It is a special time in medicine.<\/p>\n
This is a time of the most rapid transformation in generations! You have scientific knowledge and\u00a0technical abilities that far surpass those of your predecessors. You can multitask better than most. I know–\u00a0I\u2019ve seen you on the wards and in clinics\u2014whipping out your smart phones, clicking on answers to clever\u00a0questions barely out of my mouth. Us older \u00a0physicians struggle to keep up with you.<\/p>\n
What a privilege you have for a patient to say, \u201cThat\u2019s my doctor!\u201d You will care for thousands of\u00a0patients during your careers. But remember, they will only see a small number of doctors. You will be very\u00a0special to them in ways beyond your comprehension. They need an anchor, a belief that someone is thinking\u00a0about and looking after them\u2026and you will provide this without even knowing.<\/p>\n
You will experience a better balance between your work and your family life than existed for our\u00a0generation. You will no longer be such a slave to the profession in which family and friends who nourished\u00a0us were too long neglected. Our multi-professional teams help us achieve this, with each member complementing\u00a0and supporting each other. Such a balance is healthy, leads to better care and prevents burnout!<\/p>\n
It is a challenging time in medicine.<\/p>\n
The demographics are changing in our society.\u00a0There is an increased demand for your services\u00a0due to population growth and aging, as well as the\u00a0arrival of healthcare reform. Soon, the majority of\u00a0our nation\u2019s population will be \u201cethnic minorities,\u201d\u00a0looking like New Mexico. Diversity brings a rich\u00a0sharing of culture, language and values. But it also\u00a0poses threats that could divide us. We must find
\na way to overcome divides by race and ethnicity,\u00a0by gender and sexual preference, by income and\u00a0geographic isolation.<\/p>\n
Your challenge is to bridge these divides,\u00a0finding connections with patients far removed from\u00a0your own upbringing, economic status, religious\u00a0or ethnic beliefs. While we have the means to treat\u00a0virtually everyone that crosses our doors, access to\u00a0our care is not guaranteed\u2014either because of transportation\u00a0challenges, linguistic barriers, financial\u00a0impediments or social marginalization of certain
\ngroups.<\/p>\n
Our nuclear families are shrinking as young\u00a0people leave for schooling or for jobs. This leaves\u00a0no grandmother around to offer guidance to a\u00a0young, single mom about how to treat her feverish\u00a0child in the middle of the night. In such an isolaisolation-
\ngenerating environment, clinics and emergency\u00a0rooms often replace family for comfort, re-assurance\u00a0and social connection. Some people feel\u00a0so alienated, they have given up on the healthcare\u00a0system except for late night runs to the emergency\u00a0room for a neglected toothache, or an infected needle\u00a0track, or for a sick teen who delayed treatment\u00a0while waiting for access to the lone family car.<\/p>\n
We will be challenged to gain skills and an\u00a0understanding of domains far from our traditional\u00a0areas of strength\u2014population health, management\u00a0of health teams, the business of medicine. Thus,\u00a0our generation of physicians leaves you both with a\u00a0legacy and a mess!<\/p>\n
Medicine has a powerful history.<\/p>\n
Look how rapidly our field has progressed\u00a0in just a few generations and what a terrific time it\u00a0is to enter the physician workforce.<\/p>\n
First, let me recall some recent history:\u00a0when your entered medical school four years ago.\u00a0I\u2019m sure the week you began medical school your\u00a0grandma asked you, \u201cWhat\u2019s this bump on my arm?<\/em>\u201d\u00a0You protested, \u201cGrandma, I\u2019m only a beginning\u00a0medical student!<\/em>\u201d But she said, \u201cYes, I know, but\u00a0just tell me what you think this is<\/em>.\u201d That\u2019s when you\u00a0found out that what you think of yourself in this There is an expectation of your competence\u00a0and ability to heal which feels uncomfortable\u2014an\u00a0expectation you can\u2019t fulfill. But, as time marches\u00a0on, you\u2019ll grow into these new clothes.<\/p>\n Now, let\u2019s go back further in history and\u00a0reflect on what doctors in New Mexico faced more\u00a0than a century ago.<\/p>\n We begin with impotence in the face of\u00a0diphtheria. In 1882, there were no immunizations\u00a0against diphtheria, so the physician\u2019s presence at the\u00a0bedside WAS the medicine in his \u201cdoctor\u2019s bag.\u201d<\/p>\n Still, the cases were difficult:<\/p>\n Case 1- \u201cI was called to bedside on Saturday.\u00a0Found patient with difficult respiration and\u00a0suppression of urine. On introduction of catheter,\u00a0no urine was found in bladder. Performed tracheotomy;\u00a0breathing very difficult; death in about 24\u00a0hours.\u201d<\/p>\n Case 2 – \u201cPatient a five year old…performed\u00a0tracheostomy\u2026lamp went out\u2026operated with\u00a0difficulty taking about \u00bd hour\u2026spasms\u2026died in\u00a0about 12 hours.\u201d<\/p>\n In Las Vegas, NM in 1914, doctors had\u00a0many medicinal purposes for whiskey\u2014to steady\u00a0their own nerves, to use as anti-septic in the belief\u00a0that they could kill off germs that cause diphtheria,\u00a0even in kids, and as a pain killer. I relate to this\u00a0last use, for I once had shingles, which felt like a\u00a0hot branding iron on my side. I went to the local\u00a0hospital and was prescribed narcotics, which didn\u2019t Prejudice and stigmatization were as rampant\u00a0among our forebears as they are today with\u00a0AIDS, mental illness, or in the attitudes of some\u00a0toward immigrants. In 1904 a distinguished physician\u00a0from Las Cruces warned of those with tuberculosis\u00a0coming to NM for \u201cthe cure.\u201d He said, \u201cThe\u00a0army of tubercular invalids should be brought under\u00a0control, promiscuous expectoration should be stopped<\/em> This sounds remarkably like our national political\u00a0dialogue today.<\/p>\n You have skills and tools for diagnosis and\u00a0treatment that many of us on stage could only have\u00a0dreamed of when we were students. Not long ago,\u00a0when I was a student, we treated congestive heart\u00a0failure by bleeding patients and tying tourniquets\u00a0to their limbs to prevent too much venous blood\u00a0returning to overwhelm their failing hearts. Today,\u00a0you\u2019re equipped with powerful diuretics, medicines Not long ago we warehoused the mentally\u00a0ill, the developmentally disabled and the tuberculous\u00a0in sanatoriums. Today, with stronger therapeutic\u00a0means at your disposal, and better understanding\u00a0of the pathophysiology of disease, most of these\u00a0individuals live at home or in the community.<\/p>\n And not long ago, at the turn of the last\u00a0century, most health providers were physicians.\u00a0Today, physicians make up less than 10% of the\u00a0health workforce\u2014for we train with and rely on\u00a0multi-professional teams to better care for our\u00a0patients. While we train mostly in isolation from\u00a0other health professions, we will spend our professional\u00a0careers in interdependent collaboration with\u00a0a growing number of health professionals skilled in\u00a0vital areas which complement our own skills. We\u00a0depend upon pharmacists, nurses, physical therapists,\u00a0occupational therapists and even community\u00a0health workers.<\/p>\n And look what we face today. No matter\u00a0what specialty you enter, the care you give will be\u00a0affected by the social determinants of disease faced\u00a0by your patients: educational attainment, income\u00a0and poverty, access to nutritious food, yearning\u00a0for social inclusion. These socioeconomic forces\u00a0contribute more to health than all the medical care\u00a0we provide. This is a humbling thought. But we\u2019re \u201cPatient came to see me in clinic\u00a0so I could help her obtain food.\u00a0She appeared overwhelmed with\u00a0her current situation. She said,\u00a0\u201cI\u2019m losing my car at the end of\u00a0this month because I\u2019m behind on\u00a0my car payments. I\u2019m afraid I\u2019ll\u00a0be evicted because I\u2019m unable to\u00a0pay my rent. I receive some social\u00a0security benefits, but it\u2019s not enough\u00a0to cover my living expenses. My \u00a0local churches couldn\u2019t find me any\u00a0assistance.<\/p>\n I did the following: Helped\u00a0her complete her food voucher\u00a0benefits application, connected\u00a0her with \u201cadopted families\u201d to Now THAT\u2019s an example of a powerful You should all be engaged in health policy.\u00a0I want you to promise me that whatever field you\u00a0enter, you will ALWAYS ask of the patient coming\u00a0to clinic or admitted to the hospital bed, \u201cHow\u00a0could this visit or admission have been prevented?\u201d\u00a0Our Chief of Neurosurgery asked, \u201cWhy do so many\u00a0patients from rural hospitals with strokes and head\u00a0injuries have to be flown to our Hospital at enormous A pediatric endocrinologist wondered why\u00a0her diabetic patients in New Mexico had to travel\u00a0so far to Albuquerque for checkups. Half her\u00a0diabetic children were on insulin pumps, allowing\u00a0them to use the internet to download their glucose\u00a0readings and send them to Albuquerque for review.\u00a0This doctor can now advise patients on fine-tuning\u00a0their management in their homes, sharply reducing One of your classmates noticed that despite\u00a0the recommendation that all patients with congestive\u00a0heart failure contact their doctor at the first\u00a0sign they are retaining too much fluid\u20143 lb in a\u00a0day or 5 lb in a week- when asked, 4 of 5 patients\u00a0admitted with congestive failure on our service had\u00a0no bathroom scale. So she is working with cardiology\u00a0and our hospital administration to propose\u00a0buying $20 digital scales for all discharged patients\u00a0with congestive failure who don\u2019t have scales, which\u00a0is aimed at reducing re-admissions for this condition.<\/p>\n And finally, a medical student and resident\u00a0on our inpatient service explored how they could\u00a0have prevented the admission of two patients admitted\u00a0to our service in diabetic ketoacidosis. Both\u00a0were poor, on UNM Care, and since insulin was so\u00a0expensive, they had to use our hospital pharmacy\u00a0to get affordable insulin. The problem, they discovered,\u00a0was that our UNM Pharmacy was only open Like Jedis, we taught you the ancient ways\u00a0of diagnosis–using the \u201cscratch test\u201d to assess liver\u00a0size, tapping muscles to check for \u201cmyo-edema\u201d to\u00a0diagnose protein malnutrition, and observing \u201csighing\u00a0respiration,\u201d a sign of anxiety.<\/p>\n But you upstarts taught our generation how\u00a0to use dynamic documentation, how to quickly\u00a0pull up x-rays on the computer, and how to access\u00a0the latest evidence on your iPhones in seconds.<\/p>\n Older and younger generations in medicine\u00a0offer continuity and mutual learning. I experienced\u00a0this in my own home when I bought my first iPhone.\u00a0I was typing away with my thumbs when my\u00a0son looked over and asked what I was doing. \u201cI\u2019m\u00a0texting,\u201d I said. \u201cNo you\u2019re not,\u201d he said. \u201cWhat am I\u00a0doing?\u201d I asked. \u201cYou\u2019re e-mailing!\u201d he said. \u201cWhat\u2019s\u00a0the difference?\u201d I asked. He had to show me that Finally\u2026why is your class so great?<\/p>\n I interviewed faculty and staff who worked\u00a0with you over the past 4 years. And their general You have to be the kindest, most mutually\u00a0supportive, most community-minded class in\u00a0a generation. The welfare of your classmates and\u00a0their academic and professional success, not just\u00a0your own achievement, meant something to you.\u00a0In the community, you helped the homeless, the\u00a0immigrants, the disabled, the elderly and youth at\u00a0risk. You\u2019ve increased access to a life-saving drug-\u00a0Narcan- for opiate overdoses; you\u2019ve testified at the\u00a0state legislature for health improvement bills; you\u2019ve\u00a0helped communities fight youth obesity; you\u2019ve\u00a0brought a range of services to inner city school\u00a0kids, from dental health to sex ed; you\u2019ve organized\u00a0one of the largest, free flu shot clinics imaginable\u00a0(>3,000 received shots in our parking lot).<\/p>\n You\u2019ve shown the power of medical students\u00a0as leaders, reviving and sharply increasing\u00a0participation in the Student Council as a force These are the skills that predict success in\u00a0our highly social, interdependent field of Medicine.\u00a0I was touched by an e-mail I received from one of\u00a0your schoolmates relating an experience she had\u00a0during her first year PIE rotation in rural New\u00a0Mexico. She was attending a school-based clinic\u00a0near her clinical site. Through fresh eyes, she\u00a0summarized her following interaction with a teen\u00a0patient:<\/p>\n \u201cI can\u2019t get out of my mind a 16\u00a0year old I saw today. She wouldn\u2019t\u00a0look me in the eye, and sat in the\u00a0exam room sort of slumped over. I\u00a0asked \u201cWhat\u2019s going on?\u201d \u201cMy stomach\u00a0hurts and I have a headache,\u201d\u00a0she said. Then all this craziness THESE are the qualities that our field is\u00a0looking for. Class of 2016, you\u2019ve got it!<\/p>\n <\/p>\n Dr. Kaufman received his medical degree from the State University of New York, Brooklyn in 1969 and Arthur Kaufman, MD The Medical Commencement Archive It is a special time in medicine. This is a time of the most rapid transformation in generations! You have scientific knowledge and\u00a0technical abilities that far surpass those of your predecessors. You can multitask better than most. I know–\u00a0I\u2019ve seen you on the wards and in clinics\u2014whipping out your smart phones, clicking on answers to […]<\/p>\n","protected":false},"author":1,"featured_media":1447,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false},"categories":[212,366],"tags":[394,396,395],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1446"}],"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=1446"}],"version-history":[{"count":1,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1446\/revisions"}],"predecessor-version":[{"id":1448,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1446\/revisions\/1448"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media\/1447"}],"wp:attachment":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media?parent=1446"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/categories?post=1446"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/tags?post=1446"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nprofession is not important\u2014it\u2019s what your family,\u00a0your patients and your society thinks of you that is\u00a0so very important.<\/p>\n
\ntouch the pain. I was desperate. A colleague suggested\u00a0I try alcohol. \u201cI don\u2019t drink<\/em>,\u201d I objected. But\u00a0I bought a bottle of whiskey. It tasted terrible\u2026and\u00a0my pain disappeared. Swigging whiskey, I remained\u00a0drunk for a week and felt no pain!<\/p>\n
\nand every possible means taken to prevent these\u00a0unfortunates from becoming a danger to the population\u2026\u00a0I most assuredly do believe that in return for the\u00a0health-giving properties of our glorious climate, they\u00a0should be willing to submit to some legal regulation!<\/em>\u201d<\/p>\n
\nto lessen heart stress, and coronary catheters to\u00a0unblock clogged arteries.<\/p>\n
\nrising to the challenge. Community health workers,\u00a0our frontline in addressing social determinants, are\u00a0now hired for each of our primary care clinics. Our\u00a0own Gwen Blueeyes sent me this note summarizing\u00a0her work with one of our patients:<\/p>\n
\nhelp pay last month\u2019s rent, helped\u00a0her complete paperwork for the\u00a0Income Support Division to help\u00a0cover cost of her Medicare premiums,\u00a0and scheduled an appointment\u00a0for her with the hospital\u00a0Patient Financial Services Office,
\nwhich I\u2019ll also attend to give her\u00a0moral support.\u201d<\/p><\/blockquote>\n
\naddition to our heath team!<\/p>\n
\nexpense to patients and to those rural hospitals?\u201d He\u00a0set up a telemedicine program to review head CT\u00a0scans sent from rural sites so he could advise local\u00a0physicians on which patients to send, and which\u00a0could safely stay put in their home community.<\/p>\n
\ntheir trips to Albuquerque.<\/p>\n
\n8-5 when the patients were at work. They worked\u00a0at jobs without benefits and feared if they took off\u00a0from work, they could lose their jobs. The student\u00a0and resident presented their findings to the UNM\u00a0Pharmacy which agreed to stay open after-hours.\u00a0Different generations teach each other.<\/p>\n
\nlittle texting icon.\u00a0Don\u2019t ask me about Twitter!<\/p>\n
\nconsensus was: \u201cYou\u2019re just so damned nice!\u201d Your\u00a0class character has made a great impression on all of\u00a0us.<\/p>\n
\nfor positive change in our academic health center.\u00a0You\u2019ve organized mentors within your class to help\u00a0all pass the Boards! And during Match Day, instead\u00a0of rushing the table to grab and open your residency\u00a0match envelopes like most classes, you politely\u00a0approached the table calmly, helping each other\u00a0find your respective named envelopes.<\/p>\n
\nstarted pouring out.\u00a0\u201cI haven\u2019t slept in days,\u201d she said.\u00a0\u201cMy aunt keeps getting incredibly\u00a0drunk. Last night my uncle was beating\u00a0her and my aunt was so drunk,\u00a0she wandered away.\u201d \u201cI can\u2019t concentrate\u2026\u00a0My grandfather is dying. I
\njust lost 3 family members to alcohol.\u00a0My mom says there\u2019s not enough\u00a0room in her house for me. I was just
\nseparated from my sister\u2026the one\u00a0person who understands me. I can\u2019t\u00a0call her\u2014her phone\u2019s been disconnected.
\nI only eat what they have here\u00a0in school\u2014I get one or two meals a\u00a0day\u2026there\u2019s no food at home. Even\u00a0when I do eat, I sometimes throw\u00a0up\u2026I can\u2019t help it\u2026I\u2019m so tired.\u201d
\nWith my mouth gaping, I\u00a0collected myself. I got her some\u00a0extra food from the school cafeteria,\u00a0gave her a little something to\u00a0settle her stomach, gave her a hug,\u00a0and referred her to New Horizons.\u00a0Deep down, I wanted to adopt\u00a0her. She said she trusted me. God,\u00a0she trusted me!\u201d<\/p><\/blockquote>\n
\nis Board Certified in Internal Medicine and Family Practice. He served in the U.S. Indian Health Service,
\ncaring for Sioux Indians in South Dakota and Pueblo and Navajo Indians in New Mexico, before joining the
\nDepartment of Family and Community Medicine at the University of New Mexico in 1974, where he has
\nremained throughout his career, providing leadership in teaching, research and clinical service. He was promoted
\nto full Professor in 1984 and Department Chair in 1993. In 2007, he was appointed as the first Vice
\nChancellor for Community Health, and was promoted to Distinguished Professor in 2011.<\/p>\n
\nUniversity of New Mexico
\nSchool of Medicine Commencement<\/p>\n
\nVolume 3, 2016<\/p>\n","protected":false},"excerpt":{"rendered":"