White Coat Ceremony
A time-honored tradition at Mount Sinai, The White Coat Ceremony is the perfect opportunity to set the stage for excellence in all our students' endeavors - from integrity in their research to compassion in their clinical care and selflessness in their service to society. Family and friends attend the ceremony to witness the class' indoctrination into the profession of medicine. The schools most outstanding physician role models are chosen as coaters, and a member of the faculty is selected to lead the incoming students in the oath that they read before a packed auditorium.
This year's keynote remarks were given by Raja Flores, MD, Chief of Thoracic Surgery. Dr. Flores is an internationally recognized thoracic surgeon, whose specialty is treating thoracic cancers. He is widely regarded as a leader and pioneer in the field. Dr. Flores gave the inspiring and rousing speech below, calling on this year's class to strive for uncompromising excellence, and recognize the profound implications of donning the white coat. He brought this message home by sharing some very personal stories that changed his life and his perspective on the meaning of caring for the sick.
Dr. Raja Flores' White Coat Speech to the Class of 2015
The healing touch, hope, words of comfort. Now, I know what you are thinking – 'what is this surgeon doing talking about touchy-feely stuff?' I hope to enlighten you on how the human touch and the spoken word are integral to the art of surgery and medicine.
As I walked into my first day of medical school there was big bold writing on the entrance wall that read "There is no greater privilege than to be entrusted with another person's mind, body, and spirit." This is where I learned that the body is not first; it is second sandwiched between mind and spirit.
What I have found over the past 25 years is that to operate on the human body is pretty straight forward. However, to nurture the mind and the spirit in the face of disease is a lot more complex. This is the challenge that the person wearing the white coat must meet.
While the initial purpose of the white coat was to protect the patient and the physician from cross contamination, it has become a symbol of authority, science, hope, and the art of healing. It has been said it takes a village to raise a child. The same can be said about the evolution of a student into a physician who wears that white coat. A physician does not just need to learn the pathophysiology of disease, but needs to place that disease in the proper context of the individual patient. For example, the treatment of a 35-year-old newly married woman with stage II lung cancer is very different from that same stage II lung cancer in an 80-year old wheel-chair-bound man with Alzheimer's disease. It is the same disease but each case has a different context. To learn this art is an arduous task, one that requires help from faculty, peers, family, friends, and community. What you do not learn from them, you will learn from your patients.
The white coat is a symbol of a scientist. A huge amount of research is taking place within these surrounding buildings. In the laboratories and on the wards there is much to be learned and much to be improved upon. Learn to question the gold standard!
Sometimes research and academic medicine may conflict with what is in the patient's best interest. It is our job to keep things in perspective. Two months ago I was in China demonstrating a surgical technique. It was being broadcast in real time to an auditorium of about one thousand surgeons. I was not able to meet the patient ahead of time and I did not see them after the operation. The first and last time I saw the patient was when he was prepped and draped in the operating room. The procedure went as smoothly as could be. However, as I was walking out of the room, I felt sick to my stomach. I did not know this patient's name, his family or his wishes. In the operating room decisions are not just guided by disease but by the patient. While I was practicing my craft as a surgeon and educator, I had neglected my duty as a doctor. I had allowed myself to be reduced to a technician in the spirit of teaching and academia. I have vowed to never allow myself to be placed in that position again. You will find that sometimes it is very difficult to fight against the tide to do the right thing. When you wear the white coat, you need to find the courage to change things that you are not happy with. Be true to your own conscience regardless of what the masses of people are doing.
The white coat is a great equalizer. Some of you are from poor backgrounds, some from wealthy, a rainbow of colors, and a variety of religious beliefs. Medicine is a meritocracy. Here, you are all subject to the same scrutiny and are beneficiaries of the same rewards. When compared to other professions in the world, you are placed up on a pedestal - whether you like it or not!
Let me tell you a personal story. One day, I had just come home from work rushing to go out to dinner with my father-in-law, a wealthy successful businessman. He was putting on some fancy Brioni suit when he looked at me and said "You can wear a jacket like this one day when you make your first million." As I was taking off my white coat I darted right back at him "You can wear a jacket like this when you can save someone's life." Boy did that shut him up! It then dawned on me that in this society almost everything that is considered to be worthwhile is measurable. Whether its money or homeruns, bankers, businessmen, athletes, their worth is all measurable. Your worth is not. You have chosen to go into the profession that cured small pox, a disease that killed 500 million people! You have chosen the profession that mapped the human genome. This profession keeps people from dying of AIDS, and it is the one that will one day cure cancer. This is your profession.
Being a doctor is not just a job, it is a calling. A doctor is always a doctor, day or night, white coat or no white coat. Your primary obligation is always to your patients. Whether your patient is Mrs. Gonzalez from 110th Street or Mrs. Smith from Park Avenue, learn about who they are. Ask each patient something personal unrelated to their medical condition that will make you view them as a unique individual. This will help you treat the person and not just the disease.
The person in the white coat is a leader. As a physician you have more experience in human suffering than any lay person. Your patients and their families will look to you for guidance in their darkest hour. It is up to you to keep things in perspective. Many will ask, especially those with cancer "Doc, what are my chances?" It is not your job to just regurgitate statistics. To "be honest with the patient" is a cop out. Using this method just gets the burden off your own shoulders and puts it on the patients. They are coming to you for YOUR advice. It is your job to put their disease in the perspective of their particular life. This means getting to know your patient well. Even if just a glimmer of hope exists, you need to find it and exploit it. Statistics refers to patient populations and what you are treating is an individual. With great power comes great responsibility. Take the responsibility for the patients' spirit as well as their body.
If there is one trait that you must remove from yourself in the next four years, it is arrogance. Your arrogance is in direct conflict with the patients well being. Arrogance prevents learning from mistakes. It diminishes team morale, and ultimately results in substandard care. Others wear the white coat as well! Physical therapists, phlebotomists, pharmacists, they are all part of the team trying to heal the patient; and condescension should never be tolerated. Respect must be the RULE! Arrogance is your worst enemy; and even more, the patient's worst enemy.
I have learned a lot from my patients, especially about hope. Jill was a vibrant 44- year-old mother of two from Michigan with metastatic sarcoma to the lungs and she was given six months to live. She required multiple surgeries and she eventually did die but eight years later. She swore that the hope is what kept her alive and excited about life for so long. She said hope is an essential tool for healing (to heal not synonymous with to cure). She gave me a book entitled "The Anatomy of Hope. It states "Hope can flourish only when you believe that what you do can make a difference, that your actions can bring a future different from the present." All patients must have some hope if they are to live the next day to the fullest. Without hope, they will just shrivel up and die even before their disease gets to them. As physicians we must allow patients to have control over their own destiny. You may ask "How will I know what they want?" LISTEN, they will tell you.
The power of hope is nicely illustrated in a recent novel called "Cutting for Stone". The author describes a senior surgeon who asks a trainee, "In the emergency room, when a patient is in extremis, what is administered by ear?" The trainee answers correctly "Words of comfort".
A huge part of communication is non-verbal. We know this from love. So although key verbal communication skills are required, body language must also be learned. Touching communicates caring, compassion, and reassurance. Hold the patient's hand, hug them, sit on their bed, and cry with them. Let them see that you care. Allow yourself to be vulnerable and suffer with them. The relationship with a patient and family is an intimate one, and it requires cultivation. Non –verbal communication takes practice.
In the emperor of all maladies there is a quote at the beginning of the book from Susan Sontag. She states "Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick."
To all of you in this room, you will not just be physicians but you will also be patients. How will you want to be treated?
Class of 2015 - thank you.