In a few short days a new batch of physicians will walk across the stage of Jesse Auditorium, gaining the coveted initials M.D. in the process. There will be much celebration, congratulation and joy. People will be hugged and thanked, professors and friends praised. We will share with our loved ones how much their support led to our success. Unfortunately, the most important people on our journey are often left out of the celebration and merrymaking.
You, Columbia, have been the most instrumental part of our journey. Sir William Osler, one of the most well-known physicians of the 20th century, said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”
I did not realize the wisdom of these words until I stepped onto the hospital wards for the first time. I quickly learned that, unlike many of the exams we endure during the first two years of medical school, real patients do not come with classic presentations and multiple-choice answers.
In our third year of training we were set loose in the hospital, short white coats flapping in the wake of our excitement, to witness and practice all we had read about. We crashed headlong into the realities of health care, witnessing firsthand the devastation illness can cause. And when I look back over all my training, I realize that the most important things I have learned — the things I will carry with me in my career — have come from patients. I remember a remarkable woman recovering from a stroke who taught me that caring and curing were not always the same thing. I remember a family that demonstrated how to be graceful when navigating death and terminal illness. I remember a young man who helped me understand the unique struggles he faced as a minority. My list of patient memories is long.
Medicine is often painted as a scientific endeavor composed of calculations based on knowable facts. If I have learned anything during my time at the MU School of Medicine, it is that true medicine is practiced outside of algorithms and data points. In my clinical time in Columbia, I have often been more confident than skillful, and I am indebted to each patient who allowed me to fumble through my physical exam. I have often asked the wrong questions, only to have my patients gently steer me back on course. I have assumed, jumped to conclusions and misdiagnosed patients out of ignorance. Fortunately, most of my patients have not minded, knowing that their real doctor was actually the one in charge. I cannot presume to speak for my peers, but I chance to guess that they, too, have shared in these follies.
Your discomfort and inconvenience are not lost on us. I flinched each time a patient rolled his eyes at having to retell his medical history or sighed as I re-examined him for the clinical findings I missed. Yet you suffered through it, hopefully feeling that the tradeoff was worth it.
You, Columbia, have shared your most intimate stories and allowed us to be a part of your most vulnerable experiences. We have incurred a tremendous debt that many of you will never collect, a debt that you trust will be paid forward to our future patients.
In a few short days the University of Missouri School of Medicine class of 2016 will officially become doctors. We will close the door on this time in our lives and move on to the next phase of our training. Our students will spread out across the United States, from California to New York, Ohio to Florida. And yet, no matter where we go, there will always be a piece of Columbia with us. You have laid the foundation on which our future professions are to be built. You have given us a gift with the good faith that, years from now, we will earn it.
On behalf of all the students who have learned from you, thank you, Columbia. We owe this success to you.
Nathanial S. Nolan, M.D., is scheduled to graduate Saturday from the University of Missouri School of Medicine.
source: http://www.columbiatribune.com
The American health care system promises equal and nondiscriminatory treatment for all individuals, regardless of their gender identity. Yet transgender patients are all too often wrongly identified, socially ridiculed and often denied medical treatment by their physicians. A report by the National Transgender Discrimination survey found that more than one-third of respondents delayed seeking care because of this discrimination. A report by Lambda Legal increased this estimate to 70 percent. As those who identify as transgender or do not conform to gender norms become more visible, medical institutions and professionals must assure that doctors, nurses and caregivers are equipped with the skills necessary to provide high-quality, equitable health care.
