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Cowboys, Pit Crews, and a Bit of Dr. Seuss

Class Day inspires optimism for the future of medicine

OH, THE PLACES THEY'LL GO: Members of the HMS Class of 2011 celebrated their graduation just weeks before beginning residency training. Eighty–seven members of the class will stay at a Harvard–affiliated institution for at least part of their training. Twenty–nine will head to California, and 17 will train in New York City.<br/>Photo by Steve Gilbert

With their newly inked diplomas in hand, the recent graduates of Harvard’s medical and dental schools relished their accomplishments, and the sunshine, of Class Day 2011. Families, friends, and faculty looked on as several speakers underscored the optimism and joy of the occasion, while reminding the graduates of their unprecedented opportunity to improve not only their patients’ lives but also the health care system they will inherit.

James Sawalla Guseh II ’11 set the stage for the other speakers’ philosophical musings with his own glimpse into the future of his fellow new physicians with a clever retooling of Dr. Seuss’s Oh, the Places You’ll Go! Wielding his poetic license in advance of his medical license with “Oh, the Doctors You’ll Be!,” Guseh dispensed the medicine of laughter with verses such as: “What’s your chief complaint?/I ask and you share‚/What’s that you say?/A hernia repair?/Does it itch? Does it burn?/Does it tingle down there?/That must be hard for you./Are you feeling despair?/Do you need medical advice?/I better send you elsewhere‚/because I’m a medical student./I’ll be a doctor next year.”

Anjana Sharma ’11 spoke eloquently about her own and her classmates’ experiences surviving medical school. Her address started with the common fear of many successful, accomplished people—that their achievements are partly the result of a clerical error.

Speaking of the sacrifices their families made to get the graduates to this day, the faculty and staff who inspired and served as role models, the patients who taught them most of all, and the camaraderie of peers, Sharma emphasized that their relationships are what will make them better doctors. “Let’s stay close,” she said. “Let’s stay accountable to each other, and let’s work together to reshape a broken health care system.”

Commencement speaker Atul Gawande ’94, an HMS associate professor of surgery, echoed Sharma’s call to join forces for better patient care. After noting how the practice of medicine has changed over the past generation or two, Gawande expressed his appreciation of the undeniably positive effects of treatment advances. At the same time, he said, the increasing complexity of medicine has “exceeded our individual capabilities as doctors.”

He went on to talk about the “cusp point in medical generations”—where the graduating students will soon find themselves, and where they may find great opportunity. The health care system has become fragmented and segregated into silos to the point, he said, that no one person can know everything about a specific patient’s treatment.

“It’s like no one’s in charge—because no one is,” he said. “We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.” And places that provide the most successful care are those in which the team functions as a system, in which all involved in a patient’s care “actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.”

Physicians have traditionally been trained to be autonomous, independent, and self–sufficient. While these qualities are admirable, Gawande said, the pit–crew approach requires humility, knowledge that failure is inevitable, and teamwork.

Gawande exhorted the graduates to consider these values as they embark on their medical careers. Shifting from corralling cowboys to producing pit crews, he reminded them, “is the great task of your and my generation of clinicians and scientists.”

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