Commencement, 2007: Faculty and student speakers

Dr. David Guzick, M.D., Ph.D.

June 07, 2007

We pick up here where we left off in the last newsletter on speakers at the Class of 2007 Commencement.

The procedure used by the Class of 2007 to select their student and faculty speakers was as follows. First, the Class Council solicited nominations for speakers via email from members of the class. These nominations were reviewed by Council, and persons receiving a defined, minimum number of nominations were placed on the ballot. The class voted from a choice of 6 candidates for faculty speakers and 5 candidates for student speaker. The voting was conducted in February and March online via Blackboard. Fortunately, there were majority votes in both categories, so a re-vote was not necessary.

Here are the speeches given by Craig Benson, M.D., and James Powers, M.D., who were selected by the Class of 2007 for student and faculty speakers, respectively.

STUDENT SPEAKER

Craig Benson, M.D.

"Oh, the Places You'll Go, Class of 2007!"
by Craig C. Benson

Oh, the places you'll go,
Class of 2007.
Soon we'll walk across this stage,
it will feel like heaven.

There will be pictures and hugs,
congratulations galore.
We'll just be happy
not to wear the short coat anymore.

For some its been a given,
to always be an M.D.
For others not so certain,
the path was hard to see.

With all our different backgrounds,
we started here together.
We came to Rochester for med school,
despite the yucky weather.

When we saw our first tuition bill,
we had to cry and moan.
But med school was certainly worth it,
despite the massive loan.

Just think of all you learned,
each and every year.
What once seemed like forever,
is now almost here.

You're going to be a Doctor.
Yes, a Doctor, indeed.
And since you made it this far,
it's ninety-eight and three quarters percent guaranteed.

Oh, the places you'll go, Class of 2007!

Remember your first patient,
in HSF anatomy class.
Remember your first test,
you never thought you'd pass.

Recall the first heart you heard,
with your new stethoscope.
Recall the first hand you held,
to give a patient faith and hope.

It wasn't always easy,
school could certainly be a struggle.
And when times got tough,
we could all use a little cuddle.

From family and friends,
perhaps a fiancée, too.
We never could have done it,
without their help to get us through.

We also had each other,
to travel this road together.
Through thick 'n thin, ups 'n downs,
and, yes, even that yucky weather.

But, we made it to the end,
and now we're standing strong.
Even though we can't remember,
learning genetics from Dr. Fong.

Thanks to the double helix curriculum,
we will always remain curious.
And now we can pick out a study,
that is methodologically spurious.

Oh, the Places you'll go, Class of 2007!

It began with Dr. Hansen,
greeting us on Interview Day.
It will end with our Advisory Deans,
sending us off on our way.

To Denver, Chicago, Hawaii
even San Antone.
But, one third of us are staying,
right here at home.

Ready for new experiences,
we are off and away.
To save the lives of patients,
nothing will lead us astray.

You'll help patients,
do not fret or fray.
You'll help patients,
in your own BPS way.

Except when you don't,
because sometimes you won't,
and you'll feel like you're stuck in a pinch.
You may stumble and fall,
on your first night of call,
and you'll feel like residency is no cinch.

You'll try to do all you can,
but you won't be the man,
and you'll feel like letting yourself wallow.
A challenge like no other before,
your intern mind and body sore,
and you'll feel like your insides are hollow.

But then,

Remember your first patient,
in HSF anatomy class.
Remember your first test,
you never thought you'd pass.

Recall the first heart you heard,
with your new stethoscope.
Recall the first hand you held,
to give a patient faith and hope.

And then you'll start to realize,
you've been down this road before.
You've taken on many challenges,
with success you can't ignore.

If I know this group at all,
you're not the type to stay down.
There are way too many people to help,
time to erase that surly frown.

With Whipple, Adolf & Engel,
all looking over your shoulder,
you'll rise to meet this new challenge,
a little wiser and that much bolder.

So, leave the worries to the side,
with the new confidence you've found.
Be ready to take on each new day,
and see many opportunities now abound.

And with the knowledge that we've built,
and ties to where we're from,
we must now look to the future,
because the best is yet come.

Oh, the places you'll go, Class of 2007!

So, we've come to the end.
Time has certainly flown.
When you're ever in doubt,
just think how much you have grown.

Choosing to become a doctor,
is something I will never regret.
Being here at Rochester with you,
is an experience I will never forget.

As you continue on this journey,
the best advice I can give,
always put the patient first.
That's the only way I know how to live.

For, whether your first or last,
that won't determine how you fair.
Because what really matters most in life,
is how much you truly care.

Our paths will now diverge,
but, one thing will be the same.
They'll say the word Doctor,
before they say your name.

You are going to be a Doctor,
a Doctor different than the rest.
Remember your roots in Rochester,
where Biopsychosocial is the best!

Oh, the places you'll go, Class of 2007!

FACULTY SPEAKER

James M. Powers, M.D.

"THEIR yesterday, our today, you're tomorrow"
by James M. Powers, M.D.

I also want to offer my congratulations to you and your families and your friends. This is a Whitmanesque, as well as a Kodak, moment. So please repeat after me:

I celebrate myself, and sing myself.

Thank you for asking me to be your class speaker. I've been teaching medical students for 34 years and this is the greatest honor of my teaching career. I also want to thank you for being the curious and stimulating students that you were and the fine people that you are. It's been a real pleasure to know you.
This is truly one of those first days in the rest of your life, and I delight in your youth and freedom and options.

Afoot and light-hearted, I take to the open road,
Healthy, free, the world before me,
The long brown path before me, leading wherever I choose.

Now I'm supposed to tell you what your future will be and to offer some advice based on my past experiences. Most of you have chosen to go into clinical medicine, where you will focus on patient care. So I offer John Greenleaf Whittier's words to you.

The holiest task by Heaven decreed,
An errand all divine,
The burden of our common need
To render less is thine.

The paths of pain are thine. Go forth
With patience, trust, and hope;
The sufferings of a sin-sick earth
Shall give thee ample scope.

Beside the unveiled mysteries
Of life and death go stand,
With guarded lips and reverent eyes
And pure of heart and hand.

Others will pursue a research career, some after an abbreviated clinical residency, because of the awesome advances in biomedical research that have occurred in recent years and despite the current difficulty in obtaining research funding. Thankfully, special attention and concessions are being given to you neophytes to start your research careers. I offer the words of Lewis Thomas to you.

Scientists at work have the look of creatures following genetic instructions; they seem to be under the influence of a deeply placed human instinct. They are, despite their efforts at dignity, rather like young animals engaged in savage play. When they are near to an answer their hair stands on end, they sweat, they are awash in their own adrenalin. To grab the answer, and grab it first, is for them a more powerful drive than feeding or breeding or protecting themselves against the elements.

Regardless of what field of medicine you choose, clinical or research, patient-care or laboratory, academic or private practice, the words of those far wiser than I are equally appropriate.

Now the skillful workman (the resident) is very careful indeed as to what he takes into his brain-attic. He will have nothing but the tools which may help him in doing his work, but of these he has a large assortment, and all in the most prefect order. It is a mistake to think that that little room… can distend to any extent. It is of the highest importance, therefore, not to have useless facts elbowing out the useful ones.
Sherlock Holmes

Only in contest with the strong does one acquire strength… criticism is absolutely necessary for us… while it shows up our defects without any consideration, it brings us at the same time the positive knowledge of our powers.
Ramon Y Cajal
Or

Doubt grows with knowledge.
Goethe

It is also difficult for me to tell you what to expect, because we are all unique in that we have different strengths, weaknesses, desires and needs. So I really don't know what life holds in store for each of you personally or professionally. I think it's safe to say, however, that you have prepared well for life's opportunities and will certainly have both successes and failures, satisfactions and disappointments. None of us are infallible, and we all will make mistakes from which we can learn, and only hope not to repeat. As Cajal said,

We are human beings, and therefore suffering, physical and mental, waylays us continually; even apart from time, the terrible and inexorable enemy of life.

But also recall the words of Flaubert:

One's duty is to feel what is great, to cherish what is beautiful, and not to accept all the conventions of society…

Or those of La Rochefoucauld

Happiness and misery depend as much on temperament as fortune.

Or those of Aristotle

If you want to be brave, act brave.

So, act happy and you'll be happy.
Extend a warm greeting (perhaps, god forbid, even a hug) to all at the medical center, large and small, from the President to those who empty the trash cans… because happiness is contagious!

Also, while the health and welfare of mankind is an awesome responsibility and our undertakings in that arena must be measured and appropriately respectful, we also can do stupid things. In such situations, try to laugh at yourselves. This appears to have become somewhat of a lost art for my generation. Take your work very seriously, but don't take yourselves too seriously.

Their yesterday, our today, you're tomorrow.

I chose this title to share my perspective of the changes in Medicine that have occurred in my professional lifetime in the hope that you may gain some benefit or insight from it. There have been tremendous changes in the four decades that I have been in Medicine. In the real world, we have seen the blackberry go from a simple fruit to an information network with an addictive potential; the childrearing philosophy change from "spare the rod and spoil the child" to "never raise your hand against the child" to "if you touch me, mom, I'll sue you;" in personal development, from "be the best you can be" to "be whatever you want to be"; and in redressing wrongs, from reimbursing a customer for the fair market value of a lost item to a lawyer-judge in D.C. suing a cleaner for 67 million dollars, because it misplaced his pants. Our medical world naturally reflects some of these societal modifications or dysfunctions.

Many of the changes in clinical medicine also have been nothing short of spectacular. Others have been less auspicious or, in my opinion, even harmful to the multiple missions of academic medicine: education, clinical care and the advancement of biomedical knowledge.

I've seen the philosophy of medical school education move from one of: "Give them all you have and let them learn all they can" to a more "professional educator"-driven pot pourri of learning objectives, informatics, fewer lectures, curricula with less scientific content, PBLs, empowerment, life-long learning, and mentors. In residency training, we have gone from a method of watch one-do one-teach one to algorithms and practice guidelines to evidence-based medicine. Are any of these changes good? Absolutely! But let me give you another, perhaps more sobering, perspective. Jerome Groopman, the Chair of Medicine at Harvard in his recent book, "How Doctors Think", states that clinical algorithms may constrict creative and independent thinking. "Similarly, a movement is afoot to base all treatment decisions strictly on statistically proven data. This so-called evidence-based medicine is rapidly becoming the canon in many hospitals… But today's rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers", rather than what is needed for the individual patient.

However, a greater threat to your residency training and clinical practice is the time factor: not enough for some things, too much wasted for others. Our today (my generation) has too often allowed bureaucrats, regulators and lawyers (pardon me, President Seligman) to distract us from our important missions with impunity. For example, NYS Law and the ACGME that limits the number of hours a resident may be at the hospital, my clinical colleagues tell me, are interfering with the training of their residents (especially surgical types), because they are limiting their ability to participate in the appropriate continuity of acute clinical care. Another problem that needs to be controlled is the amount of time being wasted by physicians in complying with a host of regulations and directives. Many of these have had a reasonable and justifiable origin, such as combating house staff fatigue and time-activity reporting for Medicare reimbursement, but the pendulum effect has occurred with some and the once-reasonable regulation often becomes more and more unreasonable over time with others. Likewise, we have entered an era where documentation has become pre-eminent. Some clinicians spend more time documenting that they cared for a patient, then they actually spent taking care of the patient! To comply with the Core Competencies' requirements has often forced departments and medical schools to allocate one full time faculty and salary for an activity of dubious necessity.

Your time is important, no matter what field you choose.

Michael Bishop, 1989 Nobel Laureate in Medicine and a former commencement speaker of ours, states that

Reflection is central to discovery. Time and tranquility permit the intellectual synthesis and leaps of imagination that generate insight. Francis Crick has warned against the temptation to work so hard that there is no time left for serious thinking…

and Jerome Groopman says

Cogent medical judgments require time.

The importance of having enough time to spend with your patients is self-evident. So the principle is simple: the more time you spend on matters extraneous to our missions, the less time you have for teaching, research and clinical care.

I don't want to rain on your parade, so let me also say that many very positive things have happened recently, in addition to those mentioned previously. For example, Dr. Timothy Wilson in his book, "Strangers to Ourselves", documents that, while we consciously can grasp perhaps forty pieces of information per second (so-called explicit learning), we unconsciously process about 11,000,000 pieces per second (so-called implicit learning). Perhaps the old curricular philosophy was justified after all! But the really good news is that all that neuropathology is up there someplace, but you're just not consciously aware of it. It will be there, when you need it, I promise. Or, consider that Philip Howard, a lawyer and the author of "the Death of Common Sense", has started a protest citizen group called "The Common Good" to address many of today's legal and medico-legal absurdities; more importantly, the top administrators (Presidents, CEOs, deans) of the most prestigious medical centers have signed on. To my knowledge, this may be a first for academic medicine.

So the planets seem to be lining up just in time for your generation to begin to strut its stuff. You are tomorrow, you are the future, you are our hope. My advice to you now is first to believe in yourselves, follow your hearts and reach for the stars. Pick a role model in your field, someone that you admire and respect, and try to emulate her or his best qualities. Bring back honest, often pointed, sometimes painful, scientific discourse that has been replaced by political correctness and you will have your beginning. For everyone's sake, when some directive comes along that makes no sense to you, intelligent and caring physicians, ask the questions: why do we need to do this? What is the added value?

In closing, another sage once said,

It is not in the nature of man… to start out by giving up… (however) Some give up at the first touch of pressure; some sell out; some run down by imperceptible degrees and lose their fire, never knowing when or how they lost it. But Ayn Rand goes on to say that she knows that the University of Rochester’s medical school class of 2007 will be among the few who hold on and move on, knowing that the fire is not to be betrayed, learning how to give it shape, purpose and reality.

May the wind be always at your back.

Meliora,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
University of Rochester

Dean's Newsletter

Posted May 28, 2009:
A Fond Farewell to the University of Rochester

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