Good afternoon, and thank you for inviting me to be your speaker today. My name is Paul Rothman,\u00a0and I am the dean of the Johns Hopkins University School of Medicine and the CEO of Johns Hopkins\u00a0Medicine. It\u2019s my privilege to be here on this memorable occasion to celebrate you, the esteemed\u00a0graduates of the Northwestern University Feinberg School of Medicine Class of 2016.<\/p>\n
First, I want to say congratulations. You should be incredibly proud of yourselves. You have succeeded\u00a0in one of the country\u2019s most prestigious and rigorous programs, which is a testament to your immense\u00a0talent, intelligence and drive.<\/p>\n
Whether you are moving on to a residency, a postdoc, a job in industry or another professional\u00a0stepping stone, today opens up great possibilities for you. You are forging ahead in an era of unprecedented\u00a0opportunities in science and medicine.<\/p>\n
In 2016, we are on the verge of some astounding breakthroughs, thanks to increasingly sophisticated\u00a0medical imaging tools, next-generation gene sequencing, computational modeling, and other technologies\u00a0that allow us to obtain and analyze complex data sets.<\/p>\n
I started my career in 1984, when our work as medical professionals was far different than it is today.\u00a0Over the past 30 years, I have had the pleasure of witnessing stupefying advances in medicine\u2014progress\u00a0that has had enormous impact on how we diagnose disease, deliver health care and conduct health-related\u00a0research.<\/p>\n
The rate of progress should be even more\u00a0stunning during your careers. Soon, your whole\u00a0genome is going to be accessible on your iPhone.\u00a0An EKG will be self-administered at home with\u00a0a hand-held device, and an iWatch will monitor\u00a0seizure activity. Highly accurate autonomous robots\u00a0will assist surgeons in the OR. And health behaviors\u00a0will be tracked so closely that we will know in real\u00a0time whether patients are adhering to their treatment\u00a0regimens. There\u2019s no doubt that technological\u00a0innovation will save many, many lives.<\/p>\n
Which raises the question, as I look out at all\u00a0of you newly minted doctors: What is the role of the\u00a0human doctor in this brave new world of medicine,\u00a0which threatens to reduce the patient to a data set\u00a0and \u201cdoctoring\u201d to an algorithm? How can we harness\u00a0the power of technology without undermining\u00a0the doctor-patient relationship?<\/p>\n
I recently read a striking study by an assistant\u00a0professor of medicine here at Northwestern named\u00a0Enid Montague. She used videos to analyze eye-gaze\u00a0patterns in the exam room and found that doctors\u00a0who use electronic health records spend roughly onethird\u00a0of each visit staring at the computer. Not only\u00a0is that alienating, but it can mean that we doctors\u00a0aren\u2019t picking up on important non-verbal cues from\u00a0our patients.<\/p>\n
And the more sophisticated our medical\u00a0technologies get, the more potential there is for\u00a0this distancing effect. For example, a hand-held\u00a0ultrasound is more precise than a traditional physical\u00a0exam\u2014be it percussing a patient\u2019s abdomen to\u00a0determine the size of the liver or putting a stethoscope\u00a0to someone\u2019s chest to listen for abnormal heart\u00a0rhythms.<\/p>\n
But the human touch is an important part of\u00a0building trust between doctor and patient. Can you\u00a0imagine a scenario in which a doctor did a physical\u00a0exam without once actually laying hands on the\u00a0patient?<\/p>\n
I like to argue that technology serves to get\u00a0the unneeded variation out while the physician is\u00a0there to keep the needed variation in health care.<\/p>\n
The computer can ensure that the diagnostic\u00a0process is efficient and thorough, with all potential\u00a0diagnoses considered. But the physician must be\u00a0there to help interpret findings or to say, maybe\u00a0that patient can\u2019t afford that drug, or that treatment\u00a0regimen is too complex for that patient to manage.\u00a0We as human doctors can factor in so many subtle\u00a0observations and make an appropriate judgment call.<\/p>\n
In order to do that, we need to listen. William\u00a0Osler, one of Johns Hopkins\u2019 founding fathers,\u00a0is famous for saying: \u201cListen to your patient. He is\u00a0telling you the diagnosis.<\/em>\u201d And I would take this\u00a0opportunity today to echo that advice to all of you.<\/p>\n Here\u2019s the thing: I believe that most of us\u00a0who go into this field start out compassionate\u2014\u00a0motivated to help our fellow humans and relieve\u00a0suffering. I can tell you that\u2019s what drew me to\u00a0medicine, and I\u2019m sure the same is true for you.<\/p>\n It used to be we would train residents out of\u00a0this inclination to be humanistic\u2014through impossibly\u00a0grueling hours and a culture of browbeating.\u00a0When my wife and I trained, we worked more\u00a0than 100 hours a week, and it took us years to start\u00a0feeling human again after that.<\/p>\n Fortunately, I believe medical schools have\u00a0made great strides over the past decade in nurturing\u00a0empathy. We\u2019ve changed our selection criteria\u00a0to attract more caring, well-rounded people, and\u00a0our residents are now limited to a somewhat more\u00a0humane 80-hour workweek.<\/p>\n The problem is that in trying to teach our\u00a0trainees to be more humanistic, we\u2019re going against\u00a0the grain of society. In 2016, efficiency is the name\u00a0of the game, so doctors\u2019 visits and hospital stays are\u00a0growing shorter, making it harder to form meaningful\u00a0relationships with our patients. Furthermore,\u00a0so much of our communication today is now mediated\u00a0through technology. Think about it: People vet\u00a0potential mates through online dating sites. Friends\u00a0stay in touch over Facebook. We communicate\u00a0with our officemates via email.<\/p>\n Health care is a service industry, so look\u00a0at other service industries and you\u2019ll see a trend of\u00a0dramatic depersonalization over the past couple\u00a0of decades. When was the last time you spoke to a\u00a0human while making a travel reservation or depositing\u00a0a check? I just read that Wendy\u2019s is adding\u00a0self-service ordering kiosks to all its restaurants\u00a0this year. For better or worse, DIY gene testing is\u00a0already on the scene. As younger generations enter\u00a0the workforce, this trend will only intensify.<\/p>\n But here is the really good news about your\u00a0generation, and this gives me a lot of hope. Even\u00a0though millennials have been raised on technology,\u00a0study after study shows that your generation is\u00a0more community-minded than the Gen Xers and\u00a0baby boomers who preceded you.<\/p>\n You\u2019re more likely than previous generations\u00a0to state that you want to be leaders in your\u00a0communities and make a contribution to society,\u00a0and roughly 70 percent of people your age spend\u00a0time volunteering in a given year. Not only do\u00a0you all have the idealism of youth, but you\u2019re also\u00a0matching that idealism with action. And it\u2019s inspiring.<\/p>\n At Johns Hopkins, all our trainees participate\u00a0in service projects, and I suspect that\u2019s true for\u00a0most of you as well\u2014whether it\u2019s providing free\u00a0hepatitis B screenings for community members\u00a0in Chicago\u2019s Chinatown or donating your time\u00a0to CLOCC, Northwestern\u2019s Consortium to Lower\u00a0Obesity in Chicago Children. In my view, the\u00a0very best physicians are those who possess a service\u00a0ethos\u2014who are not just humanists, but humanitarians.<\/p>\n Recently, I was helping my daughter with\u00a0her medical school applications, and one of the\u00a0essay prompts included this quote from the late\u00a0Nobel Laureate George Wald: \u201cThe trouble with living with contradictions is that one gets used to them.\u00a0The time has come when physicians must think not\u00a0only of treating patients but also of trying to help heal\u00a0society, if only so that their work is not incompatible\u00a0with \u2026 surrounding circumstances, partly of their\u00a0own making<\/em>.\u201d<\/p>\n Let\u2019s unpack that quote.<\/p>\n In American cities, long-standing systemic\u00a0inequities mean that many members of our communities\u00a0lack access to adequate health care, decent\u00a0schools and other advantages that many of us here\u00a0today take for granted. What Wald is saying is that\u00a0we can\u2019t be content to cure sick people and lecture\u00a0them on how to stay well without also addressing\u00a0these underlying social conditions that contribute\u00a0to poor health and the glaring health disparities we\u00a0see in our cities.<\/p>\n We cannot satisfy ourselves with doing one\u00a0and not the other\u2014particularly in light of the social\u00a0unrest that has been happening here in Chicago\u00a0and in my city, Baltimore, over the last year and\u00a0a half following the deaths of Laquan McDonald\u00a0and Freddie Gray. These and other events have provoked\u00a0Americans to confront some difficult truths.\u00a0Wherever your career takes you next, I ask that you\u00a0try to channel those feelings into positive action.<\/p>\n After all, why put such herculean efforts\u00a0into healing people and finding cures if we will\u00a0stand for an environment that contributes to shortening\u00a0their lives?<\/p>\n When we do make scientific advances, we\u00a0have to ensure that everyone in our society\u2014regardless\u00a0of race or income\u2014has equal access to the\u00a0latest and greatest medicine has to offer.<\/p>\n In January, the director of our gynecologic\u00a0oncology service at Johns Hopkins published an\u00a0article looking at trends in the way we treat cancer\u00a0of the uterus.<\/p>\n It used to be when you operated on a\u00a0patient with early-stage uterine cancer, you did a\u00a0hysterectomy by slicing open the abdomen. The\u00a0incisions were large and sometimes could lead to\u00a0infection, blood clots, major blood loss, etc. These\u00a0days, minimally invasive surgery (laparoscopic or\u00a0robotic) has become the standard of care, curing\u00a0roughly two-thirds of these patients with far fewer\u00a0complications than the old method.<\/p>\n At Johns Hopkins, we choose this method\u00a0more than 90 percent of the time, unless there\u2019s a\u00a0complicating factor. Yet when our scientists looked\u00a0at the national data, they found a troubling trend:\u00a0African-American and Hispanic women are less\u00a0likely to get the better, minimally invasive brand of\u00a0surgery, as are patients who are on Medicaid or are\u00a0uninsured.<\/p>\n In 1966, Martin Luther King Jr. said, \u201cOf\u00a0all the forms of inequality, injustice in health care\u00a0is the most shocking and inhumane.\u201d So what can\u00a0we\u2014or, more specifically, you\u2014do about it?<\/p>\n Any strategy health care professionals\u00a0develop to address population health must address\u00a0the root causes of poor health, including poverty.\u00a0Of course, the problems associated with poverty are\u00a0incredibly complex, and breaking the poverty cycle\u00a0requires an approach with many prongs, beginning\u00a0with education.<\/p>\n I don\u2019t expect you all to have the answers\u00a0right out of medical school. All I ask, as you set off\u00a0on your quest to eradicate disease, is that you take\u00a0seriously your role as leaders in the community.\u00a0The degree you are earning today confers a measure\u00a0of responsibility, and I have total faith that your\u00a0generation will get us closer to solutions to these\u00a0pressing problems.<\/p>\n As busy as we are, trying to make our\u00a0mark on the profession and, by extension, \u201chuman\u00a0health,\u201d we can\u2019t lose sight of the people in the very\u00a0neighborhoods our institutions exist to serve.\u00a0I believe the medical community has a real\u00a0opportunity to lead in helping to heal our cities,\u00a0conquer inequality and create better opportunities\u00a0for all. That work starts with the humanity and\u00a0compassion in each of you.<\/p>\n Again, I want to congratulate you for this\u00a0terrific accomplishment. We know you are going to\u00a0achieve great things. Thank you.<\/p>\n Paul B. Rothman is the Frances Watt Baker, M.D., and\u00a0Lenox D. Baker Jr., M.D., Dean of the Medical Faculty,\u00a0vice president for medicine of The Johns Hopkins University,\u00a0and CEO of Johns Hopkins Medicine. As dean\/CEO, Rothman oversees both the School of Medicine\u00a0and the Johns Hopkins Health System, which encompasses\u00a0six hospitals, hundreds of community physicians\u00a0and a self-funded health plan.<\/p>\n Paul B. Rothman, MD The Medical Commencement Archive Good afternoon, and thank you for inviting me to be your speaker today. My name is Paul Rothman,\u00a0and I am the dean of the Johns Hopkins University School of Medicine and the CEO of Johns Hopkins\u00a0Medicine. It\u2019s my privilege to be here on this memorable occasion to celebrate you, the esteemed\u00a0graduates of the Northwestern University […]<\/p>\n","protected":false},"author":1,"featured_media":1451,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false},"categories":[212,366],"tags":[397,31],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1450"}],"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=1450"}],"version-history":[{"count":2,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1450\/revisions"}],"predecessor-version":[{"id":1453,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/posts\/1450\/revisions\/1453"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media\/1451"}],"wp:attachment":[{"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/media?parent=1450"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/categories?post=1450"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.themspress.org\/blog\/wp-json\/wp\/v2\/tags?post=1450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
\nAfrican-American adults are at least 50 percent\u00a0more likely to die prematurely of heart disease\u00a0or stroke than their white counterparts.<\/li>\n
\nNorthwestern University Feinberg School\u00a0of Medicine Commencement Address<\/p>\n
\nVolume 3, 2016<\/p>\n","protected":false},"excerpt":{"rendered":"