This spring André Picard received honorary doctorates from three universities: Carleton, University of British Columbia, and University of Toronto. The convocation speech that he delivered to medical graduates at the University of Toronto on 7 June 2017 is reprinted here, slightly abbreviated, with permission.
In my work, I meet many people, from those with acute illnesses through to those who live with rare and even fatal conditions, as well as their caregivers and care providers. I have the privilege of listening to, and learning from, their fears and frustrations, their hopes and their dreams, their wisdom and their rage, their intimacies.
My mom died a few years back of chronic obstructive pulmonary disease (COPD) — a cruel lung disease that slowly robs you of breath and makes you feel like you’re drowning on dry land. She taught me more about medicine and health policy than any so-called expert ever did because she helped me understand what really matters to patients. She was one of those little old ladies you see at the mall, dragging an oxygen tank behind them. As she aged, she had an alphabet soup of conditions, arthritis, osteoporosis, a bout of breast cancer, and COPD leading to heart problems and mini-strokes, which in turn caused vascular dementia. Top
Try to remember that behind every one of those diagnoses, there is a complex story. My mother was a child of the Depression, and going hungry in childhood had life-long health impacts. She was also a smoker — COPD is principally a disease of smokers. That leads to a lot of judgement, and assumptions, but remember, people like my mom were products of their time, when smoking was the social norm. Her doctor encouraged her to keep smoking during pregnancy because the baby would be smaller, and the birth easier.
You see many patients like my mom, and sometimes we refer to these patients derisively as “frequent flyers.” Try to remember that those frail, sick people sitting on your exam table had full, rich lives. Try, as best you can, to contextualize their illness. Top
The term “patient-centred care” gets bandied around a lot these days. What does it really mean? The United States Institute of Medicine defines patient-centred care as “care that is respectful of and responsive to individual patient preferences, needs, and values.”1 That’s nice and inspiring, but it’s also pretty vague. You’ve probably heard the expression: “I don’t know anything about art, but I know what I like.” Patient-centred care is a bit like that, you know when you experience it — and especially when you don’t. The best definition I’ve heard is the simplest: giving a patient a better day.
When all is said and done, that’s what health care is all about: making patients feel a little better. I don’t want to downplay or dismiss your knowledge and your abilities, but simply remind you of the limitation of medicine. What really makes and keeps people healthy is their socioeconomic environment — their income, education, a roof over their head, access to decent food, and a sense of belonging. Medicine is there to patch things up when people are broken. Top
One of the greatest privileges in our society is to have the letters MD after your name. Those two letters confer great power. With that power comes great responsibility: sometimes you will literally hold a patient’s life in your hands, but most of the time, you will have the power to make them feel just a little bit better. Your voice is also imbued with magical power because of those two letters, MD. Use it for good — not only for your individual patients, but also for society.
If there’s one lesson I learned from my mom, time and time again, it’s that the little gestures have the greatest impact. “Hello, my name is Jane. How can I help you?” Nothing mattered more to my mom than that simple introduction and question. In fact, one thing did matter more: that the doctor or other health care provider asking was actually willing to listen to the answer. Top
I want to read you a tweet from a physician who eloquently expresses this concept: “I had the chance to really talk with a patient today. When I say ‘talk’, I mean ‘listen’ and when I say ‘a patient’, I mean a person.” It’s something you should all strive for.
Modern medicine has become so specialized that many physicians treat specific syndromes and body parts, and the patient herself gets lost in the process. In our unrelenting quest for efficiency and measurement, we often lose sight of the person. We have filled our temples of medicine with such bedazzling high-tech tools that we’ve forgotten that we should treat people where they live. Top
In our desire to cure, we over-treat. We see death as a failure, but we can learn a lot about living from the actions of the dying. I speak to many people when they’re sick and terminally ill. I’ve even been at the bedside when they take their last breath — and it’s marvelous.
That may strike you as morose or odd, but I’m using the word “marvelous” here in its true sense — meaning “eye-opening” and “wondrous.” When people are sick, when they know there is no cure, even when they’re dying, what they care about is quality of life. They are not resigned, they are realistic. They don’t expect miracles. They want respect. Top
We hear a lot these days about personalized medicine, about drugs and treatments that can be tailored to specific genomic and epigenetic markers. What people really long for is not personalized medicine, but a personal touch. They crave a human connection. Not just care, but caring — a sense of belonging.
As a journalist, my job, ostensibly, is to write, to report, to summarize, to analyze, to inform, but my real job is to listen. Listening is a skill that will serve you all well — regardless of what program you have graduated from, but especially in medicine. Top
Listening is an art — and listeners are an endangered species. Listening well is more complex than it appears; it requires us to set aside our assumptions and prejudices. Above all, listening requires us to be quiet, to embrace silence. That’s not easy in our fast-paced world. Like accomplished musicians, we need to recognize that the silence between the notes is as important as the notes themselves.
My mom was a woman of few words, but she would let her family and her health care providers know what she liked and didn’t like — if they were willing to listen. What she hated the most was the blue hospital gown. To her it was a cloak of invisibility, a symbol of powerlessness. Top
My mom also balked at all the academic banter about privacy. She didn’t care much about what health professional saw her medical records. To be honest, they weren’t that interesting. To her, the privacy issue that mattered most was that she was too often left in the hallway of the emergency department for hours with, in her words, “my bony ass hanging out.”
And she hated when she visited the doctor’s office and he stared fixedly at the computer screen. I once accompanied my mom on an appointment to her family physician and, after five minutes of him asking formulaic questions and tapping a keyboard, I interrupted and asked: “What colour are my mother’s eyes?” For a second he was perplexed. But then he understood the gist of the question and turned beet-red with embarrassment, realizing that he never looked her in the face.
We hear a lot about personalized medicine these days, but what people really long for is not personalized medicine, it’s personal medicine. They crave a human connection: not just care, but caring. Top
As you head out into the world to forge long, successful, and prosperous careers, remember that the best medicine you can offer your patients is a listening ear. The best treatment you can offer them is a compassionate heart.
I guess my take-home message is try to treat every patient as you would treat your mother, or your grandmother — with dignity and respect.
You leave here today with great knowledge; now go out there and learn some wisdom from your patients.
1.Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.