Tomorrow you start medical school. Your dad and I are tremendously proud of you – as we have been each day of your life. I graduated as a doctor 30 years ago. Your new adventure has inspired me to think back to medical school and what I’ve learned over the years. I’m sending a few suggestions your way to mark this special occasion.
- Immerse yourself wholeheartedly in the intensity of medical school. You will be rewarded with a massive amount of new knowledge, essential skills and memories to last a lifetime.
- Never be afraid to ask questions. I like to tell our medical trainees about the Hausa proverb that says, “Mai tambaya ba ya bata.” This means, “The one who asks questions won’t go wrong.”
- Learn how to say, “I don’t know.” You may feel vulnerable when you confess that. But remember that Brené Brown said, “Vulnerability is the birthplace of innovation, creativity and change.”
- Learn quickly how to live with uncertainty and help your patients accept uncertainty too.
- Follow your gut as well as the guidelines. You will be taught about fabulous evidence-informed guidelines for almost every condition. Learn them well. But there is still an art to medicine. A good doctor learns how to blend the art with the science.
- Respect your patients’ gut instincts too.
- Be prepared to learn from everyone, especially your patients. They will teach you about perseverance and dignity. Watch and listen.
- Be prepared to take on menial tasks. There is a pecking order on some hospital wards. When I trained, we believed the undergraduates were given the worst medical jobs. We called it “scut work”. But you understand that each duty is an opportunity to learn and serve. It makes me think of the entreaty of Martin Luther King Jr. who said “If it falls to your lot to be a street sweeper, sweep streets like Michelangelo painted pictures, like Shakespeare wrote poetry, like Beethoven composed music; sweep streets so well that all the host of heaven and earth will have to pause and say, ‘Here lived a great street sweeper, who swept his job well.’”
- Advocate for your patients at all times. You will now have power that your patients don’t have. Use it on their behalf.
- Don’t be afraid to cry with your patients. You will learn to share difficult news – about cancer, disability, dementia, and much more. As you empathize with patients in these difficult conversations, it’s not a bad thing if tears come to your eyes. It’s okay for them to know that you share their pain.
- Don’t be afraid to laugh. Yes, medicine is serious business. But we all know that laughter can sometimes be the best medicine. Laugh with your fellow students, your colleagues, and your patients. Remember to laugh at yourself from time to time. Be like Cathy at Health for All who says, “I love my job because I get to laugh out loud every day.”
- Having said that, you do need professional boundaries. I know you’ll figure out what and where they are, and how to help patients understand this.
- Remember that clinician-patient relationships are among the joys of medicine. You will build therapeutic bonds with patients that will make you both smarter and healthier.
- Sometimes you will need to be firm with patients. (You’ll laugh at this because you know that on the parenting-style scale that goes from backbone to jellyfish, I’m much closer to the jellyfish end of the spectrum.) But in my work life, I have learned that it’s not always in a patient’s best interests to give them everything they ask for.
- Find ways to say I’m sorry. You will be an outstanding doctor. But you won’t be perfect. No doctor is. We all have a few cases we will never forget – the ones where we wish we’d been better or smarter or faster. Those cases teach us the most. At times, I’ve beaten myself up for not getting to a diagnosis sooner. It’s a horrible feeling. But I’ve learned to forgive myself for not being perfect. I don’t hesitate to tell patients and families when I’m sorry. They’ve always forgiven me. Patients expect us to be intelligent, dedicated, and well informed. They already know we’re not perfect.
- Take care of yourself.
- Take real holidays and trust your colleagues to cover your practice.
- Choose your colleagues wisely – ones who are in medicine for the right reasons.
- Treat medical receptionists with the most profound respect. I don’t need to tell you this because you’ve done their job. I know you will cherish them. You know that if you have their back, they’ll also have yours.
- Embrace your instincts as an historian. They will serve you well.
- Cherish the stories from your patients. I’m sure you will because you enjoy people, in general. It’s the stories that help you to appreciate even the least endearing folks. Children’s television host Mister Rogers apparently said, “Frankly there isn’t anyone you couldn’t learn to love once you’ve heard their story.”
- Along with the wisdom of Mister Rogers, you should also remember that phrase attributed to Plato, “Be kind, for everyone you meet is fighting a hard battle.” Behind closed doors, as a doctor you will learn about the complexity of people’s lives and sometimes the chaos they endure. Understanding this will make you a great doctor. Learning the harsh realities that comprise the human condition will make it easier to be kind to everyone.
- Remember what really makes people sick and what makes them well. You will be taught about immunology, pathology, infections, and much more. But you already know that the social determinants of health actually set the stage for all those biomedical actors.
- Do your part to influence those social determinants. Speak up when you see the impact of poverty, unemployment, violence, and more.
- Be thankful for a Canadian medical education. You are learning under one of the best systems in the world.
- Be thankful for the Canadian health care system. You should not have to turn patients away from basic medical care because they lack the means to receive it.
- Follow your passions. I don’t know what specialty you will choose. Let curiosity be your guide. Follow the path that intrigues and energizes you the most.
- Keep in mind that being a family doctor might be the most privileged profession of all. I’m not talking about the privileges of remuneration and respect, though those are very real. One of the privileges of family medicine is the extraordinary phenomenon of becoming woven into the fabric of entire families. When I walk into the doors of an exam room, I often know generations worth of stories about my patients. I get to share some of the best and worst moments of their lives, always looking out for their best health. You can imagine how rewarding this job can be.
- Be audacious. Dare greatly as you develop your calling as a physician. Be inspired by the likes of Tommy Douglas, one of the parents of medicare. When Dr. Vincent Lam described Douglas, he said “He sought to communicate a rare and powerful magic: the infectious substance of practical dreams. He believed that if he and his fellow citizens could envision a better society, commit to that ideal and work for it, it could become real.”
- Relax and enjoy the journey.
With much love,