Dean Rodney Croft’s complete Keynote Address

Deputy Vice Chancellor Mahoney, Sir Malcolm McNaughton,  Senior Faculty Members of Northumbria University and St.George’s University Grenada, White Coat Students, Ladies and Gentleman, I would first of all like to thank Dr. Peter Beaumont for his warm welcome, his interesting reflections as an alumnus of St.George’s University School of Medicine and his most kind words of introduction.

It is both a very great pleasure and indeed an enormous privilege  to have been asked to give the keynote address here today on what is for all of us, but especially the White Coat students, a most auspicious and memorable occasion.

As Dean of Clinical Studies in the UK for St. George’s, let me add my heartiest congratulations to you the White Coat Students who are about to enter the St. George’s Keith Taylor Global Scholars basic science programme at Northumbria University.

This is a very significant programme, not only because it is associated with a renowned UK University, Northumbria, but also in the true tradition of St. George’s School of Medicine, it is for a significant number of you directed towards training medical students who either come from developing countries or towards those who wish to subsequently practise in such countries: a dream shared by our late Vice-Chancellor Emeritus Keith Taylor. It is good therefore to see so many countries, fourteen in all, represented amongst the student body here today who number almost one hundred.

Today’s students are the third class to be admitted. I am pleased to inform you the first two classes did very well in their end of first year examinations which is not only a great credit to the students, but also to their teachers who include both Northumbria and St.George’s University Faculty.

So the previous students, guided by their teachers present here today, have set a very good example to follow; a challenge which I am sure today’s new White Coat Students will meet.

I also wish to congratulate you on the serious but celebratory Professional commitment you will shortly make to your forthcoming medical education and future as doctors to be lead by Mr Simon Crocker the UK Departmental Chairman of Obstetrics and Gynaecology and witnessed by all present.

Everyone here knows that you young men and women about to be donned with your white coats are in an extremely privileged position: I say that for the very simple reason that there are thousands of your contemporaries around the globe whose dream is to become a doctor but because of various adverse circumstances are denied this privilege. They would love to exchange places with you today because they know only too well you are joining the most noble of professions, medicine, totally committed to the curing and easing of pain and suffering in our fellow men, women and children.

However, do remember, with privilege comes obligation and it is your obligation to your newly adopted profession, to your teachers, your parents, guardians, sponsors, fellow students, but most importantly to yourselves to remain loyal to your Professional Commitment and to succeed in your professional mission. This will of necessity require long periods of intense study and hard work, but like all good medical students I have no doubt you will play hard too!

Remember also that in the rapidly expanding technological world  of medicine, patients not only require men and women of science but also doctors who have humanistic and empathetic skills.

In the Christian religion St. Luke is both the patron Saint of Doctors but also of Artists.
This serves as a very apt and constant reminder to us all that art and medicine are inextricably linked and prior to you beginning your clinical studies in two years time you will be taught during the Medicine in Society course in Grenada the crucially important practise of taking a clinical history from a patient when the humanistic bond between doctor and patient is first forged and which thereafter continues throughout a patient’s care.

Patients live their symptoms on a daily basis. A good doctor trained in taking a focused clinical history becomes a decryptor of a patient’s symptoms and if you learn this art together with your scientific knowledge, you will often by the end of taking the clinical history alone, have a good idea of the diagnosis. What you certainly also will have achieved is the firm foundation of the humanistic bond between patient and physician.
 
Always remember too, attached to every medical investigation or clinical procedure there is a concerned patient, together with their relatives and friends. The result of each blood test, ECG, X-ray, each CT, MRI scan, the outcome of each non-invasive and invasive procedure all has a very personal identity and ownership: all belonging to a specific individual and often anxious patient.
Knowledge of the science of Medicine is crucial but dealing compassionately and empathetically with patients and their relatives is truly the art of medicine.

St. George’s University School of Medicine has an established association with the Arnold Gold Humansim awards scheme in the United States and each year on the day before graduation in New York, Humanism awards are granted to a number of students who have been judged by their fellow student peers as being outstanding in exhibiting their humanistic qualities.

So teaching the Art as well as the Science of Medicine is rightfully a great priority for St. George’s.

Indeed for most of you, if not all, it was such a humanistic feeling of wishing to change and improve the lives of the sick and infirm,  thereby also positively affecting their families and friends that motivated you to seek a career in medicine, so never forget this in your basic science years.
During your training there will be periods of stress and perhaps even doubt, but that is when you can call upon your student colleagues, teachers, support staff at Northumbria, then when in Grenada Dr Rao Dean of Students and his staff and also the staff of the Department of Educational Services, and of course your family and friends for help, support and advice. But you must also draw on your own inner strength and when doing so remember the humanistic values and goals you strove to achieve; recite again to yourselves the words of the Professional Commitment you will shortly make and recall the memories of today for I am sure it will serve you well. During your clinical training too, there are many people in the UK and US to advise you along the way, so you really are never alone.

Another obligation you must fulfill is that as trainee doctors you are fully accepting the important professional duty and responsibility to treat all with whom you come into contact, irrespective of race or creed, with due manners, courtesy and respect.

You will of course during your student and indeed subsequent postgraduate careers have many examinations to take. These are obviously serious and nerve wracking occasions but can sometimes have their amusing side too. I never sat a multiple choice question paper in my career; then it was all essays and vivas. I read my basic sciences at Cambridge University and on the appointed day arrived trembling at the Anatomy museum for my Final Anatomy viva. There was a wonderful man called Mr Merryweather who looked after the Anatomy museum and who arranged when we entered the museum for our vivas and which table we had been allocated where our examiners were seated. I must have been looking somewhat pale and anxious as when he helped me on with my short student academic gown which we wore in those days, he leant over my shoulder and whispered in my ear “Don’t worry Mr Croft from Selwyn College: please remember sir just like you and me, every morning your examiners sit on the lavatory!  Good luck sir!”

So you can imagine my thoughts as I approached my two white coated examiners sitting down behind a green baize table.
However my heart sank as one of the examiners was Professor Shute, the organizer of the one year Comparative Anatomy course which we had occasionally attended, but certainly not excessively revised!

Nevertheless, one fact of comparative anatomy I do remember to this day is that the three parts of a crocodile’s jaw are represented by the three tiny bones, in the human middle ear. Now without a shadow of a doubt, I can assure you all that this fact has proved most useful to me on a daily basis during the whole of my surgical career!

However the younger man, Dr Message began by asking me some origins and insertions of muscles on a humerus which was fine. Then we moved on to a skull with the origins and insertions of the medial and lateral pterygoid muscles which I was then asked to repeat with the skull turned upside down: (nice touch I thought!). Finally he zeroed his pencil point at a tiny area on a neuroanatomy slide: I proudly announced it was the nucleus of the ementia teres…and I knew I was right; that was the detail we were expected and had to know in 1965.

He then invited the Professor to take over, who then asked “Are you interested in comparative anatomy?” “Of course sir, absolutely fascinated” I stuttered. “Good, so come over here” he retorted. He took me to a large trestle table covered with skeletal remains ranging from a sabre tooth tiger’s skull to a dormouse and asked me what in retrospect was a reasonably simple question “please show me a non-mammalian skeleton”. I panicked!...mammals, they suckle their young: my thoughts instantly turned to breasts: no you fool that’s soft tissue: he said non-mammalian, that’s without breasts and I have to choose a non-mammalian skeleton from this hoard!

The time for these thoughts to whizz through my head was probably momentary but with my adrenaline levels in the danger zone it seemed like an age and my heart raced and thumped and a rivulet or two of perspiration ran down my back. Then, right at the far side of the table I saw a strange looking skeleton and on one of its rather narrow ribs in extremely faded Cambridge ink I could just about discern the word “Penguin”. I was confident the myopic Professor would not be aware of this. “Oh there sir” “Excellent” he replied, “what is it?”
Very conscious of occupying the remaining viva time to my advantage I said “I’m not immediately sure sir, may I describe it?”

He acquiesced, so I slowly took the Professor through the large protruding beak, but small skull, the large elongated thorax and abdomen, the very short legs but enormous feet, couldn’t possibly have been webbed could they?, but extremely underdeveloped upper limbs, so can’t have been wings.…”So?” the Professor abruptly quizzed. “I’ll hazard a guess” I replied, “it couldn’t possibly be a penguin could it, sir?”  “Excellent Croft”, he exclaimed, “no need to ask you anymore comparative anatomy” and he strode off heading towards an occipital neck dissection. I intentionally lingered slowly behind him as I adjudged my viva time was almost up. It was then that I felt a gentle tap on my right shoulder, I turned: it was the younger Dr Message who then whispered in my ear “I can see the word penguin too!”

Four years from now, you White Coat Students will have the wonderful opportunity of being able to walk across the stage of The Lincoln Centre in New York in front of an enormous audience to receive to great applause, frequently augmented by yells and screams, your medical diplomas from Chancellor Modica, who will then read the Graduation Proclamation when you legally become doctors in an instant!

But take note, the Chancellor does not suddenly flick a switch to magically turn you from a medical student into a doctor in a flash; this is a gradual transitional process which actually begins here today and which continues every day of your medical student training. So never forget you are learning to become and are inexorably becoming a doctor during the whole duration of your medical student life.

The increasing responsibility this brings will be assisted by your advancing maturity brought about by the assimilation of your medical knowledge, but also by your ever increasing experience of academic and enriched cultural life that you will experience at Northumbria University here in Newcastle, at St. George’s University in Grenada and then in the St. George’s Clinical programme both here in the United Kingdom and also in the United States of America.

Travel alone is a great educator: studying a medical curriculum is an amazing educational experience: combine the two and you have the quite awesome opportunity that St. George’s medical training can give you. An experience which thereby prepares you for the medical global world in which we now live and provides you with an experience which you will carry with you for the rest of your lives.

When the mantle of the White Coat is symbolically placed upon your shoulders and when you make your Professional Commitment, you are accepting the profound responsibility essentially required of both a medical student and doctor and you are all today beginning your journey to medical qualification.

I wish you all God’s speed in your venture.

This journey will require great learning, a process which you will need to continue throughout all of your medical careers. One of the fascinationg facts of medicine is that we are on a constantly moving scientific platform with enormous changes in the prevention and treatment of diseases.
In my lifetime I have seen how many infectious disease patterns have drastically changed with improvement in hygiene, housing and education, with the development of antibiotics and vaccination programmes  resulting in the reduction of most and elimination of some infectious diseases.

But then, for example, due to lack of hospital hygiene and abandonment of principles taught to us by Lister in the nineteenth century, together with inappropriate and overuse of antibiotics, seen nature come fighting back with MRSA and clostridium difficile.
The treatment of sexually transmitted diseases was increasingly successful, until a major revolution arrived in the form of HIV.

In surgery, streptomycin drastically changed the necessity for lung surgery for Tuberculosis. Stomach resection operations regularly performed for decades for peptic ulcer are virtually now no longer necessary because of the development of powerful gastric acid reducing drugs.
New treatments for cancer are being developed all the time: now we hear of the ability of ultra violet light to be able to release coated antibodies to kill cancer cells having reached their malignant target, thereby avoiding the side effects of chemotherapy.

One of my old surgical mentors used to say many years ago “Rodney, all the answers lie on the biochemist’s bench” Then, he was right, but now to that I think has to be added the geneticist’s and the stem cell researcher’s bench.

Many people in the developed countries of the world do not now die of old age but the degenerative diseases of old age. It seems stem cell research will in the not too far distant future be able to halt and even prevent the degeneration of tissues, so theoretically we could live forever. What enormous population problems that would cause together with all the ethical problems and end of life issues with which you all will be involved.

The Professional, ethical and financial debates all these changes will generate will be endless and will be a daunting but nevertheless interesting challenge which you will experience during your future medical careers.

This constantly moving scientific platform is not only a challenge for you but also for your teachers: we too have to keep apace!

Furthermore, if you decide to specialize, choose your speciality carefully. Streptomycin changed the necessity for all the pulmonary surgeons many years ago: The many stomach operations I performed in my career for peptic ulcers are no longer necessary, operations I performed for many years gaining access to major intraabdominal arteries via large abdominal incisions can now be accessed by using a fine arterial catheter placed via an artery in the groin. So if I were beginning vascular surgery today I would perhaps be wise to opt for interventional vascular radiology. There are numerous other examples but remember when the time comes to decide on a chosen speciality do try to envisage how it may look in 20 years time.

An interesting gaze into the medical crystal ball.

So it is not just life-style issues, so fashionable with the present generation, which are pivotal in wisely choosing one’s future medical career.

A significant number of you wish to return to your home countries to practice medicine, many of which are developing countries and you may be in awe of the task ahead of you as on qualification you may think what difference can you make to your fellow countrymen, women and children.

I have no hesitation whatsoever in saying you can make an enormous difference not only to the individual patients you treat but in turn to their families and communities so the beneficial effect is far reaching.

In 1967 when I was a final year clinical student at The Middlesex Hospital Medical School in London, I did my three month clinical elective in a Mission Hospital in Zululand, now Kwazulu in South Africa. This was of course at the time of Apartheid. The hospital was the Charles Johnson Memorial Hospital situated in Nqutu, a tiny settlement on the veldt about 30 miles from the nearest town Dundee. The hospital then had over 600 in-patients, had departments of medicine, surgery, obstetrics, gynaecology  paediatrics and a two large TB wards.

The Doctor in charge was an absolutely amazing man called Anthony Barker who with his doctor wife Maggie, went out to Nqutu in 1945 having served as a ship’s doctor in WWII in the British Merchant Navy. When he arrived there the so called “hospital” was a simple wooden dilapidated disused store containing seven frightened and suspicious patients. Dr Barker and his team over a period of years transformed that dilapidated old store into the hospital I have just described. It continues with its wonderful work to this day. When I was there in 1967 we operated most days; we had outreach clinics at trading stations on the veldt, often held in the stables; one clinic indeed on the Battlefield of Isandlwana which preceded the heroic defence of Rorke’s Drift in 1879 as depicted in the famous epic film Zulu. The way Anthony Barker changed the lives of the Zulu people and the people who were fortunate enough to know him was immeasurable. He really was a truly remarkable man.

There are of course many other examples around the world of such leviathan human efforts to improve the health of the needy; so the message is: it has been done, it is being done, more needs to be done and for many of you on the Keith Taylor Global Scholars programme your turn can come and you can be successful in such a mission.

During my very memorable time in Zululand which means “Heaven land”, I naturally assimilated some of the language: I still to this day remember amatispuni amabili gatatu neylanga….two teaspoonfuls three times a day.

On leaving Nqutu, I returned to Johannesburg prior to returning home to England and was met by the wife of a friend of mine who was the Managing Director of Canada Dry in South Africa. I was in my student rig and was met at the station by this beautiful lady, Grace, wearing a lovely summer’s dress and gorgeous hat. She took me over to a stunning cream convertible Mercedes with the roof down thereby showing off its beautiful red leather upholstery. The chauffeur dressed in his very smart grey uniform with cap and shining black knee length boots was a native African (a Zulu in fact) and as we drove through the streets of Johannesburg with the sun shining, Grace asked how I had managed conversing with the Zulu patients. Having been asked this question by a lady, I just automatically came out with a string of Zulu phrases used in the gynaecology clinics on the veldt including “get undressed” “hurry up please”,(this was related to the inordinate time it took the Zulu ladies to undo their heavy leather pleated skirts) and ”lie down, look up at heaven”.  “Lala pansi begape Zulu”.

Now in 1967 at the height of Apartheid, fraternizing with native African females was I recall a capital offence. The chauffeur obviously totally unaware of my medical connection, turned round and glared at me in total amazement and utter horror to which Grace briskly patted him twice on the shoulder and said “It’s perfectly all right Mhambi, Baba’s a doctor, he was treating patients; drive on!”. Serenity was restored!    

All of you White coat students here today have a marvellous opportunity ahead of you with the global medical passport a St.George’s MD affords you. So grasp it, as there are great works to be done and wonderful ambitions to be achieved. Enjoy your student life with your colleagues, teachers, families and friends, especially as it really does go quite quickly!

Again many thanks to St.George’s for their kind invitation to address you on this wonderful and memorable occasion of your White Coat Ceremony here today which I have no doubt will live long in your memories.

Also again, many congratulations to the January 2008 students who are entering the St. George’s Keith Taylor Global scholars programme at Northumbria University.

In conclusion, may your student days and indeed the journey throughout the whole of your future medical careers and lives prove to be for you all, a fulfilling, worthwhile and joyous adventure.  
For if it is so and I am confident it shall be, you will then justifiably be able to say at the end of your medical careers and indeed lives,

“My time on earth was not wasted”.

The very best of luck to you all!
 
Thank you.

Published on 1/31/08