Speak out, but also learn to listen, Altman tells new graduates
BY MIKE GOODKIND
The time has come for physicians and medical researchers to cast aside their long-standing reluctance to enter the political fray and start becoming better communicators, guest speaker Dr. Lawrence K. Altman told new graduates of the School of Medicine at Sunday's convocation ceremony.
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Invoking the need to be both historically savvy and aware of current issues, the New York Times medical correspondent observed that "medicine is now a public institution and doctors are public servants."
"Even a private medical school as venerable as Stanford truly is semi-public," Altman said. "Any private medical schoolis so dependent on taxpayer funds that it would close without them," despite the high cost of tuition endured by students and families."
"In that setting, doctors should cease using politics as a pejorative word and become more involved in the political process," he said. "The days when doctors and scientists keep silent and default to others must end. If not, doctors and their patients will continue to lose ground, simply because that is the way it is in the political process.
"So learn to speak out on public policy issues," Altman urged.
'El Niño, El Schmiño'
Under sunny skies on the season's first true summer day, 89 new physicians, 69 new PhDs and 15 MS graduates received degrees in last Sunday's ceremonies. (Some graduates earned more than one degree.) Honors also went to several faculty members who taught and mentored the graduates.
"El Niño, El Schmiño," Dean Eugene A. Bauer taunted as the afternoon temperatures rose into the 80s.
Other convocation speakers included Dr. Edwin Palmer Rock, speaking on behalf of the MD graduates; Elizabeth Margaret Kerr, who spoke on behalf of basic science graduates; and Dr. Ross Bright, associate dean for alumni affairs, who welcomed the new graduates to the alumni association.
Past and future
Communications both in the examining room and on the political front and the importance of learning from the past were recurrent themes in this year's convocation speeches.
Historical perspectives provide a sense of our recent and distant pasts, Altman said. "But new doctors are denied this perspective because medicine and science are the rare professions that do not teach their initiates the history of their professions. I submit that such omissions from the curriculum make medical schools more trade schools than universities."
Knowing their history can help physicians understand that "most of the medicine you will practice, the research avenues you will pursue and what you will teach, is based on knowledge gained in recent years."
"We have learned more about science and medicine in the last several decades than in all of history. Those are the dividends from taxpayer and industrial investment in medical research and education," he said.
Explain without jargon
In encouraging new physicians and scientists to become more vocal on public policy issues, Altman said, "don't complain to your medical colleagues, because they already know. Instead, explain the problem to your nonmedical friends and patients because they do not know."
And, he said, "learn to explain medical problems in terms your nonmedical friends can understand, not in the jargon that fills everyday rounds and pages of scientific journals."
Elizabeth Margaret Kerr, a new PhD in immunology who spoke on behalf of basic science graduates, noted a few minutes before Altman spoke that "the majority of people I know have a PhD, and that can't be normal." So, since "most people know more about how their car works than how their bodies work," she advised graduates to "have patience and explain things to people in ways that they can relate."
Echoing her point, Altman reminded new doctors that they have already studied four years and have more training ahead. If it takes the doctor this long, he said, "is it fair to expect patients to learn what they need to know about their illness in the few minutes you spend hurriedly telling them?"
Remember that most people "do not have your understanding of what goes on in hospitals and doctors' offices," he advised. "Your burden will be to learn how to explain something as if you were an outsider, but with the knowledge that only an insider can have."
Effective physicians use some of the same skills as journalists, he noted. "Much of the work of a doctor is being a journalist, an enterprising reporter. ... What doctors call medical histories, journalists call interviews. Whatever you call it, the best clinicians and medical researchers have learned how to ask the most probing questions, then listen intently to the answers, and finally analyze that information," Altman said.
"There is a compelling reason for clinicians to listen. The patient knows more about himself or herself than anyone else."
Altman urged his newest colleagues to avoid using the faster pace driven by managed care as an excuse for being inattentive to their patients.
Instead, he said, "acknowledge that
the problem is ours, that patients registered the very same
complaint against doctors in the fee-for-service era that preceded
managed care. Doctors have no excuse for being poor listeners."
SR