To the Future Healers: Advice for the Graduating Class of 2015
On May 22nd I addressed the 2015 graduates of Samuel Merritt University at the Paramount Theatre in Oakland, California. My advice? Beware of a focus on “cure” rather than healing; Acknowledge what you didn’t learn in medical school; Care for the whole person; and finally, Lead with compassion.
To commence means to begin. You have come to the end of a long period of education and training, but it is also the beginning of your professional careers and, might I dare say—your education. While you may have been studying to become health professionals—nurses, physician’s assistants, podiatrists, occupational and physical therapists—you are all really in the business of healing.
Haven’t you been learning that all along, you ask? Well, I don’t want to disappoint you but the answer is—not exactly; at least not completely.
Let me explain.
Healing is the process of recovery, repair and reintegration. Healing is also about the process of becoming “whole.” The word is derived from the ancient Indo-European root “kailo” meaning “whole” and related to the words wholesome and health, as well as holy and hallowed. One’s return to “wholeness” may be physical, psychological, social, spiritual or all four.
In contrast, the contemporary meaning of“curing” is the elimination of (mostly physical) disease; one may be cured of disease but not be returned to wholeness or healed. Such is the case when disease and treatment traumatize one psychologically and/or spiritually without those aspects of a person being addressed. Conversely one can be healed but not cured, transcending sickness and being transformed positively even as the body declines or dies.
Note that “healing,” “wholeness” and “holy” are cognates, meaning that they are derived from the same root word. As healers, you are engaged in sacred work.
Beware of the “Cure” Mentality of Healthcare
In the last hundred years, healthcare has shifted dramatically toward a focus on disease treatment and efforts to cure. There have been many successes with this focus. With these successes, technology, economic investments and a medical industry have flooded into the cure business. This focus worked well for the diseases we suffered when Samuel Merritt first started this school in 1909. Life expectancy has risen, infectious disease has been controlled and surgery has allowed us to correct anatomical problems and repair injuries. Modern medicine can be really remarkable—quick and dramatic.
However, in the process of building the cure business we have tended to neglect healing and less prominent elements of healthcare—including those that are important for preventing disease, for facilitating recovery and for maintaining wellness when cure is not possible. These areas have been largely ignored. For example, only about 4% of our investment in healthcare goes into prevention. We tend not pay to facilitate behavior change even when that is the primary cause of our ills. We now know that only about 15 to 20% of health is the result of the medical industry, yet we spend 80% of our money there. It should be no surprise then that healthcare costs in this country are double that of any other country and that most health markers in our population are declining.
We’re not getting the same value out of the cure business that we got 100 years ago.
We need healing. Only by developing systems that help us tap into our own inherent healing capacity can we turn this situation around. So healing will soon have its heyday; it must. And you are positioned exactly in the right spot to make this happen. Built into the Affordable Care Act is not only increased access to standard medical services that millions did not previously have, but ACA is also attempting to direct a greater emphasis on prevention, on primary care, on nursing and on worksite and community wellness. These are all skills that you are now positioned to help provide.
What I didn’t learn in medical school…
People like me, physicians who trained in the biomedical model, are not in the position to provide our future healthcare system with all that it needs. I was trained as a conventional family physician with a large focus on the use of drugs and procedures. I was taught to write the orders that others would carry out. I learned procedures for removing disease and treating most people with drugs.
I didn’t learn about healing. I didn’t learn about diet and lifestyle, or about stress management, or art therapy or exercise or sleep. Nor did I learn about the importance of team care. I didn’t learn that I had unconscious biases that led me to treat different racial and ethnic groups—and women—differently. I didn’t learn about caring for the whole person or about the sanctity of all lives.
My job was to diagnose and treat disease, preferably the physical part, and let nature do the healing on its own. I learned to rely on so called “allied” healthcare professionals, the term applied to professions like yours to facilitate healing. It was only later that I learned that there was another half to healthcare and had to find out about them on my own time. It was after medical school that I supplemented my education with healing modalities, in Germany, at the National Institutes of Health (NIH) and in the military.
You will need to supplement your education too. Your knowledge is not complete.
I also had to learn the hard way about team care. During my first rotation as a resident I wrote an order for a patient I had not even talked to. The head nurse on the ward came up to me and said “Son, that order will sit there all day until you go in and talk to that patient.” I was insulted, but I went in to see the patient anyway and found out they had tried that treatment before with very bad side effects. I quickly learned to listen to the patients—and the nurses.
The world of healthcare is a very different place today and is changing rapidly. No longer are you the “allied healthcare practitioners.” As a physician I am also an allied health professional and just one member of the team. We are now taking care of patients in a “patient-centered medical home”—often at home. We are teaching healthy life skills like exercise and diet. We now need to see every patient in their whole context and learn how to address their social and environmental circumstances.
Your new job is to care for the whole person
Caring for the whole person—mind body and spirit and their social environment not just their body—is rapidly becoming part of the healthcare system. That is now part of your job. Soon the organizations that you work in will be responsible for population health, that is, the health of the community. This means that you will have to pay attention to prevention and community wellbeing. You are much more prepared for that than I was when I finished my training over 30 years ago.
This will not be easy. There will be major challenges and struggles. You will need courage and perseverance. In the book “The Little Prince” by Antoine de Saint-Exupery, the prince says to his adult companion, “to see clearly one must see with the heart, the most important things are invisible to the eye.” In the current healthcare world, the most important things are often kept invisible – they are in the background. It is time we paid attention to those things that were previously ignored.
There will be lots of resistance. Some people will disrespect or deny the value of your services—or at least not pay for them. Some may ignore you because of your gender, race, professional degree or some other factor. But those times must end. Many of those factors previously ignored are the very factors we need for healing in the 21st century. You must bring these factors out of the shadows – make the invisible visible and make them available for your patients.
Several months ago an older patient of mine broke her hip and ended up in the hospital over Thanksgiving with a hip replacement. The ease and rapidity of the hip replacement was remarkable. However, after the hip replacement she began to get postoperative delirium. She was having hallucinations, not knowing where she was, trying to get out of bed. After several days of trying to adjust her medications to reduce this and at the same time control her pain, the doctors were at a loss for other things to do. At the request of the family, a nurse came in and give gave her a Reiki treatment in the evening. This is a harmless yet poorly researched energy therapy. That night she slept all night for the first time and the next morning she woke up with a clear head, ready to be discharged. On morning rounds the next day the surgeon said, “What a remarkable case of spontaneous remission.”
This is how healing stays invisible. It gets ignored or explained away.
However, you know better. Care heals and when mixed with good medicine provides the best of all worlds. You are the ones who will make that happen. You are the ones that can make healing as important as curing.
Lead with Compassion
Let me leave you with one final thought. As you walk across the stage today you will be given both a symbol of your education and the authority (and the privilege) to engage in your chosen profession—the profession you have worked so hard attain. But never forget that there is something even more important than the diploma or that authority. It is something you had long before you came to Samuel Merritt University and it will be the key to your success as you leave this school.
You have and do carry a deep desire to help others, to care and support them, to ease their suffering and relieve their pain. This desire is your most powerful weapon to help heal.
Never let go of this desire. Hang the trappings of your profession on it. Let your calling follow your heart. Always lead with the empathy and compassion that brought you here in the first place. If you do this, the power of your diploma will be multiplied a thousand fold and you will go out into the world not just as a nurse, a PA, a podiatrist, occupational or physical therapist— but as a true healer—the noblest of all professions.
Congratulations and good luck.