Graduation address given by Professor John Horvath AO

Professor John Horvath AO gave the following occasional address at the Faculty of Medicine graduation ceremony held at 2.00pm on 1 May 2009. Professor Horvath was previously Chief Medical Officer, NSW Department of Health and Aging.

The photo of Professor Horvath is copyright, Memento Photography.

Professor John Horvath AO

Graduation address

Chancellor, Vice Chancellor, Fellow members of the Faculty, invited guests and most particularly graduates.

Why most particularly the graduates? Because this is your day! You who are graduating are the most important people here. I regard it as a signal honour to have been invited to speak to you today. Look around you at this magnificent hall because for many of you this hall will play a significant role in your life.

As a graduate of Sydney University it still gives me a real thrill to enter this Hall. This is despite the fact that I did many of my exams here - and some of them bring back some vivid memories!

When I graduated in this hall I did not think I would attend the graduation of my children, take part in days like this; go to memorable farewells; marriages; social functions and sadly even some memorial services. This hall, like the University, will remain a part of the fabric of your life.

I was instructed firmly by the Vice Chancellor to say something meaningful and important. So I thought a bit and remembered, in an very memorable address, the President of the American College of Surgeons referred at length to Humpty Dumpty. Now, I guess, most of you would have heard of Humpty Dumpty as a child. He is in fact a historical trauma victim and whose tragedy was falling off the wall. In those days he most probably wasn’t reported to the Department of Social Security for sickness benefits. However an important thing did occur. When Humpty Dumpty fell off the wall, the call went out for: “all the King’s horses and all the King’s men to try and get Humpty Dumpty back together again”.

Well, as you know they failed poor Humpty Dumpty. But it is important to recognise that the call went out to “all the King’s horses” and “all the King’s men”, not to some poor serf or ne’re-do-wells, riding any old nags, the best and the brightest were called. You are the best and the brightest and sometime soon you will be the ones called to put Humpty Dumpty back together again.

All of us up here envy you. We have made our contribution. Many of us have done lots of things with varying degrees of success, but the chances of any of us making a new contribution or leaping new hurdles is very small. So we envy you because this is all before you. You are the ones who still have a chance of putting Humpty back together again. You are the ones who are going to explore the role of the Genome, of molecular biology. You are the ones who will think up new “ologies” that none of us have even dreamt of, and with it you will have fun and you will do good. Because practising medicine most days you are able to help people. You have the potential to significantly add to knowledge and to change your communities - and perhaps the world.

It is well described that the well being and development of communities are inexorably linked to Education and Good health.

Now lots of people will say to you the “golden years” of medicine have passed. I suppose Pasteur thought that after he had finished with pasteurisation of milk and Jenner with Cow Pox, that it was all over and every generation seems to believe that they have the best of it and for some unknown reason we should cast gloom and doom over the coming generations. I often hear my colleagues say “Gee, I’m glad my children didn’t do medicine”. I have a daughter who graduated in medicine in this very hall and I am really pleased for her because she is enthusiastic and looking forward to the sorts of challenges we looked forward to.

Of course it will never be exactly the same but I put it to you with your input - it will be better. That with your energy, your skills, your knowledge and your coming wisdom, you can have just as good a career as those who say it is all over - and most likely even better because you have more resources. I am not denying that some of the pressures around you appear to be extremely oppressive. There has been a lot of anxiety over the steady diet of “change” and something referred to quaintly as “Agenda of Reform”.

As the Australian Chief Medical Officer til 10 days ago, I have certainly been right in the thick of it. This is not the first time the profession has been in the middle of a maelstrom. In 1974 when I came back to join RPAH and the University, the battle was raging over the establishment of Medibank (now known as Medicare). It was said if Medibank was introduced - medicine would never be practiced in the same way again.

Well - certainly it hasn’t. All Australians have access to a health system that produces the second longest life expectancy in the world, the best outcomes for a range of diseases such as heart attacks, cervical cancer and a whole lost of other outcomes. This is not achieved if the system is “broken” - however there are challenges. Whole population statistics hide the fact that there are inequalities in health outcomes for some of the community such as Indigenous Australians and those of the lower end of the socioeconomic scale who do not get the full benefits.

But the greatest foes of Medibank of the 70s have now become its staunchest defenders.

Heaven help anyone who tampers with Medicare. Every generation has had some difficulty with Government intervention and part of the ability of being the best and the brightest is in being able to work within the confines of the system and achieving what can be done within the system.

I am well aware of some of your concerns - will training schemes be available? Will you be able to fulfil your potential and have a career? Despite the many enquiries, reviews going on around you, it is important to be aware - almost all of them refer to the need of a well-trained medical workforce, and needing to put real dollars into it.

I don’t believe that we are at the beginning of the end, or even the end of the beginning. It is merely yet another series of changes in an ever-evolving system which is complex and has so many different stakeholders, health professionals, patients, the Government - that tension is inevitable.

But we doctors don’t practice in isolation. At the coal face we are in a multi-disciplinary teams without which we can’t achieve our goals, be it patient care or research. The world events around us and national events, make our practice even more challenging. There is little doubt that medicine, along with virtually all industries, has become internationalised. There will be greater movement of knowledge and technology across barriers, whether it be by tele-medicine or other technologies or movement of people. You are all uniquely positioned to avail yourself of these opportunities.

Lastly, because you are the best and the brightest and you will be at the cutting edge, you get to solve the problems - be they needing scientific endeavour such as the effect of climate change on disease, ethical perspectives of managing the secrets of the Genome or how to deliver services to remote communities.

So, in closing, I entreat you to take on these challenges with enthusiasm. Ignore the cries around you that “the golden days are gone”. Remember poor Humpty. It is important to remember that when he fell off the wall it was the King’s horses and men, that is the King’s resources, that were called upon to put him back together again.

I wonder if you will be the ones to restore Humpty Dumpty. Perhaps you will find the correct adhesive; or perhaps you may prefer the omelette that emerges from these eggs.

I again congratulate you and wish you all well.

Thank you