John Madden White Coat Ceremony Speech

Good afternoon and welcome to the St. George’s University School of Medicine White Coat Ceremony.  My name is John Madden; I went to Grenada as a med student in 1977 and graduated from St. Georges back in 1981 before our honored medical students were born.  Dr. Cox has told me not to go into what it was like back then, and I am Doctors Macpherson and Rao would prefer I not go there as well, but let me assure you that you will have an interesting four years at St. George’s. 

Taking advantage of the Keith Taylor Global Scholars Program here at the Northumbria University along with your studies in Grenada and clinical programs in both the US and UK will not only provide you with a world class education, but expose you to different health care systems and cultures.  In addition you will make life-long friends as you experience the trials and tribulations of being a medical student.   It will not be easy, but 4 years from now when, hopefully, we’ll all be together again reciting the Hippocratic Oath in New York City, you look back and it will seem to have gone by oh! so quickly.

I’d like to extend a special welcome to some of our guests;

Our keynote speaker Sir Miles Irving, Emeritus Professor of Surgery at the University of Manchester with his wife Pat Irving
Joseph Charter, High Commissioner of Grenada to Great Britain and his wife Valerie,
Professor Craig Mahoney, Vice-Chancellor of the Northumbria University
Dean Julie Mennell, from the School of Applied Sciences here at Northumbria University
Mr. Rodney Croft, Dean of Clinical Studies in the UK and his wife Hazel
Dean of Students Dr. Vish Rao
Dean of Enrollment Planning Margaret Lambert
Vice-Provost for International Development Calum MacPherson

To get us started this evening, I’d like to ask ___________________of St. George’s to make a few comments.

Thank you ________  for that warm welcome.

I’d now like to ask Professor Craig Mahoney, Vice Chancellor of North Umbria University to speak with us.

Thanks you Professor Mahoney.

I’d now ask Dr. Calum MacPherson, Vice Provost of International Program Development to make a few remarks.

Thank you Cal.

My Comments;

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!

Sir Miles INTRO à

Our guest speaker this evening is an amazing man with a most impressive background in medicine. 

Sir Miles Irving received his undergraduate medical education at the University of Liverpool and during his career has amassed 15 graduate degrees.  Sir Miles became a Knight Bachelor in 1995 and is a member of the Royal College of Physicians and Surgeons in England, Canada and Glasgow as well as a member of the American College of Physicians.

He has over 250 publications and while most are in the field of gastroenterology and nutrition, I did notice a few in the field of trauma. In fact, Sir Miles introduced the Advanced Trauma Life Support Course in the UK which was the first time the American College of Surgeons Program was offered outside of the US.  I myself have been an ATLS instructor for nearly 2 decades and continue teaching this every year to physicians and surgeons in the US.  St. George’s University by the way assists in offering the ATLS course in Grenada with help from our colleagues from Trinidad and Tobago. Sir Miles has also been instrumental in developing the guidelines used to merit trauma center designation in the UK. 

I would also note that this surgeon recognized the importance of emergency medicine in the house of medicine when he founded the first ever Professor of Accident and Emergency Medicine.   It is nice to see my specialty has made inroads with our UK surgical colleagues.

Sir Miles has ties to Newcastle, having trained at the Newcastle General Hospital in surgery early in his career and later as Chair of the Board of the Newcastle upon Tyne Hospitals NHS Trust.

Sir Miles remains active and is Chair or a Trustee of many medical organizations today.  Rather than go on about his many accomplishments, I think it is time to hear from Sir Miles himself, so please join me in welcoming Sir Miles Irving.

Thank you Sir Miles for those thoughtful remarks.

To welcome each of you to the Medical Profession, St. George’s University School of Medicine will now present you with a white coat.  These symbolize your entry into the medical profession and your commitment to uphold the highest ethical and professional standards.  Dr. David Holmes, Director of Collaborative Programs at Northumbria University, will call students by name and in recognition of our international enrollment, will state their country of birth.  I invite Dr. Shubhra Barush and Mr. Rodney Croft to assist Sir Miles and I in the robe-ing.

Students will come onto the stage on your left side, be robed and exit on this other side to return to your seats.

PLEASE hold your applause until the robe-ing is entirely complete, and for safety reasons, kindly keep the aisles clear while the students are passing.

STOP!!

AFTER ROBE-ING

I invite Dr. Rodney Croft to lead the recitation of the Professional Commitment. I’d ask all the newly robe-ed students to stand, and find the professional Commitment near the rear of your White Coat Ceremony pamphlets and recite the pledge with Dr. Croft.

Please be seated.

Closing Comments;

Thank you Rodney.

It truly is a privilege to be given the opportunity to become a physician.  I congratulate all of you on this occasion as you begin your journey.  Four years or so from now we’ll all be getting together again in New York City to recite another oath based on the Hippocratic Oath written in 400 BC.  Most of us believe medicine has progressed a bit since then, but I must confess I was part of a team that once used leeches on a trauma patient as part of her care following microvascular surgery.  The physician-patient relationship has changed.  In fact it has changed a great deal in the 27 years that I have been practicing medicine and I am sure it has equally changed during Sir Miles surgical career. 

Today it is not uncommon for patients to have searched the web and have found websites and blogs for people with symptoms just like they have, so they come to you suggesting their diagnosis, recommending what tests and imaging studies need to be performed, and even perhaps the treatment they need.  Perhaps the purple pill they have seen advertised on TV or perhaps a Z pack that worked for their friend who probably had a virus by the way and didn’t need any antibiotics at all, so they’d like to give it a try as well.

When I started my medical residency, there was basically little or no treatment for heart attack victims.  Today when a paramedic interprets an ECG in the field as an acute MI, the paramedic calls me on the radio and I activate the cath team.  When the patient arrives, they spend less than 10 minutes in my ED before going to the cath lab for definitive treatment with discharge from the hospital within 3 days. 

A stroke patient was frequently left in the hall of my ED when it was crowded. Today we not only occasionally give thrombolytics to dissolve a blood clot in the brain but my own department is part of a group researching the value of transcranial Doppler blood flow of the middle cerebral artery while we administer both the thrombolytic and nano bubbles to reverse the devastating effect of a thrombotic stroke.
 
You will witness many substantive changes in medicine during your medical careers as well. Perhaps some of you will help develop them.

In July of 1900 William Osler wrote the following in the Lancet; “If the license to practice meant the completion of his education, how sad it would be for the practitioner, how distressing to his patients.”  Although rather sexist, he is pointing out that a physician’s education does not end when she,     or he,   graduates from medical school.  It is an ongoing process, for which you and your patients will benefit.  Every shift I work in the ED I learn something new or am reminded of something I thought I learned many years ago.  You will learn from your teachers here in the UK and in Grenada, your clinical teachers in the US and the UK, fellow students and your fellow residents, but most of all, you will learn from your patients.  Listen to them.

We’d like to thank the Arnold P. Gold Foundation for their support.  St. George’s is pleased to have a chapter of the Gold Humanism Honor Society since 2006.  Students become eligible for enrollment through service oriented activities, and these opportunities will be announced later this term. 

I would like to thank all of our speakers, students, their parents, family, friends, faculty and staff for attending this evening as these young students begin their lifelong journey of being a physician.

Please remain seated until our faculty and all the students have exited behind the Grand Marshall, and I invite all of you to join us right outside for a reception. 

Thank you for your attention and please have a safe evening.