Take Care – Caring for Self and Others in 21st Century Medicine

Vito Imbasciani, Ph.D., M.D. '85
Vito Imbasciani, Ph.D., M.D. ’85

Vito Imbasciani, Ph.D., M.D. ’85, delivered the Commencement Address at the UVM College of Medicine ceremony May 17, 2015. He is a urologic surgeon and director of government relations at Southern California Permanente Medical Group and a retired colonel, medical corps, U.S. Army. This blog post features his speech in its entirety.

O happy day!  Congratulations to the Class of 2015 who brought us all here together to celebrate a great milestone in the life of this College, and in the lives of 113 newly certified physicians and MD-PhDs. Tomorrow you launch yourselves into a world sorely in need of your brains, your healing hands and your caring hearts.  Few accomplishments in life require so many years of unwavering dedication: if your lives were a map, today would represent the Continental Divide.  What happens to you here today you will carry with you forever, like a moveable feast. We’re celebrating today not merely the culmination of four years of hard work, but a lifetime of striving – by you, by the family that raised you up, by the faculty that trained you – and your dedication to ideals so luminous that our modern world doesn’t always know how to acknowledge them.

Those ideals come down to us distilled over centuries, beginning with the words of the oath you swear today – credited to Hippocrates, who established medicine as a profession, separate from religion and philosophy. In your life, you may swear other Oaths: the Freeman’s Oath to vote here in Vermont; an oath to get married, or to become a Medical Corps officer, as I did. But the Hippocratic Oath* has primacy of place: it is the oldest, continuous recitation and public pledge in all of human history. It commits you to high ideals – to do no harm, to place your patient’s needs before your own, to be well-kempt; honest; calm; serious; and caring – ideals that will guide you every day in your practice.

Caring for others is something you likely learned without even knowing it.  You learned it from your parents. You learned it from observing the commandments of the religion you were raised in.  You may have even learned it, improbably, from your siblings. You certainly saw it modelled by your academic and your clinical faculties. But care for whom? You are obligated by your oath to care for your patients. But you have an equal responsibility to care for yourselves, as well, and for the larger communities you live in and serve. Your patients will expect you to be a model of good mental and physical health, so you will have to corral the time and energy to do just that.

Caring gets more difficult with time.  Not because we become inured to suffering.  On the contrary.  It gets harder because things change:  your tools change, the legal environment you practice in changes. Even language changes. Take technology: the Hippocratic Oath specifically warns never to cut for stone. But I have made my living for 3 decades doing precisely that. Times change.  I learned the art of cutting for stone as a resident, and over the last 30 years watched open surgery give way first to hand-assisted, then laparoscopic surgery, then to robotic surgery. The residents I now teach have never even seen open stone surgery. Technology promises to change your professional world at an ever more accelerated rate than it did for me.

Electronics are evolving and changing physicians’ practices dramatically. Remember the rotary telephone, and how it gave way to the push-button phone, which in turn evolved into smart phones .  In medicine, the rotary phone is the old paper chart. But our new electronic medical record is only as advanced as the push-button phone.  I happen to use the most advanced electronic medical record available, but it still takes 28 clicks to order a single antibiotic and route it to a pharmacy.

The computer will evolve further, and so will the pharmacy.  It only took 12 years after graduation to reach the point where over half of the medications I was prescribing were not known when I was a medical student.  I wonder how long it will take you to reach that same point?

Changes in language and culture will continue to challenge you to deliver culturally sensitive care to diverse populations, even if you stay in Northern New England.  When I sat where you are, “cis” and “trans” referred to how you viewed a molecule through a refractive lens, not how you viewed a patient’s gender.

The Oath you take today is a great start to ordering your professional life.  But the requirements of that life are so much broader than Hippocrates could have imagined.  He could have added the admonition to learn to speak well in public. You will have to give speeches.  You’ll have to explain to patients of all educations levels (or none at all) about their diseases, and the risks and benefits of their treatment options, using language and analogies they can understand, and do it without condescending. You may feel compelled to take up the cause of large numbers of patients by publically advocating for them before school boards or city councils, or testifying with expertise before state legislators.  Remember, you get to practice Medicine not because of the degree you receive today, or because you complete a residency; no, you get to practice only by fiat of your State Legislature. So learn how to influence the laws that govern your professional life by immediately joining your State Medical Society and lending your voice.

You will do all of these things, and do them well. But one final requirement: Hippocrates says to honor your teachers and care for their children. You do that by caring for what they care for, by loving what they love. The best way to do that today is to remain loyal alumni and never to let fray the threads that bind you to this wonderful University. And someone, please, when the time arrives, come back to encourage the Class of 2045 in similar fashion

We’re here to say farewell, but not in the sense you might think.  When Romans greeted each other with the words, “Ave atque vale,” vale meant “be well,” not “farewell.” It was a true valediction – “hail and fare thee well.”  Not a goodbye, it was a wish for good health and a good life. It is what the College of Medicine and this great University, with all its proud faculty and staff, now wish for each and every one of you. Hail, and Fare Thee well, Class of 2015.

*The UVM College of Medicine Oath is adapted from the Hippocratic Oath.

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