The Importance of the Physician-Patient Bond

Class Day speaker Sanjay Gupta tells grads to respect the great privilege of caring for patients

Gupta in regalia speaking into microphone

Sanjay Gupta shares his perspective with the HMS/HSDM class of 2023 in his speech "What I Know Now That I Wish I Knew Then." Listen to his speech here. Image: Steve Lipofsky

Wow. I am so touched. I got goosebumps. Thank you, Ahmed, Dr. Ahmed, and thanks to the distinguished faculty, the guests, all the deans here. I'm really honored to be here. Most of all though, I want to congratulate the class of 2023. Huge congratulations. You have to soak this moment in. You have to just take it in and just reflect. It's one of those things. By the way, is this [doctoral hood] straight? I mean, I'm a neurosurgeon, but I can't seem to get this.

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You are now doctors and that’s for life. No matter what you do from here on out, you’re going to be doctors whether you like it or not. It's likely going to be one of the most central tenets of who you are and people are going to have all sorts of notions of who you are, what kind of person you are, what you’re capable of doing. Some may assume you’ve just gone into medicine to get rich, which reminds me of one of my favorite quotes, going into medicine for the money is like having sex for the exercise.

You will likely become the doctor of your neighborhood. Every backyard barbecue will be filled with questions about aching backs and strange rashes and even impotence. You'll be amazed at what people will suddenly be comfortable sharing with you. Embrace that role, never shy away from it. One group of people who will surprisingly not come to you as much as you'd expect, however — your kids. I have three teenagers, and if they have a medical problem, they go to mom. Mom's a lawyer, a divorce lawyer at that. I think they figured if it wasn’t a ruptured aneurysm or a brain tumor, they didn’t want to bother me with their more minor medical malady. Truth is, I wish they had.

You are the new guardians of the galaxy.

Please know that I’m tremendously honored to be here, grateful at the opportunity to share a few words, and frankly humbled that anyone would care what I have to say, but the truth is, your ears and your sensibilities, and now your ability to do some incredible things in the world at a time when we desperately need it, have taken on a greater sense of urgency. I don’t want to put too much pressure on you, but your jobs and now your role in society are more important than ever. In fact, in my estimation, you are the new guardians of the galaxy, and that is something I wanted to talk a little bit about today.

It's been about 30 years since I graduated from medical school and a lot of things have changed. The world's a tremendously different place. People have more faith than ever before, and yet we are more suspicious as well. We value our freedom and yet we too often live in fear. We spend more money on health care than ever, and yet life expectancy has decreased. We can treat and even cure diseases we barely understood when I graduated from medical school, and yet the people who sometimes would most benefit from those therapies don't have access to them.

But here's the thing: You have the ability to change that. You have the capacity to restore the faith, reverse some of those tragic trends, and reassure people who are going to come to depend on you. It is an awesome task. It’s awesome for society and it’s awesome for all of you personally as well, because I’ve got to tell you, there are going to be times in your life when the trajectory seems a little confusing. It’s going to seem a little muddled and you’re going to come to appreciate just how important the clarion call of compassion can really be. You’re going to know your purpose here on earth and it is an enormous gift.

It comes with obligations, as has been mentioned. You have to protect the legacy of medicine, you have to contribute to its growth, and most importantly, you always have to respect the sacred bond between you and your patient, making sure it stays sacred.

I can tell you, there’s no other relationship like it in society. You’ve got to remember to be humble, soak yourself in the privilege of your profession, but never the arrogance. You're going to be standing there in your crisp white coat and your patient will probably be there in a paper or cloth gown, probably fumbling with the ties. You’re going to have your tools, bright lights and hammers and blades to shine, bang, and probe, and your patients are going to be worried and sensitive and insecure. They may barely know you at that point, but you will be the most important person in their lives.

The thing I’ve really taken away is that I think it’s the greatest privilege given by one human being to another, to care for them at their most vulnerable time, to restore them to health when their bodies have betrayed them, to take them to the brink of death if you have to, but then promise to bring them back in better condition than when you started. I didn’t really know or realize any of this when I was in your shoes. It was a confusing time. Honestly, it was a noisy time. I didn't always know that I could trust what I knew.

When I was at my own commencement, I heard a story about this kid named Danny and a course that he took. Seems this kid showed up for the first class at the beginning of the semester. After that, he never came back until he took the final exam. It was 100 questions. His professor called him into the office afterward and he said, “Danny, I’ve got to tell you, I don't understand this. You come to class the first day, you never come back after that, you take the final and you got a 97. I guess I should be asking, how come you didn't get a perfect score?” Danny says, “Well, I'll tell you what doc, that first day you confused me a little.” You’ve got to be honest with yourself because the biggest lies in the world are the ones we tell ourselves.

So be kind. Take the extra moment to touch in this most human of all professions.

You’re well on your way to the medical part of your life, so I thought I’d focus a little bit today on the life part of your life. You spent years getting the big rocks in place, so think of these comments as some of the sand in between. Here are a few of the things I know now that I wish I knew then. As Dr. Karchmer said, the right decision is always to be kind. May not seem like it at the moment, and there’s going to be many sources of frustration and irritation, but the arc of history is long and you’re always going to feel better if you made the decision to be kind. I’ve always felt that in retrospect, what bothered me the most about those irritating situations is how I reacted to them, even more than the situation itself. So be kind. Take the extra moment to touch in this most human of all professions. ChatGPT be damned. Smile a lot. Even use humor. As the great Maya Angelou once wrote, “People may not always remember what you said or even what you did, but they will remember how you made them feel.”

During my neurosurgery training, I was called one day to care for a woman who’d been playing on the trampoline with her kids and at some point she was hurtled off that trampoline. We saw her in the emergency room and luckily she was neurologically okay, intact, as we like to say. Unfortunately though, she had a broken bone in her neck and would need a halo device to help her mobilize her spine. I explained this to her and then I went to go speak to her husband who was very anxious, understandably. After explaining all this to him, he looked at me a bit bewildered and said, “But doctor, you look so young. Have you ever done this before?” And I don’t know what came over me, but I paused and I smiled and I said, “Well, no, but I did stay in a Holiday Inn Express last night.” Now, apparently he had never seen that commercial. So class of 2023, be kind, use humor, always make sure to know your audience first.

Another lesson, they say don’t fix it if it ain’t broke. Thirty years later, I got a little bit of a different take on that one. Keep fixing it. “Not broke” somehow means that you’ve made it perfect, and it’s not perfect; nothing is. It is true that perfect can be the enemy of good. We say that all the time in the operating room, so it’s not take that extra millimeter of tumor that could cause blood loss, but what I’m saying here is that it means you have the opportunity to take a bunch of shots on goal. And because you can, you’re almost obligated to do so. So keep tinkering, keep improving, and yes, keep fixing. It’s an obligation to the future.

For me, it gets at this bigger idea that somehow we think of evolution as this steady march toward increasing perfection. Over the last 30 years though, I've been convinced more and more, that’s not the way it works. Instead, there are lots and lots of shots on goal, some too high, some not high enough, some far wide. Progress, it turns out, is actually quite chaotic and messy. But here’s the thing: one of those shots on goal could amount to something, could mean something new, something transformative. So graduates, keep fixing. No one’s earned the privilege more than you.

Also graduates, remember this, it’s an important one. Don’t spend your life continually trying to prove that you are smart. I’ll just say it: You’re smart. You’ve proven it. So instead, spend your time becoming wise. There’s a difference. A smart person knows the right answer, a wise person knows the right questions. So spend your time asking the right questions even if they seem dumb, because those are often the questions everyone else is too afraid to ask. And along the way, you may find yourself starting to no longer just continuously memorize the past, but instead change the future. Graduates, respect history, but don’t be afraid to make some.

Also, as much as we strive to hit the home runs and score the touchdowns and deliver the knockout punch, sometimes the small wins can lead to an outsized amount of happiness. One of the most memorable times of my life was back in the third grade. It was field day and as usual, I was the last person picked for teams. It was the beanbag toss. You had four beanbags and a target in front of you. You got three points if you got a bull’s-eye and none if you missed the target altogether. There had been three players on my team that had already gone, all four players on the other team had gone, so I was the last person to go. Frankly, no one really expected much of me, but now there was no way to escape the attention either. We were eight points down, which was a lot, but if we won this, we would win field day for the entire third grade.

I know this sounds a little silly, but it was one of those moments that still feels monumental more than 40 years later. I walked up to the line, I threw the first bag. I missed the target altogether, zero points. I still remember my third grade teacher dismissively waving his hands at me. Still stings. I had three beanbags left and nine points I needed to get. I threw the second bag. Bull’s-eye, three points. The looks I was getting from people were not so much celebratory as confused. How had this kid gone from not even hitting the target to hitting a bull’s-eye?

Next beanbag, bull’s-eye, six points. People who had started walking away were now starting to walk back. They weren’t in any way enthusiastic or encouraging. Instead, they gave me a look normally reserved for a stray dog or someone with a black eye. I was an oddity to them. That hasn’t changed. Last beanbag, bull’s-eye, nine points. Life went into slow motion at that point. It had been dead quiet, and then there was this explosion of sound, cheering and hollering, and my name being shouted by my teammates. I was the team hero for a single moment at least. It was such a wonderful, unexpected moment, one that I decided if I was ever asked to speak at Harvard Class Day, I would share the story.

The thing is, graduates, as healers, there’s going to be tough moments. That's the nature of our shared profession. Learn from those moments, but cherish the wins as well.

The thing is, graduates, as healers, there’s going to be tough moments. That's the nature of our shared profession. Learn from those moments, but cherish the wins as well. Celebrate them, no matter how big or how small. Today, you might be feeling a little scared. You might be kicking yourself or feeling that way, but don’t. Truth is, I like to be scared just a little bit. I’ve been shot at, I’ve been beaten, I’ve been starved, I’ve been humiliated, and all of that was just from my wife after our last boys’ weekend away.

But I think being scared is good. I think the corollary is also true. Never being scared, that’s bad. I’m not talking about playing games with your life. I’m talking about imagining things you never thought possible. I’m talking about actually savoring it when someone tells you, nope, can't be done, because you know deep down, you now have an opportunity to do the impossible. So graduates, do one thing every day that scares you. And as Kafka said, “In the process, you can become the action hero of your own life.”

For the last 20 years, I’ve straddled these two worlds of medicine and media and people often ask me what the connective tissue is between the two. Well, the reality is they are bound together by a critical ingredient. They contain some of the best stories and most important stories ever told. The story of people, the story of patients, the story of the scientific process, which allows us to learn more about both. In many ways, these are the ingredients for the story of humanity itself. As Dr. Cho said, "Remember the stories, share the stories, write the stories, tell the stories of the process and the people, because that’s where so much of our real learning, our real lessons come from.” So many years later, I’m still learning every day through those stories.

A few years ago, one evening I was on call, a 93-year-old man was brought into the emergency room. All I initially knew was that he had been in some sort of accident and a CT scan revealed that he had bleeding on the brain. When my resident first told me about the patient, the main fact that stood out to me was his age, 93. Being completely honest, I thought maybe he was too old to undergo an operation. But then I started to hear and listen to more of the story. My patient, the 93-year-old, I was told, was incredibly healthy. He was still an avid runner. He even still worked part-time as an accountant. They kept him around, his 65-year-old son told me, because he was such a whiz with numbers. In fact, his brain bleed had occurred because he fell off his roof after taking a leaf blower up there, trying to blow off the leaves.

Don’t cry because it’s over. Smile because it happened.

So given all that, I decided to take him to the operating room and decompress his brain. Now, as you might imagine, I was pretty nervous to see afterward how he was going to wake up, what his recovery might be like. Did I make the right decision? Had I prolonged his life or just extended his death? And as soon as I walked into the room, I knew the answer. The man was already up, reading his smartphone, his reading glasses adjusted over his white bandage. He told me that he was following the recent elections in West Africa, as one does right after emergency brain surgery.

It was pretty clear he was recovering well, and after examining him, I asked him, “How did this whole event affect you?” I was wondering how he was thinking about his mortality. He smiled and he looked at me and he said, “The biggest lesson in all this, no more trying to blow the leaves off the roof.” It’s a story. It’s a story you have to remember. And graduates, you’re going to be surrounded by data and information all the time. Surround yourself with the stories as well, and learn judgment from that. The guy taught me a lot. You only live once, but if you do it right, once is enough.

Graduates, your time at Harvard Medical School is coming to an end. But as another doctor once said, “Don’t cry because it’s over. Smile because it happened.” Dr. Seuss. Looking back 30 years, I can tell you this. Your friends from this time in your life may be some of the best friends you’ll ever have. And it is true you don’t get this time back. It’s gone, but the friends who shared this journey with you, they’re still here even if you don’t get to see them every day.

So final lesson, graduates. Of the few touchstones that you hold close to your heart place, lifelong friendships are right there at the very top. Appreciate those friendships, nurture them, make them grow. And realize that as you get older, those friendships will become some of the most valuable things you have in your life. Fly around the world, graduates, for the weddings of your friends. Be there for the births of their children, and always answer the call in their times of need. My most heartfelt congratulations to you graduates. I love you. I am with you. Now, go guard the galaxy. Thank you.