ESPN Chief Medical Correspondent Michael Kaplan, M.D.’87, was the invited guest speaker for the University of Vermont Larner College of Medicine Class of 2017 Commencement. This blog post is his commencement address in its entirety.
Dean Morin, esteemed faculty, alumni, parents, graduates, family and friends. It is a thrill and an honor to be here in Burlington and celebrate with you at the 216th UVM Larner College of Medicine graduation. I was fortunate to be educated here for my medical training and orthopedic residency in this magnificent part of the world. I realize 10 of you are lucky enough to also stay on and complete your residency on this campus. I remember my graduation here 30 years ago – 1987 – freezing cold, hail and blistering wind. My family wore every bit of clothing they brought, and we took a boat trip on Lake Champlain. No wonder I went to Birmingham for Fellowship (Just to warm up)!!!!! Pierre Galea and Meghan Breen, you’ll love Alabama.
I want to begin today with the premise that the practice of medicine is changing dramatically. Technological advances / financial considerations, hospital and clinical alliances, and sociological considerations have altered the landscape in fundamental ways since I sat where you do now. But for all of that, much of what doctors do, have done, and will hopefully always do, remains much the same. We are assigned and assume responsibility for the welfare of our patients.
Judaism suggests that medicine is a priestly vocation. That was always curious to me. I have a brother in the clergy, and while I emulate him and his mission – I know it’s not for me. Certainly, I never felt that I was very priestly and rather, being a doctor seems to call for a discreet combination of just the right amount of hubris and humility to be an effective physician. Many times I feel more like a glorified carpenter, slashing deep into the knee and carving off the end of the thigh and tibia and then hammering on a metal prosthesis. I often suggest to my kids and patients that in a few decades, future physicians will look back on our archaic methods and consider us to be philistines. For the moment, though, we can take a crooked and painful leg and restore a patient to a comfortable and functional life. Not risk free and not without an investment of time and discomfort, but typically, 90 percent predictable and worthwhile. After an operation, the body goes into high gear to recover from a calculated insult. There is an old proverb that is popular in surgery, and the 22 of you that are going into surgical sub-specialties will surely hear and that is, God heals the wounds and we doctors just change the bandages. At the end of the day, nature is in charge.
In the Bible there is a passage that reads “everything that is born must die”, and so it is also fair to assume that we are fighting an uphill battle in medicine. Ultimately our bodies deteriorate with age and Father Time wins 18/0 every season. As caregivers and particularly as medical providers, because the cards maybe stacked against us, and even if we have the most sophisticated technology and science, in the end, our patients may not benefit or survive. It’s sobering, but regardless of the very best of our care many of our patients ultimately succumb to their diseases. Nonetheless, we must have the bravado to take on the responsibility to ensure treatment to another human being and have the confidence to believe ourselves worthy of that obligation, while having the humility to know that the life surrendered to your watch, is both an awesome burden and an honor, one from which we cannot ultimately have control despite even our best efforts.
A bit more mundane, but somewhat to the point for which I was chosen here to speak, is my role as a TV personality and medical correspondent. I give insight into athletes’ injuries, the nature of their physical insults, how they are to be treated, what rehab is necessary and how it might impact their return to the field or court. This role is much like office work, explaining to patients in layman terms what to expect from various knee and shoulder maladies. Everybody likes to think they are an elite athlete. Certainly, everybody wants to be treated with respect, caring and good judgement.
It is somewhat ironic that I have the good fortune of being the Senior Medical Correspondent for ESPN. I never really watch professional sports and the names of the teams and players are foreign to me. It has been the stuff of many an embarrassing moment on set and with my family when mispronouncing athletes names or being unfamiliar with an individual’s particular prowess. Nevertheless, I remember pitching the idea before beginning my start with ESPN to my patient, who was then a Senior VP and an original founder of the network. I suggested that CNN had Sanjay Gupta for medical insights and that much of what ultimately results at the end of the season in all of the various sports is largely dependent on who gets hurt and how their injury manifests itself on their performance. After two years serving on an NFL team and knowing of the leagues imperative pledge to secrecy, I realized that the public is barred from any appreciation of what is really going on when an athlete gets hurt. Understanding the variables of how severe the athlete is compromised, what treatments and rehab is involved and to what degree it may impact their return to sport is essential to a team and the fans bottom line. Just like any discipline, a TV presence requires focus, repetition and clarity. In my late mother’s words, 10 percent inspiration and 90 percent perspiration. Also, I have the advantage that 99 percent of my audience know less about the subject than I do — and I am often reminded that I am to direct myself to a sixth to eighth grade peer group (as an orthropod), my sweet spot!
I feel obliged to offer some insights into medical media, as this distinguishes me some for the opportunity to speak to you. After 13 years of television and radio commentary and particularly from interviewing with sports analysts, it is apparent to me that there are many similarities in the disciplines of medicine and media. In both fields, an authority figure must relate to the public in layman terms what is going on when someone is hurt. The translation from didactic Latin medical terminology to understandable English requires three fundamental things.
- Understanding the pathology.
- Confidence with the ability to engage your audience honestly and cogently. And most importantly,
- Readily offering oneself up as human — real, approachable, and smile and let the world in.
You can reach them only if they can relate to you also. As my wife once gently critiqued me after an earlier TV segment in my career, “See if you can get that stick out of your ass.”
As you begin your clinical training I remind you that it is important to pay attention to the details and listen to the patient. Touch them often with your hands and your heart, empathize but remain sufficiently dispassionate to be objective, mostly appreciate everybody has a soul – and make every effort to be soulful. When you are with your patient, they must have 100 percent of your attention. No distraction can interfere with the communion between the two of you. Involve yourself with their family when appropriate. Understand their circumstance and empathize with their challenge and how the medical and physical ailment will further inspire or impose on what already is on their plate. There will be a myriad of challenges for you as a physician and a human being. They will arise for you, for your staff, hospital and fellow associates . These types of emotional demands are so varied and complex, that they are beyond discussion today. I remind you only that your patients should be given special latitude for seemingly irreverent behavior. They can misbehave. When someone is in pain, frightened and vulnerable, they must be granted a few passes on how they may slight even those who are trying to help them. Remember, your work is in fact a sacred calling – to help and ease suffering is truly a blessing.
As decent human beings, and especially as doctors who are charged with caring for the sick, we should help our patients in the words of Abraham Lincoln, “Meet with dignity, the indignity that life meets out to us.” Your residencies and continued education in professional medicine will equip you with a skill set to ease another’s pain and improve their functional capacity. The science and art of medicine combine to allow us to apply our tinctures and scalpels with only the most modest of understanding of nature’s intricate design. We have to be careful to remember that the objective is to do as much as necessary, but no more than needed. Much of what is awry in the body can heal itself, or can be adopted to, and the malady often is better than what might be a medical remedy. For all the good I have done in my experience, I only regret cases I have done, none I have canceled. It’s the old adage, do no harm. Daniel Lieberman in “The story of the human being” said, “All healthy bodies are alike, each unhealthy body is unhealthy in its own way.” We didn’t evolve to be healthy, but instead we were selected to have as many offspring as possible under diverse, challenging conditions. We never evolved to make rational choices about what to eat or how to exercise in conditions of abundance and comfort. Certain cancers, type 2 diabetes, osteopenia, heart disease, strokes, kidney disease, some allergies, dementia, depression, anxiety, insomnia, and some skin illnesses are all the direct result of this mismatch.
Evolution, or the lack of it, has provided much work for us as healthcare providers. The French Enlightenment philosopher Voltaire wrote, “Doctors are men who prescribe medicine of which they know little, to cure disease of which they no less, in human beings of whom they know nothing.” We have come far in three centuries, but have much farther to go. We are really a young science as Siddhartha Mukherjee reminds us in the laws of medicine, but we are a so the most human science. He summarizes by asserting that “It might be the most beautiful and fragile thing that we do.”
Permit me to give you some personal advice while I am on the podium. I have long been schooled with the absolute necessity of something called “shalom bayit” which means peace at home. I have the fortune to go to work happy and come home happy. I am fortunate to share my life with my B’sheirt – or soulmate and together we have produced five magnificent children (please indulge me, acknowledgement). It is essential to establish a successful life outside of medicine and to have people or environments that support you to be the most wholesome and complete self possible. Everybody needs rest, love and emotional nourishment to thrive. We play by the same rules of nature as the rest. And remember, society keeps a close eye on its doctors. There is little margin for error or lapse in judgement. Mostly, there is no excuse for not paying attention.
After all we are, for the most part, the implementers of care. The real geniuses are the innovators of science in the laboratory, not the clinic. But our mission and purpose is no less significant. Each life touched or saved is “as if a world.” Everyone here is indebted to another. To our friends, our teachers, our families, our predecessors, our country. We live in a time and place of privilege. Reap the beauty of your opportunity and the responsibility of your obligation.
I would be remiss if I did not include a comment regarding character and motivation. Each of us has a combination of traits from a myriad of histories that impact who we are and why we have chosen our professions. Faith, family, friends, loved ones and genuine altruism are among the ideal contributors to staying on track . Here at UVM I want to give special credit to the value of mentors. During the inquisitive and impressionable years of medical school and residency, there are teachers with whom you have a special admiration and trust. They’re embodiment of a physician will become for you an ideal that you can preserve forever in your heart and minds. It is a shared gift and kinship, teacher and pupil, from which there is no master…equal partners in learning and propagating the craft of medicine. No book or computer can ever substitute that bond. We all should look upon the faculty here today with a deep sense of gratitude and satisfaction.
I want to close with two take aways from a couple of giants. Albert Einstein once said “only a life lived for others is a life worthwhile.” What a perfect mantra for choosing a career in healthcare. And maybe closer to my body style, the great Buddha said “Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship.” These words are as true now as they were 2,600 years ago.
Godspeed to each of you, magnificent and powerful people.
Thank you for the honor of standing before and speaking with you. Congratulations. Mazel Tov!
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