June 15, 2020
Good morning, newly certifiable internists:
I thoroughly enjoyed being in the audience at your graduation ceremony. Your stories of accomplishment remind me that watching the development of your mastery is one of the pleasures of being an attending at RGH. Now you take your 10,000+ hours of residency preparation to be fellows and attendings. Congratulations! (And please indulge me a few moments.)
Remember that the heart of health care is in patient care – I hope that seed of meaning and purpose has not been overtaken by weeds of bureaucracy and callousness. In the two lectures I gave (on EMR and Sacred Pause) and on 5400, I tried to challenge you: how do you preserve your humanity in the ubiquitous presence of patient suffering? Suffering is a given in internal medicine; it accompanies the loss of health, and you have prepared yourselves to try to ease some of it. The forces of modern American medicine want you to become part of The Machine. But you are not parts of a machine dispensing drugs and devices, and your patients are persons, not diseased parts or examples of populations. How do you preserve your humanity? Your answers will provide a “red thread of meaning” in your personal and professional lives.
Remember that you can now really start to practice medicine as an art. The science of medicine is reductionist: science “controls for” variables in order to explain and predict biology. The art of medicine is creative: there is never any “typical” scenario, as your being is always interacting with others’, creating stories. People and their stories are complicated and wonderful, and the challenge of getting to know them can be the best reward. But you can’t do this by yourself. Model and support the building of a community of caring. A supportive community can lessen pain and suffering.
Remember to give yourselves time to reflect. Getting to know patients, you can get to know yourselves. Speaking from my experience, that process is fraught. Your assumptions and values (your stories) will change, as you realize how you can hurt yourselves and others, even when you are doing your best. Reflect and try to make your responses kinder and more responsible to others, balanced with being kinder and more responsible to yourselves. Your inner lives contain parental values (whenever you think you “should”) and other defenses and desires that have promoted your success, but may also have thwarted your authenticity and connectedness. Create your life as a work of art: smart and capable, and also kind and humble.
Our time together was brief. If you’d like, we can endeavor to stay in touch. Regardless, I wish you very well on your journeys to come.
Yours truly,
David Lee, MD