Thoughts from the Dean

Exercise Your Curiosity

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May 28, 2015
Exercise Your Curiosity

During my 2015 Class Day address, I advised our newest physicians to let their curiosity get the better of them 

In a little while, each of you will make the transition from being a student at Harvard Medical School to being a physician.

So, it's reasonable to ask: how did you arrive at this wonderful moment? Of course, you all have individual stories, but at some point you each made a commitment to the field of medicine, and as a consequence of that commitment, you have spent years studying human physiology and pathophysiology, embracing both the art and science of diagnosis and treatment.

You have learned from physicians in our hospitals and researchers in our laboratories. You have collaborated with clinicians and other health professionals in community-based and primary-care initiatives. You have engaged in health policy analyses, and you have traveled the globe pursuing global health, even to the "last mile," as we heard today. 

To be perfectly clear, you have worked really, really hard! But before you get too relaxed during your well-earned post-graduation vacations, I’m sure you all know that this career of hard work you have chosen won’t get any less challenging for quite a long time.

As you move on to residencies, you will continue to work hard. And given the nature of our profession, you will continue during your practice of medicine to be lifelong learners.

You will of course be active in the areas of our profession that have captured your current interests, but over your long professional careers, history—and my own experience—tells me that many of you will become engaged in other areas that you cannot predict today, and in fields that don’t even exist at the present time.

During your time at HMS, you have posed questions and you have taken the initiative to find answers. You have displayed aggressive curiosity. And that’s a good thing to have in our profession.

In fact, you join a long line of graduates of this great medical school—since 1782 to be precise—who have repeatedly asked and answered questions pertinent to human health, who have advanced the practice of medicine, and who have established and continued this institution’s tremendous tradition of paying our debt of knowledge forward.

Albert Einstein once wrote, “The important thing is to not stop questioning." Curiosity, he said, has its own reason for existing.

This could be a tagline for why we pursue scientific exploration of the natural world. And it is a tagline for how we hope and expect that you, the graduates of this School, will approach the practice of medicine.

Some scholars have researched the importance of curiosity in medicine. They conclude that it is a habit of the mind, one that—for doctors—is actually fundamental to understanding each patient’s illness.

Curiosity, they maintain, is pivotal to the development of sound clinical reasoning, something quite necessary in the often ambiguous world of clinical medicine. It is key to avoiding the rush to premature decisions based on incomplete understanding.

It is also key to deepening self-awareness, and to building respectful relationships with patients.

Curiosity about the individual patients before you is essential to your ability to understand their cultural background, their personal and health priorities, and their deepest values.

But the world in which you will be practicing as physicians is undergoing many changes, and these create both obstacles and opportunities to the exercise of your curiosity.

Very soon, you will be training at medical centers in Boston and around the country, each with outstanding training programs in diverse specialties of medicine. But changes in medical practice and organization are actually creating challenges to the outstanding system of graduate medical education that developed in this country over the past century, during which time a haphazard system of informal apprenticeships evolved into the remarkable training ecosystem that we know today.

That history, and the present challenges, are brilliantly documented by the physician and medical historian Kenneth Ludmerer in his new book, Let Me Heal: The opportunity to preserve excellence in American medicine.

Ludmerer, in this book, describes the ways in which the rapid pace and organization of hospital medicine, combined with well-intentioned duty hour regulations and many, many other factors, make it more difficult for training programs today to achieve what might be seen as the optimal balance between service and education that made this system great.

These same factors also make it more difficult for trainees to focus on, and properly attend to, the needs of individual patients, in a manner that satisfies both them and their patients.

In a world of 15-minute clinical visits, both during your training and beyond, finding the opportunity to exercise your curiosity, to ask non-routine questions, and to probe the non-obvious aspects of a patient’s history, can all too often get short shrift.

So, I implore you to struggle against this, to avoid narrowing your focus, so that you can continue to see beyond the routine.

The world of medicine is vast, complex and dynamic. It is a world that needs physicians with inquiring minds, physicians who can think nimbly and who are fearless and adept at asking questions, seeking answers, and then asking new questions.

Now, as HMS students, you’ve been trained to ask questions and to be open to new possibilities. Many of you have investigated questions that have piqued your interest while you have been here.

These questions cover a truly extraordinary range, from explorations of molecular biology and genetics to health systems policy and global health.

One area that underwent rapid development during your time here, and one that is certain to change the practice of medicine, is the increasing power of big data and associated analytics to reveal unique insights into health and medicine.

This includes vast amounts of genetic and other "-omics" data, as well as data from medical records and social media that can and will be linked together and mined for critical health insights.

When merged with new sensor technologies, whether associated with your watch, your phone or other devices, and the power of the Internet and proliferating apps to disseminate health information and care across geographic boundaries, these technologies will indeed change medicine as we know it.

I expect your generation of HMS grads will excel in, and advance, the use and exchange of such information.

Your generation has learned the value of, and experienced the power of, shared information. And you are comfortable tapping into any of the myriad platforms that can facilitate such sharing, or will in the future facilitate such sharing. 

But here is an important question: Will this rapidly accelerating ability to share and manage information digitally and on a global scale clash with the more personal and direct interactions you will strive to establish with your patients?

I don’t think this has to occur, and surely hope that it does not. For although none of us fully understands the rate and the power at which changes will come to our profession through new technology and its digital dissemination, what should not change, what must not change, is the fundamental value of direct and personal relationships with our patients.

But even here, there will be changes. Far more than in the past, your future in medicine will likely include being skilled at and comfortable with teamwork. It's likely that medical care is, and will increasingly be, delivered through team-based models, including both physicians and other health professionals.

As physicians, you will continue to be pivotal decision makers on how care plans will be finalized and implemented, and in many other aspects of how you will all interface with patients.

But that decisive role also will demand a refined capacity to listen, to assess, and to share goals and actions with members of your team—in a manner foreign to many physicians of prior generations.

So, in conclusion, congratulations on completing “Step One” of your training. Step One of a long and rewarding medical career in a profession that will itself evolve rapidly during your careers in exciting and unpredictable ways.

Try to be comfortable with the fact that you will never be fully trained.

This need for continual learning is one of the challenges of being a great physician, and one of the fundamental reasons why this profession is so rewarding.

So, on this important, life-changing day, I have the privilege of welcoming you all to the profession of medicine.

I urge you to continue to explore and inhabit a universe of learning and discovery.

May you remain curious, while contributing to this exceptional profession, and wherever technology takes us, may you always find great joy in caring for your fellow human beings. 

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