR SPOUSE, FIANCE, THAT ONE PERSON WHO HAS GIVEN YOU
STRENGTH THROUGH LOVE. THEIR KIND OF GIFT IS PRICELESS.

I KNOW. MY WIFE AND I WERE MARRIED JUST BEFORE THE
START OF MY SECOND YEAR IN MEDICAL SCHOOL, AT A TIME
WHEN IT WAS ALMOST FORBIDDEN TO BE MARRIED IN MEDICAL

SCHOOL.
AND DON’T FORGET YOUR CLASSMATES AND FRIENDS....THE
PEOPLE WHO SHARED WITH YOU THE SAME AGONIES AND
ECSTACIES, THE LONG DAYS AND LONGER NIGHTS, OF A

MEDICAL EDUCATION.

AND FINALLY, DON’T FORGET YOUR COUNTRY. THAT’S RIGHT,
YOUR COUNTRY. MANY OF YOU ARE HERE WITH SOME KIND OF
HELP --DIRECT, SUCH AS A FEDERAL STUDENT LOAN, OR
INDIRECT, SUCH AS SUPPORT FOR THIS SCHOOL AND ITS

FACULTIES’ INDIVIDUALRESEARCH EFFORTS.
BUT I’M NOT TALKING ABOUT MONEY ALONE. THE CITY OF
PROVIDENCE, THE STATE OF RHODE ISLAND, AND THE UNITED
STATES OF AMERICA ALL HAVE LAWS THAT HAVE MADE THIS
SCHOOL AND THE QUALITY OF ITS EDUCATION POSSIBLE. THIS
SUPPORT AND THESE LAWS ARE BASED UPON A FOUNDATION OF
GREAT IDEALS, IDEALS THAT YOU WILL TRANSLATE INTO
PROFESSIONAL PRACTICE, IDEALS ABOUT THE WAY TO ACT AND
THINKAS A PROFESSIONAL PERSON IN AMERICAN SOCIETY,
IDEALS THAT AFFIRM YOUR RIGHT TO QUESTION CONVENTIONAL
WISDOM, TO WORRY ABOUT HUMAN DIGNITY,TO STICK TO WHAT
YOU DEEM TO BE RIGHT, EVEN IN THE FACE OF MAJORITY
OPPOSITION, IDEALS THAT JOIN YOU TO YOUR PATIENTS AND TO
THE REST OF AMERICA, IDEALS THAT ARE VITAL TO MEDICINE

BECAUSE THEY TRANSCEND MEDICINE.
IT STILL SURPRISES ME WHEN STRANGERS SPEAK TO ME, BUT I
HAVE BECOME A RECOGNIZABLE FELLOW. WALKING ALONG THE
STREET IN WASHINGTON, IN THE NEW YORK SUBWAY. PEOPLE
COME UP TO ME:

"HI, DOC", OR "KEEP UP THE GOOD WORK!" OR,

"I KNOW YOU! YOU’RE THE ATTORNEY GENERAL. KEEP AFTER

THOSE TOBACCO COMPANIES."
IF MY PLANE IS DELAYED, I OFTEN END UP HOLDING OFFICE
HOURS IN THE AIRPORT WAITING AREA.

"YOU ARE THE ONE WHO FINALLY MADE ME STOP SMOKING!"

OR EVEN, "SAY, I HATE TO BOTHER YOU, BUT I’VE GOT THIS PAIN

IN MY ELBOW..."

ONCE - AFTER HEARING AD NAUSEAM ABOUT SAFE CIGARETTES
AND SAFE SEX - A MAN OFFERED TO CUT MEIN ON HIS

INVENTION FOR SAFE HAMBURGERS.
ON A NUMBER OF OCCASIONS I’VE BEEN RECOGNIZED BY A
STRANGER,

AND THEN PLEASED BY SOMEONE SAYING TO ME,

"I WANT TO THANK YOU FOR MAKING ME PROUD, ONCE AGAIN,

TO BE A DOCTOR."

I’M PLEASED, OF COURSE, BECAUSE I’°VE GIVEN MY LIFE TO THIS

PROFESSION, AND IT HAS BEEN GOOD TO ME.

But SRODEWED To SEwSsE ft WEEO

FoR ESTORATION (VY A Febe aw

PR YSICLA MW
IWAS ONCE CALLED A DOCTOR’S DOCTOR AND A SPECIALIST’S
SPECIALIST, BUT NOW I’D LIKETO SPEAK --LIKEAN OLD FAMILY
DOCTOR--DIRECTLY TO THE CLASS OF 1990, AND I INVITE THE
FRIENDS AND FAMILIES OF THE GRADUATES TO LISTEN IN ON
THE CONVERSATION I’M ABOUT TO HAVE WITH THESE YOUNG

DOCTORS.
THIS IS A SPECIAL DAY ... AND A MAGICAL DAY. RIGHT AT THIS

MOMENT, IT STILL FEELS LIKE THE LAST DAY OF YOUR MEDICAL |

SCHOOL EXPERIENCE.

10
BUT BEFORE MANY MORE TICKS OF THE CLOCK, THIS DAY WILL
ONCE AGAIN BE AN OPENING DAY ... THE FIRST DAY OF THE

NEXT STAGE IN YOUR VOCATION OF MEDICINE.

AND I USE THE TERM "VOCATION" ADVISEDLY, BECAUSE OF ITS
ROOT TERM OF "CALLING."

OURS IS A CALLING.

IT IS NOT A BUSINESS.

YOU COULD HAVE CHOSEN TO MAKE MONEY DOING OTHER

THINGS.

11
YOU --AND I-- CHOSE MEDICINE BECAUSE IT COMBINED A QUEST
FOR KNOWLEDGE WITH A WAY TO SERVE, TO SAVE LIVES, AND

TO ALLEVIATE SUFFERING.

THE MEDICAL WORLD INTO WHICH YOU GRADUATE IS VASTLY
FRoM
DIFFERENT G@@8 THE ONE I ENTERED A HALF-CENTURY AGO.

12
WHILE PREPARING FOR THIS OCCASION, I TRIED TO RECALL
THOSE DAYS WHEN I WAS IN MEDICAL SCHOOL. IT WAS BEFORE
THE AGE OF ANTIBIOTICS ARRIVED. IN FACT, IWAS ALREADY
PRACTICING MEDICINE WHEN PENICILLIN FIRST BECAME
AVAILABLE. |

AND THERE WASN’T MUCH OF IT.

FOR A WHILE, DURING WORLD WAR II, I HAD IN MY SMALL LAB
REFRIGERATOR THE ENTIRE PENCILLIN SUPPLY FOR ALL OF

PHILADELPHIA.

13
THINGS HAVE CHANGED. I VENTURE TO SAY THAT 90 PERCENT
OF WHAT YOU HAVE LEARNED IN YOUR COURSE OF STUDY FOR
YOUR MEDICAL DEGREE IS DIFFERENT FROM WHAT I LEARNED IN
MY YEARS OF EDUCATION AND TRAINING AT DARTMOUTH,
CORNELL, AND PENNSYLVANIA.

THAT’S AN AWESOME FIGURE.

AND IT’S BEEN A CHALLENGE FOR MY GENERATION TO KEEP UP

WITH THAT 90 PERCENT THAT’S NEW.

14
I’M THANKFUL THAT I WAS ABLE TO BE PART OF SOME OF IT:

I WAS ABLE TO BE AMONG THE FIRST HALF DOZEN SURGEONS

WHO BEGAN A NEW MEDICAL SPECIALTY: PEDIATRIC SURGERY.

I WAS PRIVILEGED TO BUILD THE NATION’S FIRST NEONATAL

INTENSIVE CARE UNIT.

15
YOU PROBABLY CAN’T IMAGINE MEDICINE WITHOUT PLASTICS,
BUT I THINKI WAS THE FIRST PHYSICIAN TO USE A

- POLYETHYLENE LINE INTRAVENOUSLY IN A PATIENT. I HAD
KNOWN THEY HAD BEEN USED IN CATS....THAT’S WHERE I GOT
THE IDEA.

SO NOW YOU MUST BE AMAZED AT HOW RECENTLY PLASTIC WAS

FIRST USED.... OR HOW OLD I MUST BE.

16
MEDICINE TODAY IS AT BEST AT A CROSSROADS, AT WORST INA

CRISIS. I THINK THE PROBLEMS LOOM LARGE FOR ALL OF US.

BUT YOURS IS NOT THE FIRST GENERATION OF DOCTORS FACING

A STIFF CHALLENGE.

17
EACH GENERATION THAT MOVES INTO MEDICINE MOVES,
UNWITTINGLY, INTO AN AREA OF CONTROVERSY.

BUT SOMEHOW YOUNGER ENTERING PHYSICIANS DON’T SEEM AS
CONCERNED AS THE OLDSTERS WHO TALK WITH FURROWED

BROWS.

THESE PHYSICIANS, MY AGE OR A LITTLEYOUNGER ARE
UNHAPPY BECAUSE THE WORLD AROUND THEM HAS CHANGED

VERY FAST.

18
THE GOVERNMENT INTRUDES IN THEIR PRACTICE AS NEVER
BEFORE.

THEY GRUMBLE ABOUT NEEDING TO CALL UP AN INSURANCE
OFFICE TO SEE IF A RECOMMENDED PROCEDURE WILLBE PAID
FOR.. AND THEN TO FIND THE PERSON THEY ASK DOES NOT
EVEN KNOW HOW TO SPELL THE PROCEDURE.

THESE PHYSICIANS DON’T LIKE WHAT THEY SEE, SO THEY HAVE

THEIR EYES ON RETIREMENT.

19
THEN THERE IS A YOUNGER AGE GROUP, YOUR PARENTS’ AGE.
THEY DON’T LIKE THE CHANGES EITHER, BUT THEY KNOW THEY
WILL HAVE TO ADAPT, AND THEY AREN’T TOO HAPPY ABOUT IT,
THEY ARE THE ONES WHO TRY TO TALK YOUNG PEOPLE OUT OF
GOING INTO MEDICINE.

SHAME ON THEM. I’M GLAD NONE OF THEM DETERRED ANY OF

YOU.

20
THEN THERE IS YOUR AGE GROUP, THE YOUNG PHYSICIANS.
YOU HAVE GROWN UP WITH THE NEW SYSTEMy YOU ACCEPT AS
NORMAL THE PROBLEMS YOUR PARENTS AND GRANDPARENTS
GRUMBLE ABOUT. YOU STILL HAVE THE ENERGY AND OPTIMISM

TO MAKE THINGS HAPPEN.

THE FUTURE OF MEDICINEIS IN YOUR HANDS....AS NEVER
BEFORE.
WE NEED YOU.

WE NEED YOU TO MAKE A DIFFERENCE.

21
WE NEED YOU BECAUSE THE AMERICAN PEOPLE ARE DEEPLY
CONCERNED ABOUT THE STATE OF OUR HEALTH CARE SYSTEM.

HERE ARE A FEW OF THE PROBLEMS FOR WHICH YOU WILL FIND

SOLUTIONS:

IN THE LAST FEW DECADES AMERICAN MEDICINE HAS BROUGHT
US TO THE PLACE WHERE WE ROUTINELY EXPECT MIRACLES TO
HAPPEN -- EVEN THOUGH THE REAL WORLD OF MEDICINEISN’T :
ALWAYS ABLE TO DELIVER.

WE HAVE THAT SITUATION RIGHT NOW WITH AIDS.

22
IN OTHER WORDS, WE HAVE A CLEAR GAP IN OUR SOCIETY
TODAY BETWEEN WHAT WE WOULD LIKETO SEE HAPPEN IN
HEALTH CARE ... AND WHAT CAN REALISTICALLYHAPPEN IN

HEALTH CARE.

MANY OF OUR GREAT EXPECTATIONS COME FROM OUR ABIDING
FAITH IN EVER-IMPROVING MEDICAL TECHNOLOGY.
BUT NOW, I BELIEVE THE PUBLIC WONDERS IF MEDICAL

TECHNOLOGY MIGHT BE A MIXEDBLESSING.

23
WHAT WE HAVE IS A RISE IN THE NEW TECHNOLOGIES
AVAILABLE TO PHYSICIANS ...
BUT, AT THE SAME TIME, A DECLINE IN THEIR SIGNIFICANCE FOR

A SUBSTANTIAL NUMBER OF PATIENTS.

YOU WILL HAVE TO DEAL WITH THESE ISSUES AND THEY WILL

STRAIN YOUR SENSE OF ETHICS.

24
THE GROWING GAP BETWEEN OUR ASPIRATIONS AND OUR

Be Sachs

ABILFESES WILL BE COMPLICATED FOR YOU BECAUSE OF
COMPETITION BETWEEN THE EVER-GROWING NUMBERS OF
ELDERLY FOLKS AND THE SHRINKING NUMBERS OF YOUNGSTERS

UNDER EIGHTEEN.

DURING MY 8 YEARS AS YOUR SURGEON GENERAL I DEALT WITH
ADVOCATES FOR CHILDREN AND I DEALT WITH ADVOCATES FOR

THE ELDERLY. THEY ARE BOTH VERY DEDICATED AND VERY
PERSUASIVE GROUPS. AND BOTH WILLBE QUITE RIGHTLY

COMPETING FOR A LARGER PIECE OF A SMALLER PIE. THEY ARE [S07#
WORRIED THAT THEY WON’T GET THEIR SHARE WHEN ITIS

DIVIDED UP.

25
THERE’S SOMETHING TERRIBLY WRONG WITH A SYSTEM OF
HEALTH CARE THAT SPENDS MORE AND MORE MONEY TO SERVE

FEWER AND FEWER PEOPLE.

YOU’LL HAVE TO TRY TO FIX THAT, TOO.

COSTS CONTINUE TO CLIMB, AND THE AMERICAN PEOPLE HAVE

NOT BEEN ASSURED, IN ANY RATIONAL AND MEASURABLE WAY,

THAT THE HIGHER COSTS OF A HEALTH CARE WILLIN FACT BUY

 

THEM A PROPORTIONATELY HIGHER QUALITY OF SUCH CARE.

Vee te thAave To #4 THAT, Aaso

26
REMEMBER THAT MONEY IS MORE IMPORTANT TO YOUR
PATIENTS THAN IT WILL EVER BE --OR SHOULD BE-- TO YOU.
PEOPLE ARE GENUINELY CONCERNED, EVEN FRIGHTENED, BY

THE COST OF MEDICAL CARE.

I URGE YOU DEAL WITH THAT PROBLEM HEAD-ON.

TALK WITH YOUR PATIENTS AND THEIR FAMILIES ABOUT THE

COST OF THE TREATMENT THEY ARE ABOUT TO RECEIVE.

27
DISCUSS WHAT THINGS ARE COVERED BY INSURANCE, AND
WHICH ARE NOT. MAKE THEM AS KNOWLEDGEABLE AS YOU
CAN.

YEW 7é0 THE HEALTH CARE MARKETPLACE IS NOT FREELY COMPETITIVE
AND, HENCE, IT HAS VIRTUALLYNO MODERATING CONTROLS

WORKING ON BEHALF OF THE PATIENT.
IN HEALTH CARE, RIGHT ACROSS THE BOARD, PRICES HAVE

GONE UP IRRESPECTIVE OF THE QUALITY OF CARE BEING

DELIVERED OR OF ANY OTHER MARKETPLACE CONTROL.

28
AND, TRY AS THEY MIGHT, I DON’T SEE THE MEDICAL

PROFESSION ACHIEVING MUCH SUCCESS § IN SELF-REGULATION.

THE HEALTH CARE SYSTEM IN AMERICA TODAY IS A TERRIBLE
MORAL BURDEN FOR SOCIETY TO BEAR, IN THAT THE SYSTEM

DOES NOT RESPOND AT ALL TO SOME 12 TO AS HIGHAS 15

 

PERCENT OF OUR POPULATION.

29
AND IT IS A TERRIBLE ECONOMIC BURDEN FOR SOCIETY TO
BEAR, IN THAT THE SYSTEM SATISFIES ITS OWN UNCONTROLLED

NEEDS AT THE EXPENSE OF EVERY OTHER SECTOR OF

AMERICAN SOCIETY.

2 THAT SYSTEM, /95 7s BE CHAYES

 

NOT JUST A LITTLECHANGE HERE AND A LITTLECHANGE THERE.

 

WE NEED TO BRING ABOUT A PROFOUND CHANGE, ACROSS-THE-

BOARD, IN THE WAY WE MAKE MEDICAL AND HEALTH CARE

Yoo R.

AVAILABLE TO ALL OUR CITIZENS. W& VZE& O
COC.

PAeTeCIOA Tow tv CHAT (hac éSS,

30
YOU CAN DO IT.
YOU’VE HEARD THAT THERE IS A LEADERSHIP VACUUM IN
AMERICAN MEDICINE TODAY.

B17
WELL, FILL pont BE TEMPTED &6R A "QUICK FIX" SOLUTION.

THELE IS A
92 GROWING INFATUATION WITH FOREIGN NATIONAL HEALTH
SERVICES ,5§ BASED MORE UPON DISSATISFACTION WITH OUR

SYSTEM THAN UPON UNDERSTANDING OF ANOTHER ONE.

31
MOST AMERICANS DO NOT REALIZE THAT ANY NATIONAL HEALTH
SERVICE, IS BASED UPON PLANNED SCARCITY.

EXPERIENCE THE WORLD OVER HAS SHOWN THAT WHEN
GOVERNMENT ECONOMIC CONTROLS ARE APPLIED TO HEALTH,

THEY PROVE --IN TIME-- TO BE DETRIMENTAL.

EVENTUALLY THERE IS AN EROSION OF QUALITY, PRODUCTIVITY,
INNOVATION, AND CREATIVITY. THIS IS ESPECIALLY TRUE OF
RESEARCH. THEN, LACK OF RESPONSIVENESS TO PATIENTS.

FINALLY, RATIONING AND WAITING IN LINES.

32
NONETHELESS, WE NEED TO CHANGE THE WAY WE DO THINGS.
WE HAVE THE PARADOX OF TOO MUCH CARE AND TOO LITTLE
CARE FOR DIFFERENT SEGMENTS OF SOCIETY AT THE SAME
TIME. AS HIGH-TECH MEDICINEGROWS OUT OF CONTROL,
UNBRIDLED BY INFORMED PURCHASERS, MANY PEOPLE ARE

DENIED BASIC PREVENTIVE AND PRIMARY CARE.

a 2

33
TEN YEARS FROM NOW YOU WILL BE DOING ONE OF TWO

THINGS:

EITHER YOU WILL BE WORKING WITH THE PUBLIC TO FREE US
ALL FROM A HASTILY IMPOSED NATIONAL HEALTH SERVICE,

OR,

YOU WILL BE PRACTICING MEDICINEIN A WAY VERY DIFFERENT
THAN £8 ITIS DONE NOW, AS PART OF THE BEST SYSTEM OF
MEDICAL CARE IN THE WORLD, BUT ONLY AFTER A DECADE OF

DIFFICULT/CHANGE.

34
THE OPPORTUNITY IS NOW.

THE TIMEIS SHORT.

THE STAKES ARE HIGH.

THE ALTERNATIVES UNDESIRABLE.

IT REMAINS TO BE SEEN WHETHER OR NOT AMERICAN MEDICINE
SEIZES THIS ONE AND ONLY OPPORTUNITY, WE’LL SEE. 4°%°

IT fod Voce’ AWwvO York EWELGA

35
IN THE MEANTIME, WHILE WE WAIT FOR NATIONAL OR EVEN
STATE LEGISLATIVE SOLUTIONS, AS PHYSICIANS, AS WELL AS
CITIZENS, WE NEED TO DO SOMETHING FOR THOSE AMERICANS
WHO, UNDER OUR PRESENT SYSTEM, ARE DENIED ACCESS TO

REASONABLE CARE.

WE CAN DO OUR PART BY REVITALIZINGTHE PRACTICE OF

OFFERING FREE CARE TO APPROPRIATE PATIENTS.

36
gum ZS 1, & i* RE.
yw THE ERR feats MY TrHcrE, OO nen ientb

BCFIRG
BEGAESE MEDICARE --AGAIN, I GUESS I SOUND LIKEAN OLD-
TIMER -- I FOUND MYSELF EXTRAORDINARILYFORTUNATE IF I

GOT PAID FOR 60% OF WHAT I DID.

BUT I WAS HAPPY IN MY PRACTICE, MY PATIENTS APPRECIATED

WHAT I DID, AND I CERTAINLY ENJOYED WHAT I DID FOR THEM.

37
I SEE NO REASON WHY CERTAIN FREE CLINICS COULD NOT
OPERATE UNDER LAWS THAT FORBID LITIGATION.
GIVING, CHARITY, HAS ALWAYS BEEN PART OF OUR CALLING.

WE OUGHT TO FIND WAYS TO DO IT WITHOUT PENALTY.

38
I BELIEVE THE PHYSICIANS OF MY GENERATION HAVE A
STRONGER SENSE OF THE "ART" OF MEDICINE, AND TEND TO
GIVE LESS VENERATION TO THE "SCIENCE" OF MEDICINE.

MAYBE WE CONDUCT OURSELVES THAT WAY BECAUSE WHEN WE
WERE FIRST STARTING IN PRACTICE, THE SCIENTIFIC
UNDERPINNING FOR OUR PRACTICE WAS, TO BE HONEST,

RATHER MARGINAL.

39
BUT WHAT’S THE REAL SIGNIFICANCE OF THE STATEMENT THAT
"PREVIOUS GENERATIONS OF DOCTORS PRACTICED THE ART,

RATHER THAN THE SCIENCE, OF MEDICINE?"

PRIMARILY, I BELIEVE IT MEANS THAT WE SAW MEDICINEAS A

RELATIONAL ENTERPRISE.

40
WE ASKED THE KINDS OF QUESTIONS THAT REFLECTED
CONCERNS ABOUT RELATIONSHIPS:

HOW DID WE REACT TO PATIENTS?

HOW DID WE TREAT THEM?

HOW DID THEY RESPOND TO US?

DID WE CARE ABOUT THEM?

 

DID WE CARE ABOUT THEIR FAMILIES?

41
WE HAD TO BE PEOPLE-ORIENTED BECAUSE, WITHOUT THE
BENEFIT OF C.A.T. SCANS OR N.M.R.s, JUST ABOUT EVERYTHING
WE LEARNED ABOUT OUR PATIENT CAME FROM THE TAKING OF
GOOD HISTORIES . . . THROUGH SENSITIVE DEALINGS WITH
FAMILY MEMBERS.

FOR ME THAT WAS THE FUN OF MEDICINE. EVERY PATIENT WAS

A CHALLENGE.

42
TODAY, YOU HAVE ALL THAT TECHNOLOGY TO HELP YOU OUT. IF
A PATIENT IS UNCOMMUNICATIVE FOR ANY REASON --INCLUDING
THE PATIENT’S AGE --YOU’RE NOT TERRIBLY UPSET BECAUSE
YOU’LL GET MOST OF THE INFORMATION YOU WANT FROM A
VARIETY OF MACHINES, LABORATORIES, AND TECHNICIANS.

NO DOUBT THESE DIAGNOSES ARE SPEEDY AND ACCURATE.

THE SCIENTIFIC ADVANCES IN MEDICINEIN THE LAST

GENERATION ARE MAGNIFICENT.

43
THEY HAVE PROLONGED MANY LIVES. WE HAVE ALL MADE FULL

USE OF THE ADVANCES IN MEDICAL SCIENCE FOR OUR PATIENTS

AND OURSELVES.

BUT THE SCIENCE OF MEDICINE SHOULD NOT ECLIPSE THE ART
OF MEDICINE. IN OUR SCIENTIFIC PROGRESS SOMETHING MAY
HAVE BEEN LOST... SOMETHING VERY IMPORTANT TO THE
CONTINUED STRENGTH OF THE MEDICAL PROFESSION: THE

RELATIONAL BOND BETWEEN PHYSICIAN AND PATIENT.

44
WE NEED TO RESTORE THE DOCTOR-PATIENT RELATIONSHIP AND
WITH IT, THE DOCTOR MUST REASSUME HIS OR HER POSITION
OF RESPECT FOR ETHICS, MORALITY AND INTEGRITY.

WE NEED TO GET AWAY FROM THE CONSUMER-PROVIDER

MENTALITY.

"CONSUMER" BRINGS TO MIND SOMEONE SHOPPING FOR

GROCERIES OR CHECKING OUT THE FEATURES OF A NEW CAR.

"PROVIDER", ON THE OTHER HAND, SOUNDS LIKEA GARAGE

ATTENDANT PUMPING GAS.

45
IF THE PATIENT THINKS OF HIMSELF PRIMARILYAS A CONSUMER,
GETTING THE MOST FOR HIS MONEY, SHOPPING AROUND FOR A
DOCTOR WHO CHARGES $5 LESS FOR AN OFFICE VISIT, HE
AUTOMATICALLYPUTS THE DOCTOR IN THE ROLE OF THE

SELLER, GETTING THE MOST FOR HIS SERVICES.

IF THE DOCTOR IS PRIMARILYCONCERNED ABOUT COLLECTING
HIS FEE, HE AUTOMATICALLYAROUSES THE CONSUMER
MENTALITYJIN HIS PATIENT. WE CAN’T HAVE PATIENTS
WONDERING IF THEIR TREATMENT IS DETERMINED BY THE

DOCTORS FINANCES,

46
IF PEOPLE REFER TO YOU AS A "HEALTHCARE PROVIDER’,
CORRECT THEM. REMIND THEM YOU ARE A DOCTOR, AND THAT
YOU WORK, NOT WITH CONSUMERS, BUT WITH PEOPLE WHO ARE

YOUR PATIENTS.

WE MUST VIEW OUR PATIENTS AS HUMAN BEINGS, AS ALLIES,
WORKING WITH US IN THE STRUGGLE AGAINST DISEASE.
TREATING OUR PATIENTS LIKEALLIES IN THE FIGHT AGAIN ST
THEIR DISEASE MEANS BEING CLEARER AND MORE COMPLETE

ABOUT INFORMED CONSENT.

47
THAT MAY MEAN TELLING MORE ABOUT WHAT WE KNOW IN

SOME CASES, SHARING OUR UNCERTAINTIES IN OTHERS.

IT MEANS COMMUNICATING CLEARLY WITH ORDINARY PEOPLE
WHO ARE UNDER GREAT STRESS.

IT MEANS KNOWING WHAT WE DO SO COMPLETELY THAT WE
CAN MAKE IT CLEAR TO PEOPLE WHO DO NOT COME FROM A
MEDICAL OR SCIENTIFIC BACKGROUND. YOU NEED TO Vd“
@RBORSHAND THAT IF THEY DON’T UNDERSTAND, IT’S YOUR

FAULT, NOT THEIRS.

48
EARLY IN MY OWN PEDIATRIC SURGICAL PRACTICE, I
DETERMINED THAT I WOULD MAKE MY PATIENTS’ PARENTS
ALLIES WITH ME AGAINST THEIR CHILD’S SURGICAL PROBLEM.
I’VE SAT DOWN AND TALKED WITH THE PARENTS OF MY TINY
PATIENTS.

WE’VE SWEATED OUT THE HOURS TOGETHER IN RECOVERY.
WE’VE BEEN ON THE PHONE TOGETHER WITH COMMUNITY
SERVICES AND VOLUNTARY AGENCIES TO SEE WHAT KIND OF
HELP WILL BE OUT THERE WHEN THE FAMILYTAKES ITS BABY

HOME.

49
HAS IT BEEN WORTH IT? YES, IT HAS. . . ON MANY LEVELS.
Ho woke 5
FOR ONE THING, ’VE GOTTEN TO KNOW D@ZBR8 OF

COURAGEOUS, GENEROUS, COMPASSIONATE FAMILIES.

I MAY HAVE HELPED THEIR CHILDREN OVERCOME SOME
DISABILITY. . . BUT THEY ALL HELPED ME OVERCOME

PESSIMISM, DEFEATISM, FRUSTRATION, AND DISCOURAGEMENT .
. . FEELINGS THAT ARE COMMON ENOUGH AMONG HARD-

WORKING PHYSICIANS.

50
I DID THIS SIMPLY BECAUSE I THOUGHT IT WAS GOOD MEDICAL
PRACTICE, BUT IT ALSO HAD THE UNFORSEEN DIVIDEND OF
HAVING NO ONE SUE ME FOR 40 YEARS WHEN I WAS IN
PRACTICE.

I’M SURE THAT BOTH THE DOCTOR AND THE PATIENT WOULD
PREFER TO HAVE THAT OLD RELATIONSHIP OF TRUST THEY USED

TO HAVE.

51
UNLESS WE RESTORE THE DOCTOR-PATIENT RELATIONSHIP, WE

HAVE LOST OUR WAY COMPLETELY.
IT CAN BE RESTORED.

BUT IT WILL TAKE COMMITMENTIBY PEOPLE ON BOTH SIDES OF

THE STETHOSCOPE.

52
LET ME CLOSE BY SAYING:
I HAVE NEVER REGRETTED GOING INTO MEDICINE.
I’D DO IT AGAIN TOMORROW.

I’M GLAD YOU ARE DOING IT TODAY.

I ADMIRE YOU. I ADMIRE YOUR ENTHUSIASM ... YOUR OPTIMISM

.. YOUR VIGOR ... AND I ENVY YOUR OPPORTUNITY.

MAY GOD GRANT THAT YOU USE THEM ALL TO MAKE A WELCOME

DIFFERENCE.

THANK YOU.

HEAFEH

53