Sir David Todd
Hong Kong, SAR, China
You have worked hard and are now duly rewarded; but this is just the beginning of your new life and that is perhaps why in North America graduation is known as commencement. Times have changed since nearly sixty years ago I sat where you are nervously waiting today. The medical faculty in 1952 had less than fifty full time teachers; now it has 237.
The functions of a medical school are to teach, foster research, and care for patients. I hope a significant number of you will choose academic medicine, for the Hippocratic Oath and its modern version exhort us to share our knowledge with others and organize the educational process for future members of the profession. As for research, how would medicine progress without it?
Why should medical doctors do research? Because there is always research relevant to human disease, and the current era of biology is full of intellectual excitement and promise.
Where will the future academic staff come from? Surely from some of you.
It is likely that most of you have decided what to do and I wish you every success in your chosen field. I hope many of you will become generalists rather than specialists or super-specialists. As medical care became more complex, specialization was inevitable, but perhaps we have become too organ/system orientated. There is a tendency to overlook the fact that a patient is a human being living in his or her special environment and these are important considerations in patient care. The generalist perhaps has a more holistic approach. More family physicians are needed, especially with an aging population. A friend of mine asked me to recommend a good family physician. At sixty, she thought she was too young to see a geriatrician!
We should remember that, perhaps with the exception of inoculations against disease, food, sanitation, housing, and education are more important determinants of health than medications. Public health is an attractive option for those who have a broader view of health care, and prevention is always better than cure. It was good old fashioned public health measures that brought the outbreak of Severe Acute Respiratory Syndrome (SARS) under control. Of course the prevention of disease is the responsibility of all health care professionals. Infections such as malaria, tuberculosis and AIDS; cancer; cardiovascular and life-style diseases; and environmental pollution are major causes of premature death. Many of these can be prevented by essentially public health measures.
When I graduated from medical school I was on the top of the world. But the first day on the ward brought me crashing down to earth. Nothing I did was right. The nursing staff found me a nuisance and the patients thought me clumsy. The relatively short undergraduate course provides only basic education in medicine. The vocational aspects—as well as the art of practice—are learnt during the period of postgraduate medical education and training. This is later carried into continuing medical and professional education and development. You owe it to your patients, community, and colleagues to be fully qualified in your specialty, so that the quality of practice is of high standard and is maintained. Still there is much to learn. Sir William Osler stated that medical education is not a medical course but a life course. The American playwright G. S. Kaufman said, “The kind of doctor I want is one who, when not examining me, is at home studying medicine!”
Medicine is a time honored profession. It is not a trade, and making a profit should not be your aim. There should be a large component of service which implies personal sacrifice. The labeling of patients as clients has somewhat undermined this concept.
What Mencius said over two thousand years ago when he went to see King Hui of Liang is relevant to medical practice today: “What is the point of mentioning the word ‘profit’? All that matters is that there should be benevolence and rightness.”
You are now members of the medical profession. What is it to be a professional? What is medical professionalism? It is the basis of medicine’s contract with society. It demands placing the interests of patients above those of yourself, setting up and maintaining standards of competence and integrity, and providing expert advice to society in matters of health. Essential to this contract is public trust in medical doctors and nurses which depends on the integrity and expertise of individuals and the whole profession. We live in a materialist world with many temptations; but you always have a choice. Make the right one. The trust of patients cannot be breached.
It has been said that present-day medical graduates lack the basic skill of handling people as humans, are poor at communication, and lack kindness. Professor Sir David Weatherall of Oxford University stated, “A core of facts required to practice medicine together with communication skills and an understanding of social and ethical issues can be taught and continued into postgraduate training. But, except by example, no medical school can teach a young person how to be understanding and caring. This can only come from the experience of life.” Undoubtedly role models are important. The humanitarian and Nobel Laureate Dr. Albert Schweitzer said, “Example is not the main thing influencing others; it is the only thing.” Yet the art of medicine has somehow been lost amidst the science. This faculty’s introduction of humanities into the curriculum is surely a move in the right direction.
This is a proud day for you all and for your family, teachers, and friends. It is always heartening to see a new generation taking over. Medicine is a noble profession and it is up to you to keep it that way. It is also a stressful one, but do persevere. To borrow from John F. Kennedy: “For you there is a new world to be won.”
SIR DAVID TODD, MD, FRCP, FRCPath is Emeritus Professor in the Department of Medicine at the University of Hong Kong, Hong Kong, SAR, China.
Abstracted from the address to graduates of the Faculty of Medicine, University of Hong Kong, January 15, 2011.