LSUHSC Department of Medicine White Coat Ceremony Address, 2014
D. Luke Glancy, MD
Let me congratulate each of theWhite Coat recipients on having successfully completed medical school, no small ac- complishment, and on having secured a first-rate residency appointment that will allow you to continue the life-long learning process that is a requisite for being a successful physician. The intellectual rigor that medicine demands and the opportunity to continue to learn are two of the chief joys of this, the noblest of professions. Each of us has had outstanding mentors, and hopefully, we will have more. I suspect that you will find, as I have, that mentoring comes not only from professors, but also from your fellow house officers and, most importantly, from your patients. The patient, of course, is at the center of our world. What an honor it is to be entrusted with caring for our fellow hu- man beings! It is an awesome responsibility that teaches us not only about disease processes, but about human nature and coping with adversity. Nothing is more rewarding than helping a patient through a life-threatening illness, and nothing is more humbling than not being able to do so. Now, if you will indulge me, I’d like to discuss a half dozen precepts that I have found helpful in increasing the number of salutary medical experiences and in keeping the number of unwholesome ones to a minimum. I must admit that I learnedmany of these rules by violating them, usually a most unpleasant experience. 1. TREAT EVERYONE WITH RESPECT. This includes your patients, whether they are governors, archbishops, in- digent persons, or prisoners. This also applies to all of your co-workers from the chief of the service to the janitor. An air of superiority serves no useful purpose and is often an impediment to the success of any endeavor. In this regard, the nurses are your special partners in the care of patients and deserve special respect. 2. ALWAYS CARRY YOUR SHARE OF THE LOAD. And if you are asked to carry more than your share, do so without grumbling. All of us occasionally need help, and your time will come. In the same spirit of collegiality, don’t worry about who gets credit for the life-saving diagnosis. The important thing is that it was made.
3. KNOW HOW THE BODY WORKS. This seems axi- omatic, but relating your patient’s findings to the anatomy, physiology, biochemistry, and pathology that you studied so intensely a few years ago is not always easy. All signs and symptoms, however, have pathophysiologic bases, and defining these will facilitate both diagnosis and treatment. 4. TAKE NOTHING FOR GRANTED (TRUST BUT VERIFY). When one of your colleagues or a referring physi- cian tells you about a patient or you read his or her evalua- tion in the medical record, start by believing the information because he or she often is correct and is never intentionally trying to mislead you. Just remember that because most of us run diagnostic algorithms the same way, if you believe all that you are told, you will come to the same diagnosis as the referring physician. It is better to take your own his- tory, do your own physical exam, and examine the pertinent laboratory data yourself. Youwill then often have a different data set, consequently run a different algorithm, and arrive at a different diagnosis. All of this may require getting out of bed and going to the hospital in the middle of the night, but the trip is worth the inconvenience. 5. BECOME A DIAGNOSTIC EXPERT. There is prec- edent for this. Early in the 20th century, internists were often known as diagnosticians. Regardless of one’s specialty, however, optimal treatment depends on a precise diagnosis. Much intellectual effort is appropriately devoted to devel- oping and learning treatment guidelines. All such effort, however, presupposes an accurate diagnosis. Remember the role of the history and the physical exam, which often either make the diagnosis or suggest which of our more sophisticated tests will. The ability to take a history and do a physical exam is always available. The H and P are non- invasive, cost only some of your time, and can be repeated as often as is necessary. 6. THEBUSINESSOFMEDICINE IS IMPORTANT, BUT IS NEVER PRIMARY. Virtually all physicians, especially in the United States, make a good living, but our bottom line is not the bottom line of the profit and loss statement, but the bottom line of whether we have served our fellow humans well in the most important way imaginable, i.e. by helping them stay alive and well. Judge Elbert Tuttle put business
J La State Med Soc VOL 166 May/June 2014 121
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