The Human Connection: It Matters
Remarks given during the Saint Louis University School of Medicine Precommencement on June, 19, 2017 by Peter Pronovost, M.D., Ph.D.
Welcome
Congratulations.
I hope that in this moment, you feel that all the hard work was worth it – because I can tell you that it is worth it… all the long nights, all the hours of study, all the labs, all the questions, all the memorization, all the details – it’s worth it all.
Welcome to this fellowship of physicians.
You’ve dedicated your intellect, but I’m going to ask you to do one more thing.
You also must also dedicate your own human heart.
And these aren’t just pretty words for graduation day. I’m telling you that if you wish to be an effective physician – if you really seek change in human lives and the world at large – you have no choice but to do what I’m about to tell you.
The practice of medicine, the healing arts, extend beyond the science.
The practice of medicine is inseparable from the practice of human grace – of humanism with all its majesty and messiness.
The Power of Humility (and Brussel Sprouts)
Recently I visited New Zealand, and I was moved by their culture of respect.
At the beginning of every event, they recognize the native Maori people; by reading a beautiful Maori proverb:
What is the most important thing: He Tangata, He Tangata, He Tangata.
It’s the people, it’s the people, it’s the people.
And for the world to be a better place, this must be true in patient care, in care teams, in research teams, in all organizations and society.
Being a physician doesn’t just mean you practice medicine. It means you practice humility.
All respect, all dignity, for all people.
But it’s up to you. You’re going to have to do more than acknowledge it. You’re going to have to work hard at living it. I will share my lessons of living it. After I became a doctor, it was chilly and I wore my white coat into the grocery store after work. An older woman who had a walker came up to me with a question, and I’d like to share that question with you right now. She said something to me I’ll never forget.
She said, Sonny, can you help me find the Brussel sprouts?
I had a moral moment. What does this white coat really mean? I smiled at her and here’s what I said.
Let me get them for you.
May we never stop getting people their Brussel sprouts.
Always Give More
Respect matters. Caring matters. Getting your own ego out of the way matters.
Recent research indicates that even a single disrespectful act hurts diagnostic accuracy, treatment accuracy and productivity by 16 percent.
Disrespect brings damage. By the same token, caring acts bring real benefits.
A while back, I asked our staff for examples of care that truly takes your breath away, and they answered with hundreds of beautiful stories – human encounters made possible not by studying in the classroom but by looking into your own heart.
Stories of births and deaths…
Of weddings performed in the hospital so a dying mother can be there for her son’s great day…
Of a graduation ceremony so dying father could be there to see his daughter be the first in their family to graduate from college…
Of a girl who was hospitalized for six months and desperately missed – of all things – a cow from back home… and the staff brought that cow into the courtyard so she could see her again.
Do not only be dazzled by diagnostic dilemmas and tantalizing technology.
Be humbled by why we pursue these things – the reason medicine should matter at all: micro-moments of connection between people.
Or, if you’d like a shorthand term, let’s call it love.
A Human-Centered Life
How do you practice humanism when you’ve been told that the only things that matter are efficiency and data?
If we truly accept that micro-moments of human connection enhance efficiency and improve the data, it all comes into view.
Think of it this way: it makes us quantifiably human.
With a human-centered culture we have organizations that thrive…
places where everyone –
Not just the doctors and nurses, but the people who clean the rooms and serve the meals –
Everyone is engaged, energized and empowered.
We want better outcomes for patients, so let’s treat them like the people they are – people like us.
How? Try this:
When a patient seems lost, don’t turn away. Ask where they are going and walk them there.
Stop what you’re doing and really listen to someone’s story.
Share your own heart so someone else might feel safe to share theirs.
Admit mistakes, and forgive them in others.
Ask patients not what’s the matter with you; Ask what matters to you
Learn the name of the person who cleans the rooms and thank them for preventing infections.
And – this is key – don’t limit this kindness to patients. Your staff, your co-workers, your superiors – care for them, too.
One More Thing?
When you’re being kind, be kind to yourself. Take care of your body and your mind – and guard your family and your home life and your own cares and dreams. If you want to do your best, you have to be your best. In a career with tremendous burnout rates, depression and even suicide, make yourself your first patient. Build resilience with Exercise, sleep, practice mindfulness, express gratitude, embrace positive thoughts, and make micromoments of meaning with others – this is how you thrive, and build a long and satisfying career in medicine.
The practice of medicine is the daily practice of humility.
All respect, all dignity, for all people, including yourself.
You’re going to have to do more than acknowledge it. You’re going to have to work hard at living it.
We see a provable, measurable, scientific connection between the kind gestures you offer and…
how long it takes to get better…
how much pain someone feels…
how much joy we have in our work, and…
how well our organizations perform
how much we thrive as members of our community and citizens of this country.
If you wish to change the world, it begins with this idea, what researcher Barbara Frederickson calls “micro moments of positive connection” – but what the rest of us just call “love.”
Big change is the sum of a thousand small ones -- made possible by thousands of micro moments.
The doughnut shop I pass on my drive to the hospital isn't the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle. One Sunday before Valentine’s Day, the line to get served there was long, checkered with homeless people—some of whom sleep under the highway to stay dry and protected from the wind—and more well-off people getting breakfast or bringing bagels or doughnuts to work or church.
A homeless couple stood ahead of me. Their clothes and hair were dirty They appeared very much in love—standing close, gently touching and smiling. They wanted to share a heart-shaped doughnut with pink frosting . They reached deep into every pocket counting their change, hoping to find enough.
They were a nickel short. Sheepishly, they turned to me and asked for help. I had a feeling of injustice: Here I was bringing doughnuts to doctors, nurses and staff who did not need them, yet this couple would not have breakfast without help. Not wanting to shame them, I softly told them that they could order whatever they wanted and that I would be happy to buy them breakfast.
When they ordered, the cashier looked at them judgmentally. Perhaps she had been stiffed before, or maybe she knew they did not have the money. The woman spoke up, stating “the guy behind me is buying us breakfast. The cashier looked at me and I said yes I will buy them breakfast.
That is when the cascade started. “What a great idea,” said a woman behind me, who was picking up doughnuts for Sunday school. She offered to buy breakfast for the homeless person next to her. The nurse behind her did the same, as did the police officer further back. The cascade went on 7 people deep.
As I walked out, the couple eating breakfast asked if we could talk for a minute. The man explained how they never intended to be that way. They hit some “rough patches” and made a couple bad decisions, he said. “We are something,” the woman told me. I told them that I believed them. My only request, I said, is that when they got back on their feet, they “pay it forward” to someone in need. Well 6 months later, I stopped by dunking donuts and the cashier said a guy asked me to give this to you; Written in pencil on a crinkled piece of paper ripped from a note book, it read: I bought somebody breakfast.
Love is infectious. Spread it around.
This is humanism. This is excellence. This is my fellowship… and now it is yours as well.
Closing
You are entering medicine at a time where we are making unprecedented discoveries.
You are also entering medicine when much of our very core is challenged: burnout, high cost, low quality. And only you, our future physicians can solve it.
We need you. Your patients need you. America needs you. The road will not be easy, yet it will be filled with immense joy and deep meaning. Embrace the majesty and messiness.
You have a moral duty not only to provide safe, affordable care, but also to work to ensure that people have access to it. This will challenge you.
C.S. Lewis said courage is not one virtue, it is the form of all virtues at the testing point. When you are challenged, and you will be, you will need to dig deep into your soul and draw upon your core beliefs the reason you wanted to be a physician in the first place.
When you accept this degree, may you accept humility and curiosity.
When you accept this degree, may you accept courage and compassion.
And when you accept this degree, may you practice in all parts of your life the human connection, real love.