Doctor both to patients and to the World

Commencement Address

Bernard Lown, MD

University of New England College Osteopathic Medicine

Portland, Maine

June 06, 2009

My task this morning is simple:  to congratulate you, to share with you a singular thought or two,  to challenge you and hopefully not burden you with soaring rhetoric and tired platitudes.  These orations are supposed to be short, uplifting,  and instantly forgettable. Long ago I learned that speech does not have to be eternal to be immortal.

Though I do not know you individually, I appreciate you collectively for incredible youthful resilience, for wholesome good sense and for finely honed intelligence.

You are a blessed group. At a time when graduating students face  uncertain and  bleak  economic futures, you are wanted, you are needed, you will be recruited and you will immediately find a permanent and productive niche in American society.

You are now entering a profession noble in tradition, but as profoundly burdened with problems as the society from which it stems. That we have a dysfunctional health care system is now widely acknowledged.  Health in our country presents a blatant contradiction. Despite our investing a king’s ransom, one-third of the population is inadequately protected against the unpredictability of illness.

Non-insured have reached 47 million and an additional 40 million  have  inadequate health protection. With the current recession/depression these numbers continue to climb.  The problem is not due to inadequate  funding. The US annual outlay is now about  $2.5 trillion or 16% of our GDP. We spend roughly twice the amount for health compared to the other 29 industrialized countries (OECD).

One would anticipate that with such mammoth expenditures the health  of our people would be ranked the best in the world. In fact, health indices in the U.S. are lagging behind other industrialized countries in such solid outcomes as life expectancy in both men and women and a host of other hard indices. Between 1991-2000, the failure to deliver standard care to Afro-Americans claimed 886,000 lives. According to  the World Health organization the  USA ranks an embarrassing 37th in health outcomes among 191 countries. W are afflicted with a fragmented,  bureaucratized series of cottage industries misnamed a health care system.

Most disturbing is the loss of a moral compass. Rather than being guided by a patient’s needs, medicine is increasingly navigated by  the economic bottom line. As Dr. Marcia Angell, former editor of the New England Journal of Medicine wrote recently in the Boston Globe, “The reason our health system is in such trouble is that it is set up to generate profit not to provide care.”

I confess being troubled by a deeper pathology, namely the ailing doctor-patient relationship. The distancing of doctor from patient. The accent is shifting from involvement to aloofness. Instead of considering  the whole person, we focus on our specialties. On the dysfunctional organ rather than the ailing human being. The unique individuality of a patient disappears, subsumed by a body part.

We deal increasingly with chronic illness and with the multiple afflictions which accompany aging. Let me repeat the obvious;  death and aging have no cure. Patients yearn to be healed.  The healing process transcends dispensing appropriate drugs and procedures. It requires  mobilizing  positive expectations and stimulating  faith in the physician’s ministrations within an emotionally supportive relationship. Numerous studies document that caring matters more to  the patient than a physician’s credentials.

It is told that an angel became disenchanted with heavenly bliss. He descended to earth and set up a medical practice. The first patient complained of loss of sight in an eye and paralysis of a limb. The angel touches him and instantly he sees and walks; a miraculous  cure.  As the patient is leaving he is overheard to mutter, “a typical doctor he didn’t even bother to take a history.”

In order to heal,  first and foremost one has to learn to listen. Caring is ultimately dispensed through words. Talk can be therapeutic. It is one of the underrated tools in the physician’s armamentarium. Therapeutic talk is a great art. It dissipates uncertainty, allays anxiety, instills confidence, augments a capacity to persevere and thereby promotes  recovery.

Intellectual excitement for the doctor derives largely from dealing with people, not with pathology. The physician is the spectator of a panorama of human character, motives,  and actions;  a tapestry  richer in its weave than is to be  found in the plays of Shakespeare or the novels of Tolstoy.

Having said the above, I feel as though I was bringing coals to Newcastle. For your osteopathic education embodies the above philosophy and value system.  Essential to your medical education is the primacy of the whole human being;  integrating body, mind , community as well as culture. I am here largely because of enormous admiration for this type of pedagogy.

Let me say something heretical but no doubt music to your ears. You are far better equipped to serve the health needs of the American people than graduates from allopathic medical schools. The dire urgency in American health care  is to restore the pivotal role of the primary care physician. This you are well equipped to do.

The second motif of this sermonette relates to  social responsibility, or outreach beyond the bed-side.  I deeply believe that doctors to be personally fulfilled and to fulfill their medical mission, should be socially committed.

Fifty years ago I learned a powerful lesson. At that time the USA government was encouraging people to construct underground shelters  for protection  against a nuclear strike. Though the idea was utterly mad it was sweeping the country. A small group of doctors banded together in Boston as the Physicians for Social Responsibility (PSR). Being academics we researched the effects of a multi megaton nuclear attack on Boston.  Our study resulted in five articles published in the NEJM. The impact was profound and enduring. We showed conclusively that underground shelters were probably the worst place to be in case of a nuclear strike.  In fact there was no place to hide. Our publications  put an end to burrowing under ground as a spurious defense against a nuclear attack. It also contributed to halting atmospheric nuclear testing.

When the cold war intensified in the late 1970’s a group of us reached out to Soviet doctors to form the International Physicians for the Prevention of Nuclear War (IPPNW);  a spectacular organization that helped rouse millions of people to the nuclear menace.  We were able to penetrate to the highest echelons of political power. That the world is not threatened with instant extinction is in no small measure due to our struggles. While the Damoclean sword has not been sheathed; at least it no longer is suspended over humankind’s jugular. Doctors helped achieve this.

I have learned that social conscience is not a luxury for the well intentioned, but a necessity for us to remain human.

One final vignette. From crisscrossing the world on behalf of IPPNW I learned that you can buy a coke anywhere in the world but not get safe drinking water;  yet polluted water accounts for 80% of all global disease. While nearly a billion people are undernourished and live on one dollar a day, according to the World Bank, a cow in Japan is  subsidized to the tune of  $7.50 a day. In Africa 1200 children die daily from preventable measles which would cost pennies per life saved. Such statistics are facts with the tears washed away.

I learned furthermore that health professionals  from developing countries wanted less of our technology and more to become connected with one another and with the world.  In 1987 I organized a group called SatelLife and shortly thereafter  we launched low earth orbit satellites. Since these navigated around the poles they touched every point on earth four times daily. (More frequent than we get mail in Boston)

We were pioneers in promoting email in Africa.  To isolated health workers we brought connectivity, to librarians starved for information we provided relevant summaries from the best medical journals. We gave voice to people who hitherto lived in silence.

My aim is to show you that when you see the invisible you can do the impossible. These words are being addressed largely because of my conviction that you can make a difference. For life to have meaning young people like yourselves must take to heart the words of the Afro-American poet Langston Hughes:

“Hold on to dreams

For if dreams die,

Life is a broken winged bird

And cannot fly”

The most important dream is that human beings someday will deserve the name human.  So  I urge you not to stop the climb. An aching patient  craves your healing touch. A troubled world awaits your intelligent embrace.

4 responses to “Doctor both to patients and to the World

  1. Barbara Roberts

    Such wisdom, such inspiration. Thank you Dr. Lown. I will forward your address to other would-be healers.

  2. Patricia Symonds

    How true your words are Dr. Lown. Health care has become less of a human effort to make a difference for the sick and ailing and more of a commodity with less compassion . Please keep up your climb to make a difference and to pass it on for the caring young people who are graduating into the profession today

  3. A wise speech, Dr. Lown with sage advice for tomorrow’s medical leaders. Indeed the graduates in this class will be inheriting a medical system in need of reform.

    But they will also inheret a planet in which the nuclear Sword of Damocles threatens to strike from places not previously thought possible and in ways not imagined in the Cold War. The international medical movement for nuclear disarmament will need their partnership to once again prevent the unthinkable and do the impossible.

  4. Oh that my class of graduates had heard and heeded such wisdom. the role model provided by Dr Lown can guide not only a more just and equitable system, but also provide so much more meaning to life for those following his example. his enthusiasm and pragmatic listening approach preserve his youthful energy, that belie his nearly 90 years. What a thrill to start a medical career with such a vision. Thank you Bernard!!

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