Robert Folberg
Rochester, Michigan, USA

From the commencement address to graduates of the University of Illinois-Chicago College of Medicine on May 6, 2016

It seems to me that members of the medical profession should practice expressing gratitude as often as possible. After all, gratitude may be an effective antidote to arrogance: it is difficult to be arrogant when saying “thank you.” If saying “thank you” fends off arrogance, then it is helpful to patients: who would want to be under the care of an arrogant physician?

I confess that I need to say “thank you” often to protect myself from the delusion that I might actually know as much as others think I may know. The practice of medicine is grounded in science and I need to realize—quite often—that I have reached the limits of my knowledge and must ask for help. And whenever someone helps me, and I say “thank you,” I realize how dependent I am on my colleagues in the service of my patients.

One never knows how much a heartfelt “thank you” might be life-changing.

Several years ago, we remodeled our classrooms, installing new technology, and toward the end of the project, I visited the construction site and spoke to the foreman. I asked him for a tour and he patiently explained all of the advantages that would accrue to our medical students.

And then he paused and told me that a group of our students had visited the classroom under construction a few days previously and had also asked for a tour. He paused, reflected, and related to me that at the end of the tour, our students thanked him and his crew for building a beautiful place for them to study medicine. His eyes welled up with tears and he choked back emotion while he told me that this was the first time in more than 30 years of construction work that anyone had thanked him. He conjectured that because he wore a hard hat, people thought that he lacked intelligence and that attention to his feelings wasn’t very important.

I make a habit of asking our custodial crew at the end of the day if our medical students are thanking them. After all, if, as Malcolm Gladwell asserts, it takes 10,000 hours of practice to master a skill—to play a musical instrument, to excel in a sport, to gain fluency in a surgical technique—then it takes a long time to learn how to express gratitude and to get it right. Whenever you thank a nurse, a pharmacist, a physical therapist, the social worker, or others, you will have issued an important declaration—I may be the physician but I realize that the total care of my patients is beyond my resources. The care of my patient requires “me” and ”we.” You, your healthcare partners, and your patients will all benefit from a simple “thank you.”

Class of 2016, you may feel grateful for having reached this day. There is significant accomplishment in being accepted to medical school, in learning the scientific foundations of medicine and making it past the stress of the high-stakes examinations and in having endured the intensity of your clinical training years. With this comes the realization that no one is entirely self-made; everyone has been helped along the way to achievement. I hope that you make time to express gratitude to those who helped you—your friends and your family, your mentors and your teachers.

Members of the Class of 2016, did you know that we are grateful to you? We are grateful for what you have learned and the remarkable people who you have become. We are grateful to those of you who will extend our knowledge by becoming scientists and physician-scientists, and we are equally grateful to you for aspiring to practice psychiatry in a Latino neighborhood, for intending to deliver primary care in rural Texas, for engaging in a global health initiative. Whatever you choose to do, whatever is your path in medicine—it is all important work.

It is possible that even now, having completed a curriculum that is intellectually, physically, and emotionally challenging, you have doubts about the future of medicine and your role in that future.

Please stay with me and please consider this: as a colleague of mine has expressed—there is nothing like the wonder of medicine and the gratitude of your patients. Do you remember my story about the construction foreman? Then please consider how it will feel when a patient thanks you. They may thank you for something that is medically routine—restoring self-esteem to a teenager who is embarrassed by acne, or they may thank you for the extraordinary, for restoring them to health when the prognosis was dark. You may be thanked generously when you hand a baby to new parents, and as compassionate and empathetic physicians, you may be thanked for just being there for a family when nothing could be done to save a loved one’s life.

You will not be thanked for all that you do, for promoting, maintaining and restoring health to individuals and their communities. We hope that you have professional and personal self-esteem to avoid becoming dependent upon an expression of thanks just to keep going.

Even if there is no outward expression of gratitude directed toward you, please be assured that you will often make a profound difference in the life of another person. And you will make these profound differences over and over throughout what we hope will be a long professional lifetime. What you do will have a profound impact.

And I conclude now as I began, by saying to all here—“Thank you.”