On Being a Real Doctor
Alan Alda's (the guy from M*A*S*H) commencement speech in 1979 to Columbia Medical school...... I know it is long but I wanted it on here in case I ever forget...and to remind me why I became a doctor....
Ever since it was announced that a non-doctor, in fact an actor, had been invited to give the commencement address at one of the most prestigious medical schools in the country, people have been wondering: Why get someone
who only pretends to be a doctor when you could get a real one?" Some people have suggested that this school had done everything it could to show you how to be a doctor, and in a moment of desperation had brought in someone who could show you how to act like one.
It's certainly true that I'm not a doctor. I have a long list of non-qualifications. In the first place I'm not a great fan of blood. I don't mind people's having it, I just don't enjoy seeing them wear it. I have yet to see a real operation because the mere smell of a hospital reminds me of a previous appointment. And my knowledge of anatomy resides in the clear
understanding that the hip bone is connected to the leg bone. I am not a doctor. But you have asked me, and all in all, I think you made a wonderful choice.
I say that because I probably first came to the attention of this graduating class through a character on television that I've played and helped write for the past 7 years: a surgeon called Hawkeye Pierce. He's a remarkable
person, this Hawkeye, and if you have chosen somehow to associate his character with your own graduation from medical school, then I find that very heartening because I think it means that you are reaching out towards a very human kind of doctoring. And a very real kind of doctor.
We didn't make him up. He's really lived as several doctors who struggled to preserve life 25 years ago during the Korean War. In fact, it's because he's based on real doctors that there is something especially engaging about him.
He has a sense of humor and yet he's serious...he's impertinent and yet
he has feeling... he's human enough to make mistakes, and yet he hates death enough to push himself past his own limits to save lives. In many ways, he's the doctor patients want to have, and doctors want to be.
But he's not an idealization. Finding himself in a war, he's sometimes angry, sometimes cynical, sometimes a little nuts. He's not a magician who
can come up with an instant cure for a rare disease without sweating and ruining his makeup. He knows he might fail. Not a God, he walks gingerly on the edge of disaster – alive to his own mortality.
If this image of that very human, very caring doctor is attractive to you –if it's ever touched you for a moment as something to reach for in your own life – then I'm here to cheer you on. Do it. Go for it. Be skilled, be learned, be aware of the dignity of your calling, but please don't ever lose sight of your own simple humanity. Unfortunately, that may not be so easy.
You're entering a special place in our society. People will be awed by your expertise. You'll be placed in a position of privilege. You'll live well,
people will defer to you, call you by your title – and it may be hard to remember that the word "doctor" is not actually your fist name.
I know what this is like to some extent, because in some ways you and I ARE alike. We both study the human being. And we both try to offer relief – you through medicine, and I through laughter – but we both try to reduce suffering. We've both learned difficult disciplines that have taken years to master, and we've both dedicated ourselves to years of hard work. And we both
charge a lot.
We live in a society that has decided to reward my profession and yours, when we succeed in them, very highly. It can sometimes be easy to forget that the cab driver also works 14 or 15 hours a day and is also drained of energy when he's through. It's easy to think that because our society grants us privilege that we're entitled to it. Privilege feels good, but it can be intoxicating. As good doctors I hope you'll be able to keep yourselves free of toxins.
It's no wonder though, that people will hold you in awe. I know I do. You've spent years in a grueling effort to know the structure and process of human life. I can't imagine a more difficult task. It has required the understanding of complexities within complexities, and there has been more pressure placed on you in 4 years than most people would be willing to take in a lifetime. I stand here in utter amazement at what you've accomplished. And I congratulate you.
I only ask one thing of you: Possess your skills, but don't be possessed by them. Certainly your training has encouraged you to see the human side of your work, and you've examined the doctor-patient relationship. But still, the enormity of your task has required you to focus to such an extent on technique and data, that you may not have had time enough to face your
feelings along the way.
You've had to toughen yourself to death. From your first autopsy when you may have been sick, or cried, or just been numb, you've had to inure yourself to death in order to be useful to the living. But I hope in the process you haven't done too good a job of burying that part of you that hurts and is afraid.
I know what it's like to be absorbed in technique. When I write for M*A*S*H, I'm always writing about people in crisis with what I hope is
compassion and feeling. And yet one day I found myself talking to someone who was in a real crisis and real pain – and I remember thinking "This would make a GREAT story." Both of these things – becoming set apart and becoming your skill – can make it tough to be a compassionate person.
All right, that's my diagnosis of the problem. Here's my prescription: I'd like to suggest to you, just in case you haven't done it lately, that this would be a very good time to give some thought to just exactly what your
values are, and then to figure out how you're going to live by them. Knowing what you care about, and then devoting yourself to it, is just about the only way you can pick your way through the minefield of existence and come
out in one piece.
I can be just a startling experience when you try to rank your values, though. Just ask yourself what's the most important thing in the world to
you. Your work? Your family? Your money? Your country? Getting to heaven? Sex? Dope? Alcohol? What? (I don't need a show of hands on this). Then when you get the answer to that, ask yourself how much time you actually spend on
your number one value – and how much time you spend on what you thought was number 5, or number 10. What, in fact, is the thing you value most? It may not be easy to decide.
We live in a time that seems to be spit about its values. In fact, it seems to be schizophrenic. For example, if you pick up a magazine like "Psychology Today," you're liable to see an article like "White Collar Crime: It's more
Widespread than You Think." Then in the back of the magazine, they'll print an advertisement that says "We'll write your doctoral thesis for 25 bucks." You see how values are eroding? I mean, a doctoral thesis ought to go for at least a C-note.
The question is where are their values? WHAT do they value? Unfortunately, the people we look to for leadership seem to be providing it by negative example. All across the country this month, commencement speakers are saying
to graduating classes: "We look to you for tomorow's leaders." That's because today's leaders are all in jail.
Maybe we can afford to let politicians operate in a moral vacuum, but we can't afford to let doctors operate under these conditions. You know how we're feeling these days as the power and fuel monopoly has its way with us.
Well, you people graduating today are entering a very select group. You have a monopoly on medical care. Please be careful not to abuse this power that you have over the rest of us.
You'll need to know what you care about most and what you care about least. And you need to know now. You will be making life and death decisions and you will often be making them under stress and with great speed. The time to
make your tender choices is not in the heat of the moment.
When you're making your list, let me urge you to put people first. And I include in that not just people, but that which exists between people. I
suggest to you that what makes people know they're alive – and in some cases keeps them alive – is not merely the interaction of the parts of their bodies, but the interaction of their selves with other selves.
Let me challenge you. With all your study, you can name all the bones in my body. You can read my x-rays like a telegram. But can you read my involuntary muscles? Can you see the fear and uncertainty in my face? If I tell you where it hurts, can you hear in my voice where I ache? I show you my body but I bring you my person. Can you see me through your reading
glasses? Will you tell me what you're doing, and in words I can understand? Will you tell me when you don't know what to do? Can you face your own fear, your own uncertainty? When in doubt, can you call in help?
These are things to consider even if you don't deal directly with patients. If you're in research, administration, if you write – no matter what you do– eventually there is always going to be a patient at the other end of your decisions.
Now, of course, everyone is for this in principle. Who's against people? But it gets harder when you get specific. Will you be the kind of doctor who cares more about the CASE than the PERSON? ("Nurse, call the gastric ulcer
and have him on in at three." … "How's the fractured femur in room 208?") You'll know you're in trouble if you find yourself wishing they would mail you their liver in a plain brown envelope.
Where does money come on your list? Will it be the sole standard against which you reckon your success? How much will it guide you in relating to your patients? Do patients in a clinic need less of your attention than private patients? Are they, for instance, less in need of having things
explained to them?
Where will your family come on your list? How many days and nights, weeks and months, will you separate yourself from them, buried in your work, before you realize that you've removed yourself from an important part of your life?
And if you're a male doctor, how will you relate to women? Women as patients, as nurses, as fellow doctors – and later as students. Will you be able to respect your patient's right to know and make decisions about her own body? Will you see nurses as colleagues – or as handmaidens? And if the day comes when you are teaching, what can young women medical students expect from you? Questionnaires filled out by women at 41 medical schools around the country have revealed a distressing pattern. The women were often either ignored in class or simply not taken seriously as students. They were told that they were only there to find a husband and that they were taking the places of men would then have to go out and become chiropractors. (Logic is not the strong point of sexism). They were often told that women just
didn't belong in medicine. And at times, the very professors who were grading them told them this. They would be shown slides of Playboy nudes during anatomy lectures – to the accompaniment of catcalls and wisecracks
from male students. And in place of discussions about their work, they would often hear a discussion of their appearance.
These are reports from 41 different medical schools. I'm dwelling on this because it seems to me that the male-female relationship is still the most personal and intense test of humane behavior. It is a crucible for decency. I hope you men will work to grant the same dignity to your female colleagues that you yourselves enjoy.
And if you're a female doctor, I hope you'll be aware that you didn't get where you are by yourself. You've had to work hard, of course. But you're sitting where you are right now in part because way back in 1848, in Seneca
Falls women you never knew began insisting you had a right to sit there. Just as they helped a generation they would never see, I urge you to work for the day when your daughters and their daughters will be called not "A woman doctor," or "My doctor, who's a woman…" but simply "My doctor."
It may seem strange to rank the things you care about, but when you think about it, there isn't an area of your work that won't be affected by what you decide to place a high value on, and what you decide doesn't count. Decide now.
Well, that's my prescription. I've given you a kind of big pill to swallow, but I think it'll make you feel better. And if not – well, look, I'm only
human.
I congratulate you, and please let me thank you for taking on the enormous responsibility that you have – and for having the strength to have made it to this day. I don't know how you've managed to learn it all. But there is one more thing you can learn about the body that only a non-doctor would tell you – and I hope you'll always remember this:
The head bone is connected to the heart bone – and don't let them come apart.
