We are so pleased that our own Dr. Dave Munson was invited to speak at the Tufts Medical School 2019 White Coat Ceremony. Here is his keynote speech in its entirety:
Thank you Dean Berman for that lovely introduction and thank you to the class of 2023 for welcoming me today. It’s an honor and a privilege to stand before you and share a few words. It’s somewhat hard for me to believe I’m here. I can still remember sitting in the audience in the Cutler Theater what seems like yesterday and walking on stage to receive my own white coat emblazoned with the TUFTS icon.
You know, in some respects, the White Coat is going out of style. They are rarely if ever worn at BHCHP, can sometimes impede collaboration across disciplines and have probably been traced back to the transmission of resistant bacteria. Indeed, it might not be long before incoming medical students are cloaked in Patagonia Fleeces.
But the symbolism of the coat still runs deep and in so many ways complements the Oath you are all about to take today. The coat holds tremendous meaning and commands respect. For me, the white coat embodies four distinct characteristics essential to any physician. Regardless of if you wear a white coat each day of your clinical practice, or if it ends up buried deep in your closet, I hope when you see it you are reminded of these four traits.
First, empathy. Caring for and understanding your patients is at the core of the profession you are about to enter. You will encounter people at their most vulnerable and during some of their most difficult times and to be truly successful, you must learn to sit and know their true experience. But how to do that in the era of the EMR’s 1000 clicks and the 15 minute office visit?
Listen. Be patient. And when you can, try to walk with your patients.
And I know what you guys are thinking. How do I actually learn how to do that? Well here is a little secret – you have a trump card to use over the next 4 years – you’re paying to be here!! Use it! Spend all the time you can (and then some) with patients. Sit with them (in close, like on the bed). Learn their stories. Earn their trust. No resident or attending will ever fault you for spending some extra time at the bedside getting to know your patients.
One of the most amazing parts of my time on the Street Team at BHCHP was actually going out on the street, during daytime and at night, in mostly all weather, to try to connect with some of our folks who didn’t want to come in. We weren’t usually successful but man, did I gain an appreciation of what they were facing – trauma, severe substance use disorder and major illnesses like cancer or cirrhosis – all while living outside. When those folks finally did come into clinic or to our medical respite program, I found that my connection to them was that much stronger. I knew their histories and presentations in a way that I couldn’t otherwise. And I took better care of them as a result.
You all will find the same. Take the time to get to know your patients. Learn to listen to what they say and try when you can to walk in their shoes. Soon you’ll notice that the bond you have with them will grow deeper. You’ll better understand how diseases present differently in each of your patients and your diagnostic skills will grow. You’ll develop more patient centered treatment plans and watch as those you care for follow your advice and actually get better!
So in addition to learning the Krebs cycle this year and understanding hyponatremia, take the time to hone the skills you all need to become empathetic clinicians.
Next, advocacy. I want you all to recognize the tremendous power that these white coats hold and to use that power to be forces for positive change in the world. Some of you have probably already become aware of your newfound ability to influence. Raise your hand if you’ve had a relative or friend ask you a medical question already? [If you haven’t, get ready for Thanksgiving]. It really is amazing how people respond and react to the two letters you have after your name or the white coat you have on. If you haven’t realized it yet, the profession you are about to enter is respected tremendously and you will have the ability to command attention in any room, large or small, from a rural village to Washington DC. Having such power is an immense privilege, and with it comes a responsibility to give back to society.
Now the obvious question is how. How do I even know what to influence and how could I possibly have any impact in the middle of busy clinical work or a research career. Here’s the key: Start small. You might not think of it as such, but writing a letter on behalf of a patient – to excuse them from jury duty, to defer their heating bill, to postpone a court date, is advocacy.
Recently, I was lucky to participate in a State Commission that examined Massachusetts’ law around involuntary commitment for substance use disorder. More than 20 of us met over the course of a year to develop recommendations for the state Legislature. I was continually amazed with how the other members of the Commission – lawyers, legislators, health policy experts, looked to the physicians involved for guidance and expertise in crafting the final document. It was incredibly rewarding to play such a pivotal role in this important work.
As it will be for each of you. Regardless if you devote your career to making new discoveries, developing policy, running a company or simply caring for patients, you’ll have ample opportunity to impact the greater world around you in a positive way. Make the most of these opportunities and you’ll find greater fulfillment as a physician.
Ok. We’ve talked about empathy and advocacy. Now, service. This is the idea that you will spend your career, and indeed most of your life, putting the needs of others before your own. In many ways that is the essence and defining characteristic of the field of medicine. It’s humbling and can be incredibly rewarding to be the person who is relied on by others in their own times of tragedy and strife. Whether you become a surgeon, a radiologist or a pediatrician, your career will be spent taking care of other people. Let me tell you about one of my primary care patients – he was a man I saw on street outreach weekly for many years. A long-time user of IV heroin, he would always politely dismiss my overtures at bringing him in for treatment. He became housed and I was lucky enough to be able to visit him at home where he and his partner lived happily with their two cats. Unfortunately, his partner passed away of an infection and my patient grew increasingly melancholy. After about a year, we finally got him to come into the clinic weekly, started suboxone for his opioid use disorder and were working towards a goal of getting his hip replaced when he began to complain of difficulty swallowing food. I wish I could say that I convinced him to be seen by ENT immediately, but I think he was terrified and it took about 3 months before we found the large cancer in his throat. 6 weeks later, he required a tracheostomy to breath and couldn’t speak. I said goodbye to him just before he transferred to hospice.
Following your patients through the peaks and valleys of their lives, and being the person they rely on for guidance through it all, will be one of the most rewarding aspects of your time as a physician and indeed, of your life. But be warned: it will require you to sacrifice. You may miss holidays, birthdays and anniversaries due to the tension between caring for others and caring for yourself. And if you’re not careful and you don’t pay it close attention, it’s easy to get so lost in service that you look up and find yourself burnt out.
That’s where the final trait comes in, and indeed, it might be the most important: Joy.
I want you all to pause for a second and close your eyes.
What drove you to be here today?
What is it that you love about the idea of becoming a doctor?
Is it the thrill of connecting with and curing patients? The chance to discover a new therapy that will change the course of disease? Do you dream of running a hospital system or influencing government to change health policy? Whatever it is, hold that thought in your mind and take a picture. Now take that picture [pretend you’re using a Polaroid, not an Iphone] and tuck it in the top front pocket of that new coat of yours.
I want you to keep that idea, that little kernel that causes your stomach to flutter with excitement, close at hand through this year and the years ahead. Joy. Joy is what will sustain you through this work and is the anti-dote for burnout. Joy will get you through studying for the boards, through long nights on call as a resident and through both the triumphs and tragedies of your time in practice. Whatever you find as joyful in medicine, keep it close at hand and learn to recognize when it’s not there.
For me, seeing patients is what I love. My role at BHCHP has evolved since my time on the street team and over the past year I had stopped seeing patients regularly. This spring, I found myself dragging and realized I wasn’t having fun at work. So I changed things up and for the past two months have been spending a full day each week doing direct patient care. Sure, there have been trade-offs: my schedule is more compressed and I’m probably writing a few more notes from home. But I can already feel my tank filling back up.
The next four years will pull you in myriad of directions but please keep focused on what it is that finds you joy. Come back to this on a regular basis and make it a point of your practice. While the field you are about to enter can be hard, it’s indisputably fun and can allow you to feel more fulfilled than any other profession.
Ok. so, let’s summarize.
Empathy: learn to walk in your patient’s shoes.
Advocacy: be a force for positive change.
Service: work for others not yourself.
Joy: remember what you love about this work and hold it close.
Whether you end up wearing a white coat every day of your career or bury in the back of your closet until your 20 year TUFTS reunion, please keep in mind those four simple ideas.
Thanks so much for your time today and best of luck in the years ahead.