Graduation address given by Emeritus Professor Kerry Goulston AO

Emeritus Professor Kerry Goulston AO, Faculty of Medicine, University of Sydney, gave the following occasional address at the Faculty of Medicine graduation ceremony held at 11.30am on 1 May 2009.

The photo of Professor Gouston giving the occasional address is copyright, Memento Photography.

Emeritus Professor Kerry Goulston AO

Graduation address

Your Excellency Professor Bashir, Professor Hearn, Professor Robinson, Colleagues and Graduands.

First - congratulations to you, your family and your loved ones.
Congratulations, not only for graduating from a University that has a rich history and an extremely high international reputation - but also for surviving the first third of your intern year.

Only a few weeks ago I attended a reunion of my graduating class in this Great Hall. I reflected at that time that, although some had faltered or fallen by the wayside over the decades, the overwhelming majority had become leaders. Leaders in their chosen speciality, in the profession, or in the community. And the overwhelming majority had served their community faithfully as a Good Doctor.

Some might say that to be a good doctor you only need two things:
- A good memory
- And an ability to get on with people.

So I have been reflecting on what I think might be the essence of a Good Doctor.

I believe it is Commitment. Commitment
- to those we serve - our patients
- commitment to those we work with - our colleagues
- commitment to the community
- and commitment to ourselves.

First - our patients.

Francis Peabody rightly said “the secret of the care of the patient is caring for the patient.”

Our Course emphasised Evidence Based Medicine. But I am sure you have realised already in your Intern Year that every patient is different. Every patient presents a new and interesting challenge. Medicine is more than EBM or practice guidelines. How we manage each patient depends on what they want from us.
What do our patients want from us? They want a well trained scientifically based doctor (and the USydMP has given that to you). They want you to be empathic, to be a good listener and to be willing to give time, support and respect to them.

In Boston I worked with a bloke called Franz Ingelfinger - a legend in Gastroenterology who went on to be Editor of the New England Journal of Medicine. He wrote - when ill himself with oesophageal cancer:

“Doctors for various reasons find it difficult to put themselves in the patient’s place. They do not sufficiently appreciate, or perhaps do not have the time to appreciate how the patient feels and how the patient reacts to the medical information they are given, reacts to the procedures to which they are exposed.”

Ingelfinger foresaw that the trend to increased efficiency in hospital and healthcare might actually hinder empathic medical practice and might foster if not arrogance, at least the appearance of arrogance.

We know that the increasing pressure of work, the emphasis on a more efficient throughput, will not result in better health outcomes for the patient, unless CARING is up there as number ONE.

Caring for the individual patient (and importantly for their family as well) has to carry with it not any vestige of arrogance, but compassion and humility.

As Balint put it modestly, our aim should be “to cure sometimes, relieve often, comfort always.”

Again to quote Ingelfinger - my role model - “Good Doctors are always aware of how little they know.”

So - please never say to a patient “there is nothing more we can do for you” - Just be there for your patient.

The second commitment is caring for your colleagues.

You must be sensitive to pick up warning signs that might alert you to the fact they are having trouble coping. By colleagues - I mean not just your fellow Doctors, but all Clinicians who work with you - nurses, allied health and support staff - that is all who work with you in caring for patients. You have a duty of care to them.

The third commitment is to the Community.

In our own Faculty we have those who are unafraid to speak out about broad social issues - people like Steve Leeder, Ian Hickie and Simon Chapman. I hope many of you will follow their example the years to come.

I will just concentrate for a minute on our own Public Health System in which you are now working.

After 4 months, you must by now agree with the message of the recent Garling Enquiry into NSW Public Hospitals. Garling praised the skill and commitment of clinicians working in our hospitals. But highlighted “the pressures on a skilled workforce spread too thinly and too poorly supported in many administrative tasks which take them away from their patients”. He spoke of the NSW Hospital System being on the brink of crisis.

Many of us have tried, and are trying to make that System better. To make it a happier and more fulfilling place for clinicians to work in. To strive for patients entering the Health System to have prompt access to the best care. For patients to have the same outcome from their care regardless of where they live, their ethnic background or their financial status.

Now it’s your turn - I challenge you to get engaged, and show your commitment to speak out, to speak out for our patients, our community and for those who come after us.

You will be the teachers and the role models of many young students and doctors in the decades ahead. This will be both a responsibility and a joy.

Finally, the commitment to yourself. Your own well being. You need to discover and nurture interests outside medicine and lead a balanced life. You need to never be fearful of saying “I don’t know.” “I need help.” “I made a mistake.”

As Clint Eastwood in Dirty Harry says to the villain in the final show down, “a man’s GOTTA know his limitations.”

The final commitment has to be not only to look after yourself and care for yourself, but also for your own loved ones.

At our recent reunion, talking with my colleagues, I was struck by a clear message from them. They felt that their chosen profession had given them much happiness and many rewards.

But what they deemed the most precious reward in their life (and what was their main topic of conversation at that reunion) was NOT their professional or academic achievements BUT deep long-lasting friendships,
- ‘soul mates’
- the love of their own family and loved ones;
- seeing their children and their grandchildren start life with a balanced and true sense of moral values.

Perhaps of all the 4 commitments I’ve spoken about, this last one is the one I hope you especially remember.

Thank you.