Surgeon General Vivek Murthy Shares Wisdom for New Health Care Professionals

Vivek Murthy, MDEarlier this year, Vivek Murthy, United States Surgeon General and Co-Founder of Doctors for America, delivered the commencement address at Harvard Medical School. In his speech he challenged the graduates to stand up for their values and vision and to be leaders in improving our health care system. During the next two weeks, the newest generation of aspiring physicians will matriculate at medical schools across the country, entering the profession at a time of great challenge and opportunity. We have chosen to reproduce an abridged version of his speech as it holds important messages not only for recent graduates, but for all new physicians. A video of the entire speech can be viewed here.

My parents came to the U.S. as immigrants from India. There were many reasons why they left everything they had ever known to move halfway across the world, but there was no catalyst in their journey more important than education. They crossed continents and oceans and endured countless acts of discrimination because they hoped for a life in which their children – my sister and I – would have limitless opportunities. They raised us to believe that our reach should always be greater than our grasp. And they believed that the gap between those two things would be bridged by education.

Quote1_3My parents are probably not so different from the people in your lives – your family members, friends, mentors and champions – whose commitment and love for you made this moment possible.

Today, I’d like to talk to you about standing up for your values and your vision as you build lives as physicians and dentists.  I’d like to talk about why doing so is hard but also important not just for you but also for the world.

You have now joined a long legacy of healers who stood up for their values and their vision when it counted the most – and who changed the world around them as a result.  Doctors like Elizabeth Blackwell who believed that women have the same right as men to be physicians—and who overcame opposition and ridicule to become the first woman to earn a medical degree in America.  Doctors like former Surgeon General C. Everett Koop, who spoke the truth about HIV prevention despite fierce political opposition because he believed that science and public health should not be compromised by politics.

As doctors and dentists, we share a singular core value that binds us together: an unflinching commitment to improve the lives of our patients.  This is our true north.  But how this value is reflected in your work – your vision – will be unique to you. Your vision may include providing the best possible care to individual patients, pioneering research, advancing medical education, shaping health policy, creating new health care technology, or many other paths. Your vision may also change over time. And that’s ok.

Quote2_2It’s also ok if you don’t have clarity on your vision today. Figuring this out can take time. It will require exploring new ideas throughout your career, especially when that voice within tells you softly but insistently that you are not fulfilled.  And it will require never settling for someone else’s path just because it is easier.

Why is this important?  Because when you are working toward a vision that is firmly grounded in your values, you will be capable of astounding creativity and massive impact.  Staying true to your values and your vision is how you can change the world.

And we need you to.  You enter the world of medicine at a time when we are facing crises with costs, quality, and coverage. We are also grappling with critical public health challenges: an epidemic of obesity and chronic disease, widespread tobacco-related disease that will claim more than 400,000 lives a year, a resurgence of vaccine-preventable illness, and unacceptable disparities in health.

But you have the power to change this.  You can help us build a 21st century model of health where our exceptional power to cure illness and deliver care to patients is exceeded only by our ability to prevent illness and promote wellness.  You can help create a culture of health in America in which all institutions – not just our hospitals and clinics but also our schools, our houses of worship, and our businesses – embrace their roles as stewards of health in the community.

Now, to build a life guided by your values and your vision is not always easy.  It risks disappointment and failure.  To walk this path requires people who remind us of what really matters and who help us find the courage to pursue it.  Our family and friends are some of our best anchors. But perhaps the most powerful force in keeping us grounded in our values is our patients themselves.

I learned this during my third year of medical school when I met a middle-aged woman named Ann who had been diagnosed with throat cancer.  Ann’s condition had progressed to the point where she needed surgery and a tracheostomy so she could breathe.   I was assigned to follow Ann right after her procedure.

As I took the elevator down to meet her in the post-operative care unit, I reviewed the questions I was supposed to ask to look for evidence of airway compromise, excessive blood loss, and other potential complications from the procedure.  I felt ready to demonstrate that I knew the facts.

But when I got to Ann’s bedside, I realized she was awake and alert but couldn’t talk.  She was shivering even though the room didn’t feel cold.  And I will never forget the look of fear in her eyes, which were red and moist as she cried quietly in her bed.  My carefully chosen questions suddenly felt less relevant.

I tried asking if she was in pain or having trouble breathing.  She shook her head “No,” seeming frustrated that she couldn’t speak.  I asked a few more questions, and she shook her head a few more times, continuing to shiver and cry.

Finally, I put away my list of questions and pulled out a spiral pad I kept in my pocket to record personal reflections. I positioned it carefully under her hand with a pen.  “Can you tell me how you are feeling,” I asked.  She took the pen and slowly wrote three simple words that have stayed with me ever since: “I am scared.”

Quote3_1On the frayed pages of my spiral pad, she began to write about her fears of never speaking again and of what might happen if her cancer progressed.  After I went home that night, I re-read her scrawled notes.  After all the procedures I had seen and the facts I had absorbed that day, that one conversation with Ann felt the most meaningful.

I kept that piece of paper in my white coat pocket to remind myself of the simple but powerful lesson that Ann and the thousands of patients that I’ve been blessed to care for since then continue to teach me – that the humanity of our patients lies at the core of everything we do as doctors.  It is bigger and more important than everything else.

Many of you have had patients who have touched your lives in deeply and all of you will in the years ahead.  I hope you draw on these patients to remind you of the values that you want to define your lives.

Now, even when we remember our vision and values, to translate them into reality takes courage.  As the gifted poet Maya Angelou once said, may she rest in peace, “without courage, we cannot practice any other virtue with consistency.  We can’t be kind, true, merciful, generous, or honest.”   I believe courage lies within all of us.  But it can be buried in fear and self-doubt.  You may not realize it’s there until you are tested.

One of my first tests was nearly 20 years ago when my sister and I were building our first non-profit organization, VISIONS.  We had trained a team of college students from around the country to travel to India to conduct HIV/AIDS education workshops in schools and colleges.  But 5 days before our departure, we found out that we lost all our funding.  Our choice was to return home and get jobs or find a way to raise $15,000 in 5 days – a fortune to college kids with shallow pockets.

But we believed in our vision, and we believed in each other, so we took the plunge and started calling everyone we knew for support – and even people we didn’t know. We worked day and night, held events, wrote letters, and went to local media. Amazingly, people started giving.  Initially a few dollars.  Then a little more.   Ultimately, we raised the $15,000 just in time to get to India.  That summer, we reached thousands of students through our workshops and laid the groundwork for an organization that would expand our efforts over the coming years.

This experience taught me that we are capable of far more than we imagine – especially when we are fighting for a vision and values that we deeply believe in. I’ve drawn on that moment many times in my life when fear and the noise of day-to-day life made me doubt myself and wonder if I should settle for safer paths even if they weren’t what I really wanted to do.

Quote4When I first became an attending physician, I decided to set aside time between weeks of patient care to work on ideas for new technologies that would improve patients’ lives. And it was my experience in VISIONS that made me keep trying even as my pile of failed ideas continued to grow.  Eventually, one of my ideas took root: that of using social networking and information technology to improve collaboration in research.  This became the basis for building a company, TrialNetworks, which is now improving clinical trials around the world.

My experience in VISIONS and TrialNetworks gave me the courage to build Doctors for America a few years later when I was inspired by a simple belief: that doctors should be leaders in fixing our health care system.  I didn’t know much about policy or grassroots organizing, and I was warned often by veterans that doctors were too busy, too cautious, and too cynical to get involved in fixing health policy.

But I also knew many of my colleagues came to medicine inspired by high ideals and by patients who touched their lives as Ann did mine.  They wanted to practice in a system that served those ideals – and so did I.   I found myself up late at night imagining how much we could do if doctors spoke up, and I was blessed to find a few good friends who felt the same way and inspired me to act.  When we eventually started Doctors for America, we found thousands of doctors and medical students in all 50 states across specialties and ages who were hungry to have a voice in creating a better health care system.

One of these physicians was Mona, a private practice allergist in Florida with a husband and four children under the age of 10 who had lots of ideas for improving the health care system but wasn’t sure anyone would want to hear them. She began by painstakingly writing her first letter to the editor.  And to her surprise, it was published.  Now, just a few years later, Mona has published many more pieces, spoken at dozens of events, led a prevention and education bus tour, and helped countless fellow physicians in Florida find their voice and speak up for patients.

Colleagues like Mona not only give me courage, but they remind me that we can no longer remain within our exam rooms and ignore what happens in our communities.  As physicians and dentists, we must have a presence in both places.  Our sacred responsibility is both to help the patient in front of us and also to safeguard the health of the nation. It is a big responsibility, but one that we are called to meet.

As you begin your lives as physicians and dentists, as you ponder the great challenges that loom before our patients and our country, as you consider how you will respond to these calls to action, remember this: the world needs dreamers and doers.  It needs doctors and dentists who can imagine the world as it should be and who have the courage to step forward with open minds, clear eyes and full hearts to transform those dreams into reality.

More than ever, the world needs you.

Quote 5There are those who might tell you that you are too young and inexperienced to solve the problems we face. But when I hear such views, I think of the medical students and residents on this campus who launched a movement to revitalize primary care.  I think about the young entrepreneurs who are employing big data analytics to improve quality of care.  And I think of the many students who have served in free clinics in some of the poorest parts of America and the world because you believed it was not enough to talk about disparities but to be part of the solution.

So I challenge you to find your vision and stand firmly by your values as you build your careers.  Standing up for your vision and values means you have to remain standing, especially in the face of hardship.  It won’t be easy.  But it’s your job.  It’s who you are now.  If you build a life on your values and your unique vision, you will change the world.  And you will inspire others to do the same.  Don’t ever let anyone tell you otherwise.

Here is my prediction: 30 years from now, when commencement speeches are given at medical and dental schools around the country, when praise is heaped upon the pioneers who led our country forward during a time of great change, they will speak of the bold, courageous men and women who became healers on this day.

They will speak of the historic era of uncertainty and opportunity into which you stepped.

They will describe how your courage and conviction overcame your fear and doubt as you built a foundation of health for a nation that was badly in need of healing.

They will observe that, at a time of division and polarization, you built partnerships with the people and institutions around you and restored faith in what we could do as a people when we came together.

And they will declare that this was a generation of whom much was demanded and one that stepped up and delivered, leading our nation from a place of peril to a place of promise.

This is your moment.  This is the future you can create. Your job is, as it has always been for healers throughout the ages, to fill darkness with light, to face down ignorance with knowledge, to replace despair with hope. Rise to this challenge.

[Photo Credit: Meredith Nierman]


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