Dr. Rob Horowitz is an Associate Professor of Clinical Medicine and Pediatrics, and is board-certified in Internal\u00a0Medicine, Pediatrics and Hospice & Palliative Care Medicine. After 14 years of working as a rural Emergency\u00a0Physician, in 2012 he moved his professional come to the University of Rochester Medical Center division\u00a0of Palliative Care, where he cares for children and adults who have serious illness. Dr. Horowitz also established\u00a0and served as Medical Director of URMC\u2019s Adult Cystic Fibrosis Program from 1999 until 2015.<\/p>\n
In addition to his clinical duties, Dr. Horowitz is Director of the Medical School\u2019s Year 2 and Year 3\u00a0Comprehensive Assessments, which are longitudinal formative assessments of student communication skills,\u00a0medical knowledge and professionalism utilizing patient-actor interviews, multi-source feedback, peer- and\u00a0self-assessments, and other modalities. He also teaches medical students in multiple other small and large group\u00a0settings and facilitates several groups for clinicians, including Balint groups for physicians and Nurse Practitioners,\u00a0and a support group for Palliative Care Unit nurses, techs and others.<\/p>\n
Hello Class of 2016 and hello to your family, friends, colleagues and dignitaries. What an honor,\u00a0that you invited me to deliver your Last lesson from the University of Rochester School of Medicine and\u00a0Dentistry faculty. It will be a brief one, less than ten minutes; and it will be a review, a reminder of what\u00a0you already know. Or, and I say this with sadness and some urgency, it may be a reminder of what you\u00a0once knew, and may be in the process of forgetting. This Last Lesson is grounded in words from Francis of\u00a0Assisi, which I paraphrase here:<\/p>\n
Work of our hands is labor.
\nWork of our hands and our head is a craft.
\nWork of our hands, our head, and our heart is an art.<\/p><\/blockquote>\nTHIS is the last lesson: doctoring is an art, a work of your hands, head and heart, or more prosaically,\u00a0a work of skills, knowledge and humanity. This reminder is important, even for you, who were socialized\u00a0here in Rochester, the home of biopsychosocial medicine. In fact, it\u2019s a response to recent conversations I\u2019ve\u00a0enjoyed with many of you, who, poised for internship,\u00a0wondered whether health-care-the-business\u00a0has taken the heart out of medicine- the-calling.\u00a0The answer is a resounding NO. But let me respond\u00a0directly to your words, first about hands and head.\u00a0Here are two quotes from you, representative of\u00a0many others:<\/p>\n
I just don\u2019t know enough to be a good doctor.
\nI\u2019m about to be revealed as a phony.<\/p><\/blockquote>\nI respond with a story from long ago and\u00a0yet not so long ago: twenty three years ago I was\u00a0a Med-Peds intern here in Rochester, just completing\u00a0my first Medicine rotation at Strong Memorial\u00a0Hospital, when in Morning Report the chief resident\u00a0asked me to offer a differential for the case.\u00a0I was paralyzed. I had no idea how to explain the\u00a0patient\u2019s symptoms. I tried to smile and charm my\u00a0way through it, but I stumbled and fumbled, until\u00a0a fellow intern completed the task that I couldn\u2019t. I\u00a0felt ashamed\u2026revealed as a phony, an imposter.<\/p>\n
As you know, aversive conditioning is deep,\u00a0and this experience stuck with me. In the succeeding\u00a0years, whenever I saw a particular colleague who\u00a0witnessed my humiliation on that day long ago\u00a0approaching down the hall, I was tempted to, and\u00a0sometimes DID, turn in the opposite direction, so I\u00a0wouldn\u2019t have to feel his scorn.<\/p>\n
Sounds silly from this vantage, nearly a quarter\u00a0century later, doesn\u2019t it? In fact, a medical student\u00a0suggested so last year in response to me sharing this\u00a0story. He challenged me to find out if my impression\u00a0was accurate. And so I did. Last June, seated behind\u00a0me in Grand Rounds was that well-admired physician.\u00a0I took a deep breath, turned around, and asked\u00a0him what he recalled about that infamous incident,\u00a0my unmasking. His response was, \u201cAre you kidding,\u00a0Rob? I was too busy feeling like a fraud myself to take<\/em>
\nin anyone else\u2019s difficulties! Sounds like we were in the\u00a0same boat<\/em>.\u201d<\/p>\nWhat a gift of relief his words were! A few\u00a0minutes into Grand Rounds, he put a ribbon on the\u00a0gift when he tapped me on the shoulder and whispered,\u00a0\u201cY\u2019know, Rob, I\u2019ve always thought you were a\u00a0pretty smart guy.<\/em>\u201d<\/p>\n
There are two morals here: First, you can\u2019t\u00a0pack all the information you will ever need into your\u00a0head. In 1950 the doubling time of medical knowledge\u00a0was 50 years; in 1980, 7 years; in 2010, 3.5\u00a0years. This means during your tenure here\u2014whether\u00a04 years or 13 years\u2014the base of medical knowledge\u00a0has more than doubled and, for some of you,\u00a0several times over! So, of course, please learn from\u00a0your knowledge gaps, and master how and where to\u00a0seek answers. And please recognize that knowing it\u00a0all is not the most important \u00a0measure of our competence\u00a0as doctors.<\/p>\n
Second, the collision between our cognitive\u00a0limits and our inherent drive and perfectionism,\u00a0which made this professional \u00a0achievement possible\u00a0in the first place, is a perfect recipe for self-doubt\u00a0and self-judgment. And if these become our lifestyle,\u00a0we will live a \u00a0disheartening and depleted life.\u00a0Please be kind to yourself, and find in your community\u00a0colleagues and mentors who are open to genuine\u00a0reflection. Don\u2019t wait 25 long years, like I did, or\u00a0forever, to make peace with your humanity.<\/p>\n
Now, what about the Heart component of\u00a0Doctoring? I will share two quotes from you, similar\u00a0to many others:<\/p>\n
I\u00a0know empathy is important, but there isn\u2019t enough\u00a0time to be empathic.
\nI\u2019m working so hard to be smart and productive, I\u2019m\u00a0afraid I\u2019m losing my caring.<\/p><\/blockquote>\nLet me respond with a second story, a fresh\u00a0one about the profound opportunity for compassion\u00a0in simple moments. Last Friday morning, into the\u00a0exam room stormed my new patient, a 50-something\u00a0year old woman I\u2019ll call Wendy, who has widely\u00a0metastatic cancer and severe pain, for which she\u00a0was referred to me. You see, I\u2019m a palliative care physician,\u00a0and as such, I am a pain specialist. She sat\u00a0opposite me and as she launched into her agenda,\u00a0she leaned forward so far that I was forced to lean\u00a0back.<\/p>\n
She damned the medical system, and she cursed the\u00a0siloed subspecialists, and she asked why the hell she\u00a0should trust me, yet another siloed subspecialist, to\u00a0help her, or to even care. I asked if I might share an\u00a0observation with her. She nodded. I told her, \u201cI want<\/em>
\nto help make sense of what\u2019s going on, and to care for\u00a0you and help you, but your manner appears so angry, so\u00a0critical, I am not sure how to reach through it to you.\u00a0Can you help me?<\/em>\u201d She softened a bit, and responded,\u00a0\u201cI\u2019m afraid that if I stop being angry, I\u2019m going to cry.<\/em>\u201d\u00a0I inched closer, until our knees were almost touching,\u00a0and looking into her now moist eyes, I said,\u00a0\u201cThen cry<\/em>.\u201d She gasped and her head bowed, tipping\u00a0forward as if she was collapsing, and to stop her descent,\u00a0I reflexively leaned forward, until the tops of\u00a0our heads were gently touching. We were posed like\u00a0an A-frame, and she wept. I put my hand on her\u00a0shoulder and told her, \u201cI am with you, Wendy<\/em>.\u201d And\u00a0between sobs, she stuttered, \u201cYes\u2026now\u2026 I know.<\/em>”<\/p>\nThere are two morals here. First, you can\u00a0choose to cultivate the habit of compassion. Indeed,\u00a0I share this story not to show off my compassion-finesse,\u00a0but to demystify, to define and to normalize\u00a0it. We respond compassionately to suffering simply\u00a0by witnessing it, approaching it, and inquiring\u00a0about it. And by that alone, we offer healing. And it\u00a0doesn\u2019t have to take a lot of time.<\/p>\n
Second, it is vital to be compassionate to both your\u00a0patients AND to yourselves. Because just as you can\u2019t\u00a0possibly know everything that matters, neither can\u00a0you possibly tend to all those in need. Please remember\u00a0that you actually DO need to sleep and to eat,
\nto tend to your spouse, your partner, your children,\u00a0your friends, your inner life, and your pleasures.<\/p>\nSo, this last lesson is a reminder of what you\u00a0knew when you first came here to enter this amazing,\u00a0privileged profession: Hands, head and heart are all\u00a0three essential to the art of doctoring. If you choose\u00a0to make compassion your default mode, then you\u00a0will know definitively\u2014in your own heart\u2014that\u00a0health-care-the-business CAN\u2019T take the heart out\u00a0of medicine-the-calling.<\/p>\n
You can only imagine how inspiring it is,\u00a0from this stage, to look upon you, our colleagues. To\u00a0celebrate you, to be awed by you, and to know with\u00a0great confidence that your skillful hands, your brilliant\u00a0heads, and yes\u2014your loving, beautiful hearts\u00a0will be a blessing to your countless beneficiaries,\u00a0your patients, who now await your arrival. For this\u00a0we are forever proud and grateful. Congratulations.<\/p>\n
<\/p>\n
The Medical Commencement Archive,\u00a0Volume 3, 2016<\/p>\n
Dr. Rob Horowitz, MD
\nUniversity of Rochester School of Medcine
\nCommencement Address<\/p>\n","protected":false},"excerpt":{"rendered":"Dr. Rob Horowitz is an Associate Professor of Clinical Medicine and Pediatrics, and is board-certified in Internal\u00a0Medicine, Pediatrics and Hospice & Palliative Care Medicine. After 14 years of working as a rural Emergency\u00a0Physician, in 2012 he moved his professional come to the University of Rochester Medical Center division\u00a0of Palliative Care, where he cares for children […]<\/p>\n","protected":false},"author":1,"featured_media":1401,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false},"categories":[15,201,11,366],"tags":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1400"}],"collection":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/comments?post=1400"}],"version-history":[{"count":3,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1400\/revisions"}],"predecessor-version":[{"id":1403,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1400\/revisions\/1403"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media\/1401"}],"wp:attachment":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media?parent=1400"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/categories?post=1400"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/tags?post=1400"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}