Revised Friday, June 26, 2015
Thank you, thank you. CEO, President, and Chancellor Smart, Dean Gladly, Provost Provokus; both Vice Deans, Senior Associate Dean, all eight Associate Deans, all eight Assistant Deans, all five Assistants to the Dean; Professors and Chairs, Professors, Associate Professors, Assistant Professors, Adjunct Professors, Clinical and Volunteer Affiliated Professors etc., Instructors, teaching assistants, laboratory assistants, Chaplains, 600 odd members of the academic staff, Emeriti upon Emeriti, and e-simulated patients. The Board of Trustees, Regents, Accreditation. And special salutations to you compliance officers and you development directors, officers, functionaries, interns, squads of you with more appearing by the minute by spontaneous generation. My apologies, in my day you didn't exist. And, oh yes… students. Parents, spouses, partners, significant others, your CPAs and lawyers. And friends. Thank you, all, thank you. It’s a privilege to stand at the teleprompters with you.
Looking around at you wonderful faculty, all in academic garb, I am reminded that – here’s the required introductory humor -- in my day the academic headgear was a mortar board; now, an ice bag.
It’s traditional that a graduating class’s endurance, a quality crucial to coping with the real world, be tested by having to listen to an old grad ramble on about how it was before the class was born. I am here to tell you that I graduated before disposable hypodermic needles, when urinary catheters dangled free into gallon glass bottles of old cider, and – gasp! -- mercurials were the best treatment of syphilis and acute pulmonary edema. And when we still did housecalls. I’m so old I remember when “health reform” meant not smoking or eating pork and eating peanut butter and gluten steaks, not some new legislation enabling free liposuction or regulation making 16 ounce cups of soda illegal.
But you young whippersnappers need to know that our day was not uninformed; even then we learned the Krebs Cycle, all ½ page of it. My dad, who graduated from this school before I was born, missed Krebs by five years. But his Gray’s Anatomy was as huge as mine – or yours.
Hmmm….Oh my! I see that my time is up. I used it all saluting the faculty, which, like learning the Krebs Cycle, takes longer every year and finally has taken over, and dishing out the obligatory humor, more required every year, and nostalgia, which doesn’t ever decrease. Farewell, lots of luck, always be loyal, join the Alumni Association. [Collecting notes, starting to return to seat -- but wait! I'm being signaled to return to lectern.]
You say I can take a little longer? Thank you! Well! I get to say what I really wanted to say after all! It’s going to be dead serious. No more humor.
Ever since I shambled these halls, the ones that were here going on 70 years ago, it has been my dream to stand and address a graduating class of my alma mater, even though it has a different name now, Loma Linda University. When I graduated it was the College of Medical Evangelists. Odd name, long gone. Does it make you wince? It did me, a little, back then. Not now. As a matter of fact, I would feel especially comfortable, and proud, if it were a class being graduated by the College of Medical Evangelists that I now speak to.
Actually, I wasn’t asked to speak to anybody. Whoopi Goldberg got invited to address the graduating class of Savannah College of Art and Design (SCAD), maybe the largest institution in the world for training creative spirits, but she’s funnier than I am. So this is total fantasy. It’s what I would say if I were living out my dream and really addressing a graduating class in medicine, a different kind of practitioner of the creative arts. But in fact this is not a real speech, it’s a pretend speech, which is so much better for both you and me. And the PR Department. Don’t look for this on uTube. You will have to settle for Whoopi.
My topic today is, or would be, “Be Ye Not Conformed,” Romans 12:2.
Whoopi Goldberg beat me there too, almost. “Be Unique – be Weird,” she extolled, sounding weirdly serious. But the weirdness Whoopi was promoting is not really all that unique, nowadays. Actually Whoopi Weirdness is the new cool conformity, the voting majority. Me, I’m urging you to be really unique, weirder than Whoopi urged upon art school grads, who never required much urging in that direction anyway.
I’m urging: Love your patients. Don’t just process them, love them. Serve them.
That basic message is hardly new, certainly not at CME or LLU. I’m pretty sure I heard it at our graduation 60 years ago. Our graduation orators have always warned of the impediments to loving, even serving, the patient – the stock market, really promising property in Thousand Oaks to grab, a house and Chris-Craft speedboat at Lake Arrowhead. And soon enough we were wearied and annoyed by patients beseeching, badgering, hassling, phoning at all hours, refusing to pay, leaving us for other doctors. And then they started suing us.
But the impediments I was warned about were ant-hills or pebbles compared to the battlements, the continental divides, the Himalayas that will separate you from patients. The world has changed in every way, hitting medicine the worst way, and it all seems contrived to separate you from your patient, to distance you, to alienate you from the patient and the patient from you. You may identify with the Samaritan in the parable but will leave as wide a swath between you and the patient as the Pharisee did. You and your patient will be separated by more hassle and tragedy than Romeo and Juliette. You will be as virtual and unreal to your patient as I am to you giving this address.
Before your fifth class reunion you’ll more likely shrink from, or fear, or dread patients, if not hate them, and everything that comes with them or from them, than love them, if you are aware of them at all.
So I’m delivering my message without the airiness I’d have given it just ten years ago, and with a helluva lot more urgency [pounding the podium, making the PA ring] than it’s been delivered before in history, or is being delivered from an actual mouth to actual ears anywhere in the world today, including maybe Loma Linda.
Rather than still thinking of the patient while you’re driving home, or mulling the diagnosis while you’re shaving in the morning (or doing your hair and nails), you will be preoccupied with HMO and hospital and regulations and laws and review boards and contracts and malpractice premiums, pay rolls; with finding people to hire who will not sue you or be drugged out, or be sufficiently diverse of color and gender to satisfy the government. And the layout and graphics for your TV ad and i-app. (My advice is to hire a SCAD art school grad.) You will be more occupied with making the remuneratable diagnosis, not the right one. You will be obsessed by what the next law and regulation might require or prohibit. You will live in fear of being fined and penalized by the HMO, the state, the IRS, the HHS, or somebody; of ordering too many lab tests and being penalized or not ordering the right one and being sued for missing the diagnosis; of being exposed as greedy if not fraudulent. While you’re being sued by the patient or the hospital or the government, the government will be suing your hospital for discrimination or not providing free abortions to employees, or maybe sex changes, or for nonconformity to something, and you’ll be suing the hospital for deprivation of income, or maybe suing the HSS or countersuing the FDA or the IRS or your CPA, or writing letters or blogging the AMA or the HSS or the FDA or the NYT.
You will be answering to committees, bureaus, boards, panels, the media, activists, lawyers, courts, codes, manuals, databases, Medical Associations at all levels, insurance entities of a hundred sorts, the Health Industry, the government, but not to patients or your conscience or to your God.
I understand you are given a course in “Seeing The Whole Patient.” (We were given courses in the Pauline Epistles.) How can you see a whole patient through the whole ball of wax of bureaucracy, and you barricaded and cowering behind your own wall of court functionaries, bodyguards and security guards, stand-ins, proxies, nurse-surrogates who explain, instruct, actually talk to the patient, while your managers and attorneys are clamming you up.
And how can you love or serve your patient if finally you actually see him for only four minutes, and won't talk to her on the phone.
But your university has prepped you pretty well for dealing pragmatically and paradigmatically with today's patients. Those courses about The Whole Patient are good. LLU's Simulated Whole Patient Labs just what the doctor ordered. And LLU can boast of the renowned and cutting-edge Institute of Bioethics, started, by the way, by my classmate, Dr. Jack Provonsha. More Insitutes of sundry wholenesses, wholly donor-centered, are on the way. And you havgeore been made ready for coping with the system, you must have had seminars with business school faculty, CEOs and CFOs of wildly successful Adventist Care Facilities, and squads of lawyers and asset managers, and field trips to Humana, simulated, virtual, or otherwise.
But I'm here to urge infinitely, impossibly, more than what the most advanced curriculum and seminars in the world can possibly train or coach you to do -- to love your patient. Serve your patient. Love your patient as God loves him, not as the HSS, GovtCare, the courts do.
But…that’s…absurd! Serving, loving patients like that, now, nowadays -- it’s against all manuals and scripts and operating procedures and regulations and laws! Studies have shown it’s against evolutionary ethics. It’s weird-weird. Nonconformity on steroids. Art students are models of conformity, compared. It’s asking way too much. Nobody expects it. Nobody else is doing it. It's not only out of style, it's irrelevant, it's counterproductive. Despite all the “we care” hype, the whole Health Care Industry, probably many of your classmates, certainly your billing agency, would be at odds with you. You might well suffer for it, financially, maybe even professionally. Maybe you’ll be fired by your group, or fined by some agency or board for practicing low quality medicine, or, worse, failure to meet production quotas.
You will be one helluva non-conformist.
Serving and loving your patients will be as challenging for you as serving and loving their God was to early Christians being thrown to lions.
That’s what you’re up against.
Against all that, try to remember – Be not conformed to this world! You have no choice but to conform to regulations, but be not conformed to their spirit. You must conform to the law but not the culture of the law. In the six minutes you are permitted to have with a patient, let him, her see a glimpse of a weirdly otherworldly godliness if only in your tone of voice, not a glum apparatchik.
You must remember -- it’s Christ you’re following, not SNOMED codes, or HMO or GVTCare regs, some political agenda, or the government. You -- and your patient -- belong to Christ, not to CaesarCare. If you like your patient you may not be able to keep him (or her), but pray that God will.
When, after waiting 8 or 9 months, the patient finally gets a 5-minute appointment with you, it may occur to you as a Christian physician that you should pray with her, like CME physicians used to, years ago. The next instant you'll be wondering what the hell ever gave you that idea. Anyway, you can't in 5 minutes. Adjusting her Prozac dose is more crucial, and reimbursable.
Now then, my dear very real graduating class, by fulfilling only in my imagination my dream of addressing you could I so bullheadedly describe all that you will be up against, holding no punches, to get my point across to you in a manner you would not be hearing live in real time from this big tent in front of the Coleman Pavilion looking out over this gentle campus, or any campus. But by the same license I can be equally audacious in proclaiming the very real advantage, crucial advantage, that you, and no other graduates, have. You have the heritage of the College of Medical Evangelists. You have God! God who is the author of love, the only source of it, who is Love Himself. Ethics isn't, God is. Pray without ceasing. It'll take nothing less.
Now then, yes, Farewell! Good bless you! Oh, may God bless you as you bless those He as entrusted to you – no, no longer -- those otherwise assigned to you. For six minutes max.