The Greater Louisville Medical Society is actively involved with medical students at the University of Louisville. I had the pleasure to address the incoming Class of 2019. GLMS provides all members of the incoming class with their first white coats. It is a memorable ceremony, attended by proud parents, grandparents, and friends of the students.
Before the students are presented with their white coats, they pledge to uphold the Declaration of Geneva. When I entered medical school during the last millennium at the University of Alabama, I took the Oath of Hippocrates. Many medical schools have abandoned the ancient Oath, and in adopting the Declaration of Geneva, they bring new social consciousness into existence.
The Declaration brings many improvements over the Oath, such as "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient." These things weren't considered in ancient times, I suppose. The Declaration doesn't mention the obligation to share our wealth with our teachers contained in the Oath, "...and if he is in need of money to give him a share of mine, " so I suppose modern thinkers believe that medical school faculty are adequately compensated.
I spoke to the students about the significance of the white coat, and mentioned the words of Dr. Greg Henry, a past president of the American College of Emergency Physicians, who talks about his White Coat Ritual. He says, "Every time I put on the coat, I stop for two minutes. I stop for two minutes and remember Galen and Hippocrates. I pick up the coat: 'To whatever house I shall enter, it shall be for the benefit of the sick.' At that moment I am Doctor of Medicine; I carry with me a 2,500 year tradition, and shame on me if I do not carry it out with dignity for the next eight hours. My problems are not the patient's problems. For that period of time, I am the agent and servant of the patient - I am proud to be the servant of the sick. I put on that coat and I'm a better person. All my petty prejudices should disappear when the coat goes on. That's what the coat is all about." I am encouraged by these words, and reminded of the weight of our responsibility. It makes me remember my ancient Oath.
One thing that was not mentioned, but is becoming more evident to me, is the need to be mindful. We're being pushed and pulled in countless directions, by government regulations, financial pressures, stress, sicker patients and longer hours, and the need to adopt ever-more-complex technological advances. What is missing in all of this, I believe, is a sense of the moment.
Mindfulness is the practice of maintaining a nonjudgmental state of heightened or complete awareness of one's thoughts, emotions, or experiences on a moment-to-moment basis. When I first heard about it, I was skeptical, thinking it was just another New Age fad. As I learn more about it, I believe that understanding and embracing this concept can be beneficial.
Being mindful with our patients can give us power and make us better physicians. By concentrating on the moment, we achieve an actual awareness of what is happening at that time, instead of thinking about trying to fix the immediate problem, hurry on to the next patient, returning a pressing phone call, answering an email, or thinking about when we're going to get a break. We can truly focus on patients and their families, getting insight on what's happening to them, and understanding subtle cues about their situation. It's beneficial, because patients can sense a level of awareness when we're interacting with them. If we are present and mindful, a better connection will naturally develop.
I hope it's not a passing fad. The connection between a patient and a physician is more important than the blood pressure reading last month or the serum squirrel level today. Sure, the science of medicine is integral to what we do, a required element of our profession, but the art of medicine, in forming a bond with patients, is at the heart of our being. Recognizing the power of presence and touch can be exhilarating.
Mindfulness helps us exhibit the power of being under control. No matter what is going on around us, eliminating the effect of outside influences and living in the moment lets us achieve the proper focus. It's like trying to look beneath the surface of choppy water - there's too much disturbance on the surface to see what's below. Contrast that with looking into a still pool of water - we can easily see to the bottom. Mindfulness eliminates all of the outside noise and lets us see, and act, clearly.
The U of L Class of 2019 has a bright future. I hope they can incorporate mindfulness into their habits, and transform the kind of medicine they will practice.
