369 Take Oath at School of Medicine White Coat Ceremony

dr william s andereckSt. George’s University School of Medicine (SGUSOM) officially welcomed a new class of 369 medical students from 43 countries at the SOM White Coat Ceremony held at Charter Hall on Sunday, August 24th.  The class of 2012 received words of inspiration and warm welcomes into the medical profession and the SGU community by SGU Alumnus and Master of Ceremonies Dr. Randy Becker, Chancellor Charles R. Modica, Prime Minister Hon. Tillman Thomas and Keynote Speaker Dr. William S. Andereck.

A familiar yet central part of the White Coat ceremony showcases students swearing a professional oath, promising to act with integrity and in an ethical manner during their training and career in medicine.  As Medical Director of California Pacific Medical Center’s Program in Medicine and Human Values, Dr. Andereck’s distinguished career in medical ethics served as inspiration to this new generation of medical students, further substantiating the importance of serving their patients with honor, dignity and humility.

“To help, not to harm,” the essential duty of the physician for over 750 years, was the essence of Dr. Andereck’s address, asserting that the principles of competence, compassion and commitment are the cornerstones of the practice of medicine.  When implemented as one, he explained, these essential principals produce not only highly skilled professionals but physicians who possess compassion and humanity.  Clinical competence, for example, must be well balanced with respect and a sincere concern for one’s patients.

Dr. Andereck discussed the swing of the medical pendulum as it moved from one extreme to another. Initially, it was thought that patients do not need to play an active role in their medical care. Critical aspects of care such as diagnosing the nature of the problem and treatment options were very much the decision of the attending physician. This was well illustrated statistically when in 1960, 90% of doctors interviewed said that they will not always tell their patients what is wrong with them. However, just 18 years later, with growing emphasis on respect for the individual and taking into account their goals, values and aspirations, an overwhelming 99% of physicians said that they will fully disclose the patient’s diagnosis at all times.

Today, the challenge for the modern physician is to find the right balance between individual needs and public health needs. Here is where a fourth principle – justice – is to be fully embraced in their professional life. The modern doctor is faced with not only the care of his patient but with the responsibility to treat the poor with the same skill and attention as the rich. Moreover, they must also successfully face the challenge of the statistical patient as they seek to balance scarce resources with the needs of the patient. More and more physicians are called to administrative roles and must be prepared to take a holistic approach to medical care.

Parents of the incoming class were specially commended for already instilling in their sons and daughters these cornerstone principles of medicine along with the qualities of compassion, humility, industriousness and willingness to work hard. These are not just virtues of medicine, but virtues of life.

Since 1979, Dr. William S. Andereck has combined the private practice of internal medicine in San Francisco with his ethics work and a busy clinical practice. As Medical Director of California Pacific Medical Center’s Program in Medicine and Human Values, he oversees a vibrant and rapidly growing center which provides ethics consultation, educational programs and policy development services within a large community hospital located in San Francisco.  He has also chaired the hospital’s ethics committee since its inception in 1985.  At present he is a trustee of the California Medical Association.

Dr. Andereck’s community interests include a long-standing affiliation with youth soccer and a ten-year term as Director of the San Francisco Zoo.  He and his wife Helga have three children.

Inaugural Nursing Program Commences

On Saturday, August 23rd, St George’s University inducted 25 students into the inaugural four-year program leading to the Bachelor of Science in Nursing (BSN) degree. In a ceremony attended by Grenada’s Prime Minister, Hon. Tillman Thomas, the charter class was urged to follow the example of the many outstanding role models in their profession.

inaugural nursing program students

Provost of St. George’s University, Dr. Allen Pensick, used the occasion to spotlight the illustrious past of the profession which stemmed from individuals’ desire to serve the needs of the sick.  Keynote speaker Dr. Judith Balcerski, a registered nurse who served as Dean of the Barry University School of Nursing for 33 years, congratulated these ‘brave and privileged individuals’ on being the first nursing class at SGU.  She encouraged them to continually reflect upon the many outstanding men and women who entered the profession years before: Catherine of Sienna, Clara Barton, Florence Nightingale and Mother Theresa to name a few.  Dr. Balcerski explained that learning their stories will bring to life the heart and soul of the nursing profession and will serve as inspiration throughout their journey in nursing education and nursing practice.

Drawing upon an impressive career, Dr. Balcerski eloquently defined the profession as both a science and an art, to which she added “sense and heart.”  From these four words, Dr. Balcerski created an acronym, SASH, which she threaded throughout her speech and inspired a new generation of nurses.  “Remember nursing as a sash, a mantle across your shoulders of science, art, sense, and heart.”

Judith BalcerskiDr. Balcerski encouraged the students to “practice by evidence rather than myth,” as they apply the skills learned in the anatomy, physiology and chemistry classrooms. This, she explained, is the science aspect of the nursing profession.  She then defined the art of nursing, and encouraged the students to employ creative methods in dispatching their duties for the benefit of their patients.  Creativity, said Dr. Balcerski, can help a patient accept treatment when they are fearful, eat when then have no appetite and sleep when they are not willing.   The sense comes into play each day, as good sense sustains oneself when tired, frustrated and in need of a fresh perspective. Above all, Dr. Balcerski stressed, “heart is what presses you to take care of someone who is different from you. Heart will press you to take care of the criminal and the Queen equally.”

To mark their entry into nursing, the students were presented with stethoscopes and lamps.  During the ceremony the aspiring nurses joined members of the profession in making the Florence Nightingale Pledge.

The Nursing Program was conceived as a response to the mandate by the Caribbean Community (CARICOM) that all nurses in the region hold a BSN degree by the year 2010.  This program is uniquely structured to allow enrolees, after 30 months, to sit regional and international licensing exams.  Upon successful completion of these exams, the students can join the workforce while completing their studies. Chancellor of the University, Dr. Charles Modica says that through this initiative, St. George’s University is extending its commitment to building human resource capacity, increasing access to quality tertiary education and improving health care in developing countries.

Read Dr. Judith Balcerski’s Keynote Address

John Madden White Coat Ceremony Speech

SGU alumnus Dr. John Madden, Associate Dean of Students, United States and Director, Office of Student Development and Career Guidance, was the Master of Ceremonies at the August 2008 Keith B. Taylor Global Scholars Program White Coat Ceremony.

Voltaire once said “Those who are occupied in the restoration of health to others by the joint exertion of skill and humanity are above all the great of the earth.  They even partake of Divinity; since to preserve and renew, is almost as noble as to create.”

While I know some Trauma Surgeons that have taken Voltaire’s Divinity concept quite literally, I think he otherwise has the right idea; a physician is engaged in a wonderful profession- maintaining someone’s health or attempting to restore an ill or injured patient to a healthy state.

I am an emergency physician in Delaware and also an Associate Dean of Students for St. George’s.  I work at a very busy ED where we see over 150,000 patients a year. It is a Level I trauma Center for both adults and pediatric patients. I trained at Jacobi Hospital in the Bronx where I was taught that the emergency department was the safety net in health care; when there is no where else to go for care, you go to the ED. We are the 7-Eleven in medicine- 24 hours a day, seven days a week, 365 days a year.  We care for the sick and injured, young and old, with or without a shirt or shoes on, whether they are intoxicated, abused, victims of crime, those that committed those crimes, those who think they are ill but are not and even those without the ability to pay or a place to call home.  We care for those who have experienced perhaps the most significant crisis that they will ever experience in their lives.

I wouldn’t have it any other way.

I have also been privileged to only work at places where physicians in other hospital emergency departments send their patients because they lack the ability, or in rare cases the compassion, to care for certain types of patients.

We’re here to witness you symbolically join this noble profession of medicine by donning your white coat and reciting an oath.  Today you become part of a tradition that goes back over twenty five hundred years; the physician as a servant of the sick.

During the next several years, here in Newcastle, in Grenada, in your clinical training in the US or UK and during your residency, you will hear your teachers discuss “Core Competencies.”  There are 6 Core Competencies, all of which are vital to your education;

  1. Patient Care
  2. Medical  Knowledge
  3. Practice Based learning & improvement
  4. Interpersonal and communication skills
  5. Professionalism and
  6. Systems Based Practice

Except for medical knowledge, these competencies don’t mean much to you right now. You will become adept at all of these during different phases of your training, but they all start right here – today!  A friend of mine once told me that medicine attracts the best and the brightest from college, but I am quite sure, and lucky for me, that being the brightest in organic chemistry does not make one a good physician.  It is the respect and compassion you show towards those with whom you come into contact, be it patients, fellow students, school officials or the staff that clean your classrooms and it starts right here – today.

Medicine is a team sport.  The physician doesn’t save lives, the team does. Often members of the team never lay eyes on the patient- they may be reading an x-ray many miles away or even on another continent and notice a small growth on an imaging study, or a lab tech that identifies the pathogen infecting the patient that prompts you to change the antibiotic you are giving the patient. We’re all in this great profession together.  Treat each other with respect now and you’ll treat your patients the same way.

You have many hurdles between today and your graduation.  Take it one step at a time- your first hurdle may be a biochemistry or an anatomy exam while your roommates hurdle might be microbiology.  Help each other get over the hurdles and cross the finish line together.  Thousands of Saint George’s students have preceded you.  They had the same concerns and uncertainties that you probably have right now, but they have graduated and as physicians have touched hundreds of thousands of lives.  Your ability to touch these lives starts right here and now with the help of your faculty and fellow students.

I wear a white coat most of the time when I work.  I might change into a hospital gown when I am treating someone who is actively bleeding or needs to be sutured or perhaps even has the potential to vomit on me.  Anyone who has tried to collect a urine sample from a baby boy or even changed their diaper quickly learns how to keep a safe distance.  But after a serious trauma case or a cardiac resuscitation, I’ll put the white coat back on when I go to speak with the family to tell them either the good news or perhaps the news they have been dreading since being summoned to the emergency department.  I put the white coat on so that can see immediately that the physician speaking with them is part of the profession of medicine.  The white coat is the robe of our profession.  Wear it proudly!

The Not so Quiet Art: Medicine in the 21st Century

Keith B. Taylor Global Scholars Program White Coat Ceremony Keynote Speaker Professor Sir Miles Irving, Professor of Surgery at the University of Manchester and Consultant Surgeon at Hope Hospital Salford for 25 years, explores the ethical responsibility and generosity of spirit which is at the core of the medical profession.

Provost Macpherson, Vice Chancellor, Dr Rao, Distinguished Guests, Students, Ladies and Gentlemen.

It is indeed an honour to be asked to deliver this keynote address at your white coat ceremony here in this magnificent Arts Centre in Gateshead on the banks of the River Tyne next to the ancient city of Newcastle.

Enoch Powell, a famous British politician of former years, once advised me “always lecture with a full bladder, then you will not go on too long.” I want to add my own variant of this advice “lecturing five weeks after a knee replacement produces exactly the same benefits without the risk of any embarrassing accidents”.

Newcastle has a long history of the teaching and practise of medicine as– evidenced by the ancient company of barber surgeons that existed in the seventeenth century and their beautiful surgeon’s hall, now sadly long demolished. In my own specialty of surgery the names of the Newcastle surgeons  Rutherford Morison and Grey Turner  stand out in the fields of abdominal and oesophageal surgery whilst Rowbotham was one of the world’s pioneers in the scientific approach to the management of head injuries. In paediatric medicine the famous, and still ongoing ,“Thousand Families Survey” was initiated in this city by Sir James Spence  and in the field of maternity care Newcastle was the first to establish flying squads for women who developed complications whilst  giving birth in their own homes.

This fine tradition of scientific medicine continues to this day with Newcastle playing a leading role in many areas particularly genetics and  stem cell research and the problems of ageing.

May I say at this stage how impressed I am at what St Georges University School of Medicine is doing to help tackle the massive shortage of doctors in this world of ours. I have long been aware of your existence and the work you are undertaking not least because one of the key individuals in your foundation, Paddy Ross was a colleague and friend  of mine when we were training in surgery at St Bartholomew’s Hospital in London many years ago.

It is now some fifty years since I qualified in medicine from the University of Liverpool and over that time I have seen miracles in the practice of medicine that almost defy belief. Not a week goes by without some new advance in medicine being reported and indeed, though now retired from clinical medical practice I still experience new facets of my profession through its Research and Development activities,  and not least  today when for the first time I am taking part in a white coat ceremony,  which is not a tradition in British medical training. But more of that later.

So what of my title today?  It  is taken from Virgil’s book the Aeniad  which  contains the following phrase;

Scire postetates herbarum usumque medendi 
Maluit et mutas agitare inglorious artes.

Translated into English this reads;

it was his part to learn the powers of medicines and the practice of healing, and careless of fame, to exercise that quiet art.

From the time of Virgil to this present day  I believe the core of our profession remains  this combination of  the powers of medicine  with the practice of healing implemented within a framework which incorporates the features  of the Quiet Art , and which distinguishes the whole from a mere technical exercise.

I first heard of this term when I was given a book compiled by a great Liverpool Physician called Robert Cooke who brought together an anthology of sayings about doctors. This book was given to me by the author in my first year after qualification following my looking after him for several weeks. Here it is, and it has remained a constant support to me throughout the fifty years since I qualified. How so ?

I want you now to picture a famous painting, currently in the Tate Gallery, called “The Doctor”. . It is by the famous painter Sir Luke Fildes, also from Liverpool, who has portrayed a bearded doctor of the 19th century sitting by the bedside of a dying child throughout the night whilst her parents look on anxiously. The doctor  almost certainly did not know what was wrong with the child and even if he did he equally certainly  was not able to do anything about it, but he was there  bringing  comfort  at the time of greatest need of the child and her parents.

It was undoubtedly stimulated by the fact that Fildes had himself  suffered the death of  a son and indeed it  is said that the picture is a tribute to the doctor that looked after his son.

I always thought that this painting portrayed the final moments of the child as shown by the obvious distress of the parents but in reading further about it I understand that the glimmer of light from the approaching dawn is meant to show that in fact the child was getting past the crisis and was to recover.

What did the public of that time think of such doctors who had little to offer but kindness and compassion. Robert Louis Stevenson the famous author of the book Treasure Island  wrote the following:

There are men and classes of men that stand above the common herd: the soldier ,the sailor, and the shepherd not infrequently ,the artist rarely, rarelier still the clergyman; the physician almost as a rule. He is the flower(such as it is) of our civilisation; and when that stage is done with, and only to be marvelled at in history, he will be thought to have shared as little as any  in the defects of the period, and most notably exhibited the virtues of the race. Generosity he has ,such is possible to those who practise an art, never to those who drive a trade; discretion tested by a hundred secrets; tact tried in a thousand embarrassments ;and what are more important, Heraclean cheerfulness and courage. So that he brings air and cheer into the sickroom, and often enough ,though not as often as he wishes, brings healing.

Heady stuff,  but only one example of many similar pieces written around this time. Nowadays he would of course have included women doctors in his description. It is interesting to note that of all the attributes that Stevenson values in the physician the one he mentions last of all is healing. That’s not to say he does not value healing; the parents in Fildes’ painting want healing of their child more than anything else, but Fildes, who you recall had himself   suffered a death of a child was depicting all those other attributes mentioned by  Stevenson. I consider that these are  the Quiet aspects of the Quiet Art. I hope that what follows will persuade you that these Quiet aspects of medical practise are as important today, in this era  of high technology medicine, as they have ever been.

Even as Stevenson and Fildes were writing and painting ,the effects of the scientific enlightenment were beginning to bear fruit and allowing our profession to emerge from what Sir Frederick Treves the famous London surgeon described as the medical dark ages.

Treves was an exemplar of that combination of medical science and the Quiet Art for not only did he have the skill and knowledge to save the life of the king by draining an appendix abscess  on the eve of his coronation, but  also in a truly humanitarian  act rescued the  Elephant man from poverty and captivity in circus shows and looked after by  giving him accommodation in the Royal London Hospital.

So is it different today when we have the most powerful array of effective treatments that has ever existed and which backed by sound evidence expands at an almost exponential rate?

Our 21st Century patients have high expectations of what we have to offer and expect the highest standards of care.

However there is a paradox at the present time in  that whilst we deliver increasingly effective medical care , in the Western World  there is an unprecedented interest in, and use of complementary therapies ,for which there is no scientific evidence.

Does this represent a reaction to the fact that in delivering our successful high technology treatments the medical profession of today may be tending  to ignore the Quiet aspects of our practice  with the result that, as suggested by the title of my talk today, Medicine in the 21st Century is not as Quiet an Art as it should be.

If this is the case then we, as a profession, will be missing out on just those aspects of our work that make our occupation so enjoyable and memorable.

Every experienced doctor will tell you when he or she looks back on their professional lives that  the rare moments of triumph of diagnosis and treatment are always  recalled with pride and relish as great occasions, whilst those terrible cases that go badly wrong are remembered  with sadness and often guilt. However, the vast majority of routine cases that go well are rarely remembered.

However , the really  memorable  moments one recalls  are often  those  when  one is using the attributes common to all good doctors when  practising the Quiet side of our art.  For example when one is alone with a patient at a time of difficulty, bringing reassurance through the holding of a hand  and patiently listening or alternatively joining in the moments of fun, laughter, and at times hilarity.

Careers in medicine are gilded by such memories of  patients  and events. I once recall sitting with  an elderly nun  who was accepting with amazing calm and equanimity  the fact that she had an inoperable malignant disease and that her life was coming to its end.. As our conversation drew to a close  I commented that I knew that nuns  took their religious name from that of a saint yet I had not heard of a saint Thecla which was her professed  name .Sister Thecla  looked at me, smiled sweetly and said “no, not yet, but soon”.

Even awful times  can have their  lighter moments  and episodes of bravery . Some thirty five years ago when terrorists  were regularly bombing  London  the criminal high court of London ,known as the Old Bailey  was attacked and some 160 people were injured. I was the duty surgeon at St Bartholomew’s Hospital ,Britain’s oldest hospital now approaching its 900th anniversary , which was situated very near to the Court. Amongst the injured was  Judge Caesar Crespi, a rather large man  who was heavily overweight and who was caught in the blast just as he was being evacuated from the building. He was brought to the hospital still in his gown and legal dress ,bloodstained and awry. As I triaged him at the hospital entrance he greeted me with a booming voice saying, doctor, I tried to save the Old Bailey by putting myself between the bomb and it.

A few weeks later  the hospital was full of the victims of the Tower of London bomb explosion  and  I recall the singular  horror of a young visitor  from New Zealand   with his leg blown off by a terrorist bomb pleading with me not to cut off his new shirt which” daddy has just bought me”. Years later this memory was lightened when on a visit to New Zealand I discovered the boy had turned into an adult  who was  a skilful  football player.

That the quiet  art is relevant across the whole spectrum of medical practise including research is shown by  Sir David Weatherall, Regius Professor of Medicine at the university of Oxford and a Fellow of the Royal Society, the highest accolade in the scientific world this country can offer, and a medical scientist of the world rank. His book about science and research in medicine is titled Science and The Quiet Art   and has on its front page  the picture by Fildes to   remind us that  medical progress through research and its high technology outcomes  needs to be combined with what he calls the importance of the pastoral role of doctors in patient care to counter the dehumanising effects of purely technological approaches to ill health.

So what has all this to do with your white coat ceremony today?

Well. let me start by saying that I realise that this is a significant and memorable day for you and your family and friends and one you should relish, enjoy and remember.

My introductory comments have been designed to show you that what you are committing yourselves to in today’s ceremony is not just about the practice of clinical science and advanced technology but also about the wider humanitarian side which is encompassed in the words Quiet Art and is almost certainly what Dr Gold was aspiring towards when he introduced the White Coat Ceremony.

So, let us for a moment briefly look at the origins of the White Coat Ceremony.

I must say that I was intrigued when I first heard about it for in all my years in travelling to the USA I had not come across it until very recently.

You however will all know that it is a contemporary medical ritual devised by Dr Gold of the Robert Wood Johnson Foundation. It was introduced some 15 years ago in 1993  at the university of Columbia under the title humanism in medicine.

Then it consisted of symbolically putting on a white coat and receiving a book on doctoring and a pin for the coat saying Humanism in Medicine. Putting on the coat was regarded as a statement that  the doctors to be  are accepting the ideals of the Hippocratic Oath and those of a great profession. From its origin in the United States it has spread quite widely and involved other medicine related specialties.

I have no doubt that some public statement of what is expected of doctors, and the opportunity for them to acquiesce to the values extolled is necessary, be it at graduation or as today at the start of you careers.

One has to ask whether such a symbolic act in which you take part today would have prevented the darker side that has at times afflicted our great profession . History reveals that the medical profession during its existence has embraced some pretty disgraceful practitioners.   For instance records show that the biggest professional group in the Nazi party of Germany was made up of doctors. Many terrorist leaders have been doctors, and in Russia psychiatrists were involved in  the imprisonment  of political dissenters. In recent times in my own country Dr Shipman, a general practitioner deliberately killed a huge number of elderly patients. Within the last few weeks  Radovan Karadzic from Serbia has been arrested and is to be tried before the international court in the Hague for Genocide. He too is one of our profession who at the time of his arrest was practising medicine.

The University of Maryland justify their White Coat Ceremony   by saying that it recognises  the point of entry into the profession of medicine and is a vow to maintain professional  attitudes and behaviours in work and relationships with classmates, teachers patients and the community at large.

I know that I am not alone in wondering whether this rationale presents too conventional a picture of medicine and its practitioners.

For instance the order in which the University of Maryland  has stated  the goals is not one that I would consider appropriate for the 21st century.  Personally , I would have put  them in the reverse  order on the grounds that our  first responsibility is to the community  and patients  we serve.

Additionally I believe that the profound changes that have occurred at an exponential rate in the practice of medicine within the last few decades  require a radical alteration  in the way we think about and manage the delivery of medical care.
Such challenges are not addressed by this conventional view of our profession nor ,I believe, are they  represented by  the conventional view of the white coated doctor a portrayal which reinforces  the more technical side of the profession.

This leads me to explore the symbolism of the white coat, particularly here in the United Kingdom where as far as I am aware the White Coat Ceremony is unique to the University of Northumbria in its relationship with St Georges University.

The fact is, that in this country doctors have a uniquely British problem with white coats. Although many patients, particularly older ones, prefer to see doctors in white coats, doctors themselves are not keen on them .Indeed many abhor them, and they have long been banished from children’s hospitals and psychiatric institutions. A major blow to their use occurred last year when the Government’s Department of Health recommended that they should be forbidden on hospital ward rounds on the grounds of infection control.

To be frank, and to use modern parlance, in Britain White Coats are not regarded as ”cool”.

On the other hand the symbolism of the White Coat is not entirely without significant meaning in this country. Another book which has brought stimulation and pleasure into my life as a doctor mentions the white coat in its title. White Coat Purple Coat is written by a Welsh respiratory physician called Dannie Abse.

This physician poet talks about  the white coat as the mark of the doctor and the purple coat as that of the poet

Song for Pythagoras

White Coat and Purple coat
A sleeve from both he sews
The white is always stained with blood,
That purple by the rose,

And phantom rose and blood most real
Compose a hybrid style
White coat and purple coat
Few men can reconcile

White coat and purple coat
Each can be worn in turn
But in the white a man will freeze
And in the purple burn

However, although I am sceptical about the symbolism  of  the white coats in  today’s ceremony I believe that the ceremony  has another outcome which will be of equal if not more importance to you in the professional life that lies ahead of you.

I know from reading commentaries on the  White Coat ceremony on the web by some of your colleagues who have been through the ritual  that they too have had doubts about its message and significance. Such doubts are important for they introduce you ,at the very start of your professional lives, to that essential requirement of a good doctor namely a high degree of scepticism and the associated ability to think laterally about your profession, its values and its teaching. This is in marked contrast to cynicism which is destructive because it almost invariably descends into inactivity rather than the creativeness which can be generated by scepticism.

Why is scepticism so important at this early stage in your careers.? The answer is because at this stage of your training you are very susceptible to didacticism not least because of the many good personal  attributes that have led to you wanting to enter medicine as your lifetime profession.

One of your medical student colleagues writing in a medical journal some 15 years ago summed up these attributes when he wrote this about  being a medical student.

I am that most fragile of hobbledehoys, the doctor soon to be; infinitely malleable, ludicrously credulous, brazenly idealistic and just plain scared.

In such a state  the acquisition of the art of being sceptical ,as opposed to cynical ,is one to be cultivated for the history of medicine repeatedly shows that ,in some areas, what one day is taught as infallibly correct, within a short time is shown to be of no value or even dangerous. One of the greatest realisations by our profession in recent years is that virtually everything we do is  a balance between benefit and harm and it is in assessing this fact for each of our patients wherein lies the skill of modern medicine. Indeed to reinforce my scepticism I  about white coats I have to remind you that they themselves can be pathogenic for  there are a group of patients who exhibit   the condition of white coat hypertension, a rise in blood pressure  occasioned  by the sight of a doctor in a white coat.

The Quiet aspects of our profession, including scepticism, are an integral component of good medical practice in the 21st century and can generate therapeutic benefits in their own right.

There is general agreement that doctors in addition to being clinically competent should be well rounded individuals with a range of outside interests. Sometimes these interests can overlap with ones professional practise and be of value to patients. There is sound evidence that music and art have valuable roles in treating certain medical conditions.

You may be surprised to know that a search of the literature shows that poetry too  can have a significant place in medical practice. The medical journal the Lancet  has  recently had more than one article dealing with the role of Poetry on the Ward Round  which, amongst other things, can certainly be  used to address the most difficult and sensitive  situations. Take this poem for instance which touches on the issues of racism, anti Semitism and that most difficult of all problems namely when a doctor develops a profound dislike for a patient and even momentarily may wish not to treat him  or even to do him harm

Dannie Abse,  CASE HISTORY

Most Welshmen are worthless ,
An inferior breed doctor,

He did not know I was Welsh.

Then he praised the architects of 
The German Death Camps-
Did not know I was a Jew.
He called liberals “white blacks”,
And continued to invent curses.

When I palpated his liver
I felt the soft liver of Goering: when I lifted my stethoscope
I heard the heartbeats of Himmler; 
When I read his encephalograph
I thought,”Sieg heil ,mein Furher”

In the clinic’s dispensary
Red berry of black bryony,
Cowbane, deadly nightshade,
Yet I prescribed for him as if he were my brother.

So the message for  you, tomorrows generation of doctors who will be practising in the 21st century, is to be competent in embracing the powers of medicine and delivering healing but to be so within the framework  of the quiet aspects of our profession.
I you can reach the standards laid down by Robert Louis Stevenson for a perfect doctor remember that they were reached by doctors who like Sir Luke Fildes portrayal  showed devotion and a quiet heroism  but who, incidentally, never wore white coats.

This, underlying timeless approach, whilst coping with all the excitement of the new technologies which will inevitably unfold, will ensure continuing public support (currently running at a level of around 95% trust for British doctors)for our profession in the 21st century.

Before I step down from this podium I want to give you something to raise your morale.
I am well aware that talks such as I have given today are very much ”old  dog to young dog” activities and as such may soon be forgotten. The ideas and values that I have advocated are much more likely to be sustained if they arise, are developed, and are taken forward by people of your own generation.

I therefore have found it highly encouraging that what I have advocated today for your consideration is already being promulgated by your own generation.

When I had finished compiling this talk I turned to a literature search and to my amazement and alarm came across an article (from which I have already quoted earlier in this talk)  written in 1993  and published  in the Journal of the Royal Society of Medicine, by Jason Warren, a medical student from the university of Adelaide , under the title courage and the quiet art: night thoughts of a doctor to be.

It was a profound and challenging article, virtually identical in content and approach to, but far more  eloquent than ,my talk today and also  centred  around  Fildes painting , My reaction was that had the author heard what I have just said he would have had a claim against me for plagiarism.

This all goes to show that you  like him , at the start of your careers ,possess in your minds all the potential to be just as radical and innovative as any else in our profession as long as you let your thoughts flower within an atmosphere of humility and scepticism

I wish all of you commencing your clinical careers a long and happy time in our wonderful profession and hope that  this ceremony  today will  permanently foster  within you the quiet aspects of our  Quiet Art .

St. George’s University Inaugural Parents Weekend

sgu parents weekend august 2008In an effort to address the needs of SGU’s increasingly diverse student body (this year’s incoming School of Medicine class alone originated from a record 29 countries) and their often anxious families, SGU faculty and staff initiated the Beyond Spice : Inaugural Parents’ Weekend.The purpose of Beyond Spice was twofold: designed to further enhance the students’ initial experience at the True Blue campus and solidify a comfort level for their families.

From Friday, August 22nd to Sunday, August 24th, 155 family members of incoming classes in the Schools of Medicine, Veterinary Medicine and Arts and Sciences participated in a weekend of informative and culturally entertaining events.  For two days, families, friends and loved ones of the students were welcomed by SGU with tours of the campus and its beautiful surroundings, presentations by both faculty and students including question and answer sessions, a lunch barbecue on Black Sand Beach and a late afternoon boat cruise.

According to Mr. Colin Dowe, the event moderator and Assistant Dean of Enrolment Planning for Admission, “Separation anxiety is more on the part of the parents than on the students.”  With that in mind, a series of presentations appropriately titled “Caring from Near and Afar” were delivered at the University’s Bourne Lecture Hall by several departments including Housing, Department of Educational Services, Student Government Association (SGA) and Counseling.  Each session afforded families the opportunity to share their lingering concerns, make comments and recommendations and ask questions. In a Parents Q and A Session, Chancellor Charles R. Modica and other members of the administration fielded questions about the various political issues in medical and veterinary education, and discussed the future growth of the University.  Many parents asked well-prepared questions.

A presentation by the Student Government Association (SGA) President, Jesse Livingston, served to alleviate concerns of those parents who expressed that many of the students are still very young, and for some this is their first time away from home.  Jesse assured the parents that students fully adjust within the first semester on campus, and that many departments within SGU are on-hand in various capacities to assist in their transition.

Department of Educational Services Director Andre Havenga discussed the variety of programs, courses and workshops which provide academic support services to the student body.  With humor and sincerity, he expressed reassurance to parents saying, “Your children are resilient and smart and will get through this much better than you.”

SGU was pleased with the positive feedback received from many participants from the weekend of events.  One parent described her experience in Grenada as thrilling, “This is a fantastic place, and I have nothing but pleasant sentiment and positive vibes. “

The weekend’s success was not just a tribute to St. George’s University but to Grenada and its people as well.  On Saturday afternoon, after attending the Inaugural Nursing Program Commencement on campus, Grenada’s new Prime Minister, the Hon. Tillman Thomas, came unexpectedly upon five tour buses filled with excited SGU families setting off on an island excursion.  His face showed deep appreciation at Grenada’s opportunity to welcome and share the Island with the University’s extended family.

The Beyond Spice Parents’ Weekend demonstrates the University’s commitment to the students, their families and generations to come.  We hope to learn from our inaugural event and make this weekend even more rewarding in terms to come.

Speaker Addresses the Incoming Medical School Class on “The Quiet Art”

The weekend of August 16th marked a celebration for St. George’s University School of Medicine (SGUSOM) and Northumbria University’s School of Applied Sciences (NU) as they welcomed a new class of medical students into the Keith B. Taylor Global Scholars Program (KBTGSP).  This class, the fifth consecutive, has 147 students from 12 countries, a significant increase from the 54 students in the January ‘07 charter class. The White Coat Ceremony marks the beginning of medical studies as the official entry into the profession of medicine.   Students don the white coat, a symbol of their chosen profession, and swear a professional oath, promising to act with integrity and in an ethical manner during their training and careers in medicine.

kbt white coat group

The Keynote Speaker was Professor Sir Miles Irving, Professor of Surgery at the University of Manchester and Consultant Surgeon at Hope Hospital Salford for 25 years.  Professor Irving, in his addressed entitled, “The Not so Quiet Art: Medicine in the 21st Century” explored the ethical responsibility and generosity of spirit which is at the core of the medical profession.  He continued to say that courage, humility and generosity of spirit must be ever present in the doctor patient relationship, expressing that these “quiet aspects of medical practice are as important today, in this era of high technology medicine, as they have ever been.”

To further his message, Professor Irving referred to two powerful pieces of art, one a well-known late-Victorian painting by Sir Samuel Luke Fildes (1844-1927) and the other a literary piece by Scottish author Robert Louis Stevenson.

The Doctor, which hangs in Britain’s Tate Gallery, is a beautiful work that conveys on canvas a physician’s compassion and concern for a young patient.  In the background you see daylight entering the window indicating that the child has survived the night.  Professor Irving’s own interpretation of the image was that while the doctor most likely did not know what was wrong with the child, and with equal certainty was not able to do anything about it, the physician was there bringing comfort to the child and family.  He then raised the question,” What did the public of that time think of such doctors who had little to offer but kindness and compassion?” To answer this he referred to Stevenson, who wrote of the physician, “He is the flower of our civilization… who most notably exhibits the virtues of the race.  Generosity he has, such is possible to those who practice an art.  So that he brings air and cheer into the sickroom, and often enough, though not as often as he wishes, brings healing.”

Professor Sir Miles Irving effectively, and with deep sincerity, illustrated to the incoming class the vital importance of balancing the clinical aspects of medicine with the ‘Quiet’.  To ignore the ‘Quiet’, he says, “Will be missing out on just those aspects of our work that make our occupation so enjoyable and memorable.”

The Master of Ceremonies was SGU alumni Dr. John Madden who also serves as our Associate Dean of Students, United States and Director, Office of Student Development and Career Guidance. A native New Yorker, Dr. Madden joined the second class of SGU medical students in August 1977.  Dr. Madden practices emergency medicine at the Christian Care Health System in Delaware.  He was President of the Medical Staff from 2005-2007, is currently Vice-Chair of the Board of Directors, and leads the hospital’s flight crew team. He and his wife of 28 years, Janet, have two children, Andrew, 21 and Patrick, 16.

Chancellor Charles R. Modica welcomed the students to St. George’s, Northumbria University and Newcastle, and the profession of medicine.  This year’s White Coat had particular significance as it also marked the close of the Keith B. Taylor Global Scholars Program Inaugural Parents’ Weekend.  For two days, family, friends and loved ones of the students were welcomed by SGU and NU with tours of the campus and its beautiful surroundings, presentations by both faculty and KBTGSP students and an evening boat cruise along the River Tyne.  The staff of both institutions worked tirelessly to assure a seamless weekend filled with informative and entertaining events which conveyed both SGU and NU’s commitment to the KBTGSP students and program.

Professor Sir Miles Irving is a Past President of the Association of Surgeons of Great Britain and Ireland and Past President of the Association of Coloproctology.  He was Regional Director of Research and Development for the northwest of England and National Director of Health Technology Assessment for the Department of Health.

During Sir Irving’s tenure as Professor of Surgery at the University of Manchester and Consultant Surgeon at Hope Hospital Salford for 25 years,  he was also Advisor in Surgery to the Chief Medical Officer of England and to the army.  His White Coat Ceremony address drew upon the literary compilation of well-known Liverpool physician and medical editor Robert Coope’s “The Quiet Art”.  This anthology was given to Professor Irving by the author himself, and has served him as a constant support throughout his fifty year career in medicine.

Since retiring to Newcastle he has served as Chairman of the Newcastle Hospitals NHS Trust for eight years and as a governor of both Northumbrian d Newcastle Universities.  He is currently Chairman of NHS  Innovations (North) and Chairman of the council of the Order of St. John in Northumbria.  He is a Fellow of the Royal College of surgeons of England and an Honorary Fellow of the American and Canadian Colleges of Surgeons.  He is a founding fellow of the UK Academy of Medical Sciences and an Honorary Doctor of Civil Law of the University of Northumbria.

Read Prof. Sir Miles Irving’s complete keynote address.

Climate Change, Water, and Sanitation in the Caribbean

environmental conference panel

On Monday, June 23rd, Taylor Hall opened its doors to a unique three-fold conference. For five consecutive days, the critical environmental issues of the Caribbean, including climate change, water and sanitation, were addressed.  The 4th Biennial Caribbean Environmental Forum (CEF) and Exhibition, 14th Annual Wider Caribbean Waste Management Conference and the First Caribbean Sustainable Energy Forum provided essential information and solutions to a regional and international audience which included a cross-section of influential representatives from the government sector.

Distinguished guest speakers representing the Austrian and German governments shared their expertise with regard to the Conference’s theme: Climate Change, Water and Sanitation: A Shared Responsibility.  His Excellency Ambassador Dr. Ernest Martens of Germany, pointed out that Germany is a key player in the movement towards sustainable development and alternative energy sources such as wind, hydro-electric power and bio-energy. In fact, 10% of Germany’s electricity and 5% of their energy are from these alternative sources.

Her Excellency Ambassador Magister Marianne Feldmann, Austrian Embassy for Venezuela and the Caribbean, Venezuela, disclosed that Austria also is one of the world’s leaders in hydroelectric power. Ninety percent of their electricity comes from hydroelectric power and as such, they have much to offer the region (Caribbean) both in terms of technical and financial support as the region actively seeks to harness their natural resources for renewable energy.

In delivering the keynote address, Dr. the Rt. Honorable Keith Mitchell, Prime Minister of Grenada, highlighting collective responsibility that Grenadians and indeed all peoples of the region must share, said, “We cannot be mere passengers to solutions.” He notes that it is important to take stock of what is happening with our supply of food, water and energy; that harnessing the sun’s energy needs to be more actively pursued as a viable option and as an alternative source of energy; and that waste as a potential resource needs to be more closely examined. This point was further emphasized by the United Nations Environment Program (UNEP) representative, who noted that the most serious cause of marine pollution is still that of untreated waste water. The sad reality is 85% of waste water continues to enter our oceans untreated.

Senator Ann David Antoine, an honorary member of the Caribbean Environmental Forum (CEF) also noted that as this year is the International Year of Sanitation, it is an apt time for such focus.  She highlighted the fact that we cannot ignore the basic needs of sanitation and a good, clean water supply, since they speak to the very dignity of people.  “ The Grenadian public must be sensitized to the challenges we face and also to workable solutions.”

Distinguished members of the audience included: Sen. Elizabeth Thompson of Barbados, Ambassador Angus Friday and representatives from Costa Rica, Ecuador, Chile, the Caribbean, Canada, the United States, Austria and Germany — a truly international cross section. Chair of the Grenada National Solid Waste Management Authority Ms. Aine Brathwaite, who worked assiduously to ensure that Grenada hosted the conference, thanked all for the level of interest that the conference drew. She emphasized that in the matter of waste management, “imperative need for action has never been more urgent” and the “need to sensitize our people of what is at stake.” She points to public awareness, education and the implementation of laws as positive steps in the right direction.

Dr. Denis Paul, Vice Provost for Institutional Advancement on behalf of Chancellor Charles Modica, and Dr. Allen Pensick, Provost; welcomed the conference participants, stating that “SGU is proud to be a collaborator.” He encouraged them to take some time off from their packed schedule to enjoy the ambience of the campus and wished all a successful conference. Topics addressed at the conference included: Integrated Water Resources Management in a Changing Climate, New Challenges and Approaches to Human Health and Sanitation, Waste Management, including Solid, Liquid and Hazardous wastes, Bio-medical and Technological Waste, and Energy Management including Renewable Energy. It was clear that at the end of the conference there was much food for thought and the challenge now lies in maximizing the information gleaned to the benefit of the countries of the respective participants.

It seemed appropriate that this year’s CEF-4 Conference be the inaugural conference held at St. George’s Taylor Hall.   The Late Vice Chancellor Emeritus, Keith Breden Taylor, DM, FRCP (1924-2006), for whom the facility is named, worked tirelessly to implement his vision that St. George’s University should grow into an international university.  He achieved that by creating a Panel on Research and Scholarly Activity in 1992; founding a research institute in the Windward Islands Research and Education Foundation (WINDREF) in 1994 which allowed the development of a graduate studies program; and by instituting the School of Arts and Sciences in 1996 which broadened the academic opportunities for students in the region. The international scope of the Environmental Conference is consistent with his hope and plan for SGU.

In addition to providing the venue, as a major co-sponsor St. George’s University also provided logistical support, accommodations, transportation and technical support.

Published on 7/3/08

St. George’s University Hosts Inaugural Parents’ Weekend, August 22, 2008 – August 24, 2008

sgu parents weekend august 2008St. George’s University will be conducting its inaugural Parents’ Weekend from August 22, 2008 through August 24, 2008. The “Beyond Spice” Parents’ Weekend (Grenada is also known as the “Spice of the Caribbean”) will allow parents and families to experience the full educational program, with its emphasis on student services and commitment to student well-being, as they enjoy the elegant beauty of its breathtaking campus and surroundings.

SGU’s Robert Ryan, Associate Dean of Enrolment Planning and member of the “Beyond Spice” Parents’ Weekend Committee, explained that selecting the date for the event was the first step toward maximizing its effectiveness for both parents and students. “Inviting the parents of our medical and veterinary medical students to Grenada the weekend after classes start has several benefits,” said Dean Ryan. “We (the committee) believe that having parents join their children a week after classes begin will give the students an opportunity to assess and request any additional items needed to make their stay in Grenada most productive and comfortable.  In addition, the campus and its students will have settled nicely into a routine, allowing parents to experience SGU’s impressive facilities in a less frenzied environment.”  Dean Ryan also mentioned the resulting benefit of opening up a minimum of 300 coveted airline seats on an already limited flight schedule to Grenada.

Dean Ryan explained that more and more parents were arriving with their students in Grenada at the beginning of term.  “The University is thrilled to see this level of care on the part of families, and we have become extremely frustrated that we are unable to marshal the necessary University resources to pay full attention to them since we are settling in the students who have just arrived.”  The University is committed to focusing on the parents’ needs and has dedicated a full weekend to do so.

The “Beyond Spice” Parents’ Weekend will include tours of the campus and its state-of-the-art facilities including labs, library, lecture halls and dorm rooms.  The faculty and staff of the University recognize the importance of familiarizing both the parents and their children with not just the University’s True Blue campus, but the Island and its people.  Therefore, tours have been arranged so visitors can experience the Island’s pristine surroundings.

A Question and Answer Session with the top administration as well as informative presentations from the Department of Educational Services, Professors, Counselors, Student Government Association, Housing and Clinical have been carefully planned to assure parents that in addition to providing an internationally recognized academic program, their children’s well being is the University’s utmost priority.  Several exciting cultural events are also included in the festivities.

The weekend’s activities will close with the School of Medicine’s White Coat Ceremony to be held at 4:00 pm on Sunday afternoon.  After inspirational speakers, students take an Oath to the Profession of Medicine.  A reception for students and families will follow.  The School of Veterinary Medicine White Coat Ceremony will be held the Tuesday prior, and all SVM parents are invited to come early to attend the event and stay to enjoy the weekend festivities.

St. George’s University has planned a similar event in the United Kingdom with our Northumbria University (NU) partner, welcoming parents of the Keith B. Taylor Global Scholars Program students during the weekend of August 15th.   Due to a smaller class size of approximately 150 students, SGU and NU are confident that holding Parents’ Weekend during the start of classes will not interfere with its similarly scheduled events.

The University looks forward to Parents’ Weekend becoming a new tradition on both the True Blue campus as well as its Northumbria University campus.

If you are interested in attending, please contact us at ParentsWeekend@sgu.edu.

Dr. Jim Yong Kim Speaker for 2008 School of Medicine Commencement Ceremony

dr jim yong kimOn Saturday, May 3rd, St. George’s University’s School of Medicine held its Annual Commencement Ceremony at Avery Fisher Hall in New York City.  Two ceremonies were needed to accommodate the more than 500 graduates from the December 2007, May and June 2008 classes. Students received their diplomas in front of the largest audience in SGUSOM history, more than 5,000 family members, friends, faculty, and administration.

Provost Allen H. Pensick  opened both ceremonies with an introduction of the SGU faculty including Chancellor Charles R. Modica, and gave a special welcome to His Excellency Dr. Angus Friday, an alumnus of SGUSOM and the  Ambassador Extraordinary and Plenipotentiary, Permanent Representative of Grenada to the United Nations.  Dr. Pensick paid tribute to the founders of the University for their vision, dedication and leadership.  Following Chancellor Charles Modica thanked the friends, family, faculty and staff for their collaborative support of the SGU graduates.  He stated that all SGU graduates had worked long and hard to achieve their goals, and acknowledge that this class, the class that arrived in Grenada three weeks before Hurricane Ivan in 2004, had risen above extra challenges and had dedicated much to the rebuilding of Grenada.

The Commencement Speaker, Dr. Jim Yong Kim, has committed over 20 years to improving health in developing countries.  Named by Time Magazine as one of the “100 Most Influential People in the World” in 2006, his expertise in the fields of HIV/AIDS and tuberculosis, and his effective implementation of related health programs is internationally recognized.   Dr. Kim began by stating that as far as he could remember, commencement speeches were either eminently forgettable or irritating.  He hoped to be neither.  His speech was both memorable and inspirational as he gently, intelligently and with humor and understanding, explained his world view, lived by him in detail, that an individual or a small group can significantly change the world for good.   He used his background and life to show that a small group of dedicated professionals have contributed to the impact of disease on many small communities and, in fact, in the world at large.  He exhorted each and every graduate to remember that every one of them could help suffering in the world, both on an individual patient, in communities, and larger communities throughout the world.

In 1987, Dr. Jim Yong Kim, along with Dr. Paul Farmer, Ophelia Dahl, Thomas J. White and Todd McCormack, co-founded Partners In Health (PIH), a non-profit health organization dedicated to providing a “preferential option for the poor.” PIH has developed into a worldwide health organization that supports a range of health programs in poor communities in Haiti, Peru, Russia, Rwanda, Lesotho, Malawi and the United States.

Dr. Jim Yong Kim holds appointments as François-Xavier Bagnoud Professor of Health and Human Rights at the Harvard School of Public Health, and Professor of Medicine and Social Medicine at Harvard Medical School. He is Chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital, a major Harvard teaching hospital; Director of the François-Xavier Bagnoud Center for Health and Human Rights; and Chair of the Department of Social Medicine at Harvard Medical School.  Dr. Kim also co-chairs the Joint Learning Initiative for Children with HIV/AIDS, Learning Group 3, “Access to services and protection of human rights.”

During a three-year leave of absence at the World Health Organization (WHO),  he served as director of its HIV/AIDS Department which included coordinating HIV efforts with the TB Department.  Dr. Kim returned to Harvard and is currently leading a new Harvard University-based initiative in Global Health Delivery, which is designed to discover and widely share knowledge about the effective implementation of health programs in poor communities.

Dr. Kim trained dually as a physician and medical anthropologist. He received his MD and PhD from Harvard University. Dr. Kim has been recognized on numerous occasions, including being awarded a MacArthur “Genius” Fellowship in 2003; being named one of “America’s 25 Best Leaders” by US News & World Report in 2005 as well as one of the “100 Most Influential People in the World” by Time Magazine. He was a Contributing Editor to the 2003 and 2004 World Health Report, and his edited volume, Dying for Growth:  Global Inequity and the Health of the Poor analyzes the effects of economic and political change on health outcomes in developing countries.

Published on 5/5/08

Grenada Embraces Public Health Week

public health climate changeMonday, April 7th marks the beginning of the 2008 National Public Health Week (NPHW) which this year focuses on Climate Change: Our Health in the Balance.  April 7th this year was also World Health Day which honors the establishment of the World Health Organization’s (WHO) Constitution on April 7, 1948.

The University lauds Grenada’s efforts to raise awareness of individual responsibility in a global world.  In an effort to raise awareness of the numerous hazards which range from extreme weather events to changes in the dynamics of infectious diseases, SGU’s Public Health Students Association, the Department of Public Health and Preventive Medicine along with its Associate Professor and Environment Scientist, Dr. Hugh Sealy, have developed a series of week-long events designed to educate and empower both students and community members.

Public health organizations and agencies worldwide are observing this week to highlight the adverse effects that climate change has on the health of populations, and SGU is a part of this world wide effort.  It is incumbent upon all public health institutions to educate people to the very real consequences of climate change on health, but according to the WHO, the health effects are diverse and global in nature.

The World Health Organization states that the health impacts of climate change will be difficult to reverse in a few years or decades. However, if we make certain environmental, behavioral and policy changes, many of these possible impacts can be avoided or controlled. Additionally, many of the steps needed to prevent climate change will have overall positive health benefits.  St. George’s University is eager to communicate the connection between the way we lead our lives, our impact on the planet and the planet’s impact on our health.

The following are activities scheduled for this week: 

Monday, April 7 at 12:00 PM – Tree Planting Ceremony (location: between the gazebos in front of SD4 and SD6)

Wednesday, April 9, at 7:30 PM – Movie: An Inconvenient Truth, followed by a discussion and Q&A session (location: DES Car Park/Courtyard) (refreshments will be sold)

Wednesday, April 9, at 8:00 PM –You Decide Program Television Program featuring Dr. Hugh Sealy (Community Channel 6 – Live broadcast).  Dr. Sealy is an Associate Professor in the Department of Public Health and Preventive Medicine & a Member of the Executive Board of the Clean Development Mechanism under the United Nations Framework Convention on Climate Change.

Thursday, April 10 – Campus Poster and Slogan Campaign (led by PHSA, public health students will erect slogans and poster related to the theme around campus.

Friday, April 11 – Visit to the Anglican High School by the PHSA and other public health students to engage them in an Interactive health education session on the impact of climate change on health.

Friday, April 11 – PHSA Fundraising Party
Funds from the movie and the party will be donated to charity for the prevention of malaria.

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Published on 4/11/08