Physicians are not fundamentally different from their patients

Delivered at the Harvard Medical School Class Day Ceremony, May 25, 2017.

Distinguished faculty, dedicated staff, and most importantly, loving parents and family members:

Thank you for all you’ve done to support us and transform us into doctors. Harvard Medical School Class of 2017, congratulations. It is an enormous honor to address you all today.

When I was a third-year medical student, I scrubbed in on the surgery of a woman with ovarian cancer. The purpose of the surgery was to see whether her cancer had spread to other organs. The surgeon instructed me to put my hand on the patient’s liver. As I ran my gloved hand over it, I felt hard nobs of cancer press against my fingertips. I realized that after the anesthesia wore off, the surgeon would have to tell her patient that the cancer had metastasized.

I, however, wasn’t there for that conversation. As medical students, we periodically get pulled out of the hospitals for PowerPoint presentations, group discussions, and role-play scenarios. On the day of this surgery, it just so happened that I had to participate in a medical school exercise called “breaking bad news.” Along with each of my classmates, I was given a pretend patient’s medical history: a middle-aged woman with back pain that turned out to be due to metastatic cancer. In a mock exam room, I sat across from an actor pretending to be this patient and told her the diagnosis.

It was purely a coincidence that the “breaking bad news” exercise coincided with the operation I observed that morning. But the fact that my attending surgeon was communicating such a serious diagnosis with her real patient as I play-acted the same scenario with an actor reminded me that medical school has been a dress rehearsal for the real responsibility of medicine.

When I consider that responsibility — whether it be performing surgery or telling someone life-altering news — I am struck by the vulnerability of patients. The word vulnerability comes from the Latin root vulnus, meaning wound. To be vulnerable means, being capable of being wounded. Our patients come to us so that we may heal their wounds, but in seeking care, they open themselves to being wounded anew — both physically and emotionally. Being a patient almost always entails physical pain, uncertainty, and a loss of control. Patients let us into their stories before they can know if we will respond with compassion and understanding, or if we will brush them off or make them feel ashamed. By saying out loud this hurts and I don’t know what to do, patients open the possibility of sustaining further wounds. But yet, it is only through telling their stories and putting trust in others that they may be healed. In this way, vulnerability is a prerequisite for healing.

When we started medical school, our faculty told us our best teachers would be our patients. I think we have a lot to learn from our patients about the power of vulnerability. Though no one says it directly, medical culture implies that vulnerability is for patients, not for doctors or medical students. It wasn’t until I became a patient myself that I learned to embrace my own vulnerability.

After my third year of medical school, I was diagnosed with depression. Though research published by our own classmates and faculty shows that greater than one in four medical students have the symptoms of depression, the experience itself can be painfully isolating. In my new role as a patient, I told my story. I said out loud this hurts and I don’t know what to do. It was scary — just like it’s a little scary telling you this story today — but I learned that my vulnerability was rich, fertile soil for my own healing and growth, for forging more meaningful relationships, and for gaining a deeper understanding of my patients.

This next stage of our training will be incredibly exciting: we will step out of this extended dress rehearsal and take on the responsibility of caring for patients. In addition to providing excellent care to our patients, many of us will make important contributions to research, health policy, global health, or social justice. But at the risk of a being a downer on graduation day, we will also all face challenges. There will be the daily struggles of sleep deprivation and feeling like we just don’t know enough. Many of us will deal with family illness, personal loss, and yes, depression. We may wonder if we’re cut out for the heavy responsibility of medicine. In these moments, I hope we will embrace our vulnerability and share whatever is troubling us with each other, our friends, and our families. The alternatives — silence and isolation — might feel safer in the moment, but in the long run, keep us from growing into our best selves. Just as importantly, I hope when our colleagues and students open up to us about their struggles that we recognize their vulnerability for what it is: not weakness, but courage.

I really believe that when we take care of ourselves and each other in this way, we are so much better equipped to care for our patients. Our patients will come to us with challenges far beyond what many of us will ever experience. Our patients will be wounded not just by disease but also by trauma and neglect, marginalization and inequality. As physicians, we will be in the unique position to see our patients’ vulnerability and help transform it into healing. To do that well we need to see that we are not fundamentally different from our patients. We are all human and therefore all vulnerable. And that is a powerful, beautiful thing.

Colleen Farrell is an incoming internal medicine resident.  She can be reached on Twitter @colleenmfarrell.

Image credit: Shutterstock.com

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