Sir Kenneth Stuart, August 2007

Chancellor Dr. Modica, Vice Chancellor Professor Fidler, Lord Walton, Dr. Rodney Croft, Dr. Rao, Dr. Chaudry, Dr. Baruha, Dr. Cheryl Macpherson, invited guests and colleagues and, in particular, the undergraduates, because it is primarily you whom I address today, my first words must be of congratulations on the profession you have chosen and of welcome to this, the first staging-post on your way towards it.

I am deeply flattered to have been able to join the long and distinguished list of St. George’s white coat speakers. Some of you might recall George Bernard Shaw’s words: “What really flatters a man is that you think him worth flattering.” I am more than flattered by the invitation to deliver this address. I am deeply honoured.

This is both a personal and a pubic occasion. It is personal for you, the undergraduates, your families and your friends. You are embarking on the study of a profession that will inform your lives for years to come. It is also a public mark of a partnership between the St. George’s University School of Medicine and the University of Northumbria, which, I predict, will make it the largest and most important international centre for medical education for years to come. I congratulate its architects for their wisdom and foresight. There is an old African adage which says: “If you wish to go quickly, go alone; but if you wish to go far, go together.” I am confident that the journey of this partnership will be long and fruitful.

International university collaboration

This partnership is characteristic of developments, already underway, that are hallmarks of the new world that globalization is calling into being. Universities working together towards shared interests and goals will have potentially powerful unifying effects for otherwise separate groups and for scattered communities. They have special capabilities and provide special opportunities. They can chart a path through different cultures and assist people of diverse backgrounds to work together towards a sense of a shared humanity. They can provide a much needed international educational outreach.

Achieving this is essential if we are to, in the words of Nelson Mandela, “make the world safe for diversity.” Never before have so many peoples and countries had so much in common; and yet never before have the issues that divide them been more numerous and threatening. I look to the time when there will be global networks of universities which will facilitate collaborative and educational exchanges worldwide. There has been too much of a tendency for doctors and other health professionals to train and work in geographical, social and cultural isolation. We are now at a crossroads of international change – development, history, education and human spirit. Vigorous initiatives towards exchanges between medical undergraduates and young graduates are now being catalyzed. Such exchanges are essential underpinnings for what is now being termed the ‘global village.’

It has been my privilege not only to witness but to participate in the unfolding excitement of the academic growth and international expansion of the St. George’s University School of Medicine for nearly 30 years. There are several reasons why I am confident that you, the new undergraduates, will find your own educational journey through the joint curriculum provided by the partnership between these two illustrious institutions exciting.

There aren’t many universities that would be able to offer part of their undergraduate training against a background of flowering frangipani, flaming poinsettias and the azure blue water of the Caribbean, a choice of undergraduate colleagues from more than 80 countries, a range of US and UK teaching hospitals for clinical studies, a selection of teachers and instructors from among the most highly qualified in the world and the best equipped undergraduate teaching laboratories to be found anywhere.
Undergraduate educational challenges

The period of training you are now embarking on will bring challenges and rewards for you yourselves as undergraduates and, yes, for your teachers as well. Teachers of medical undergraduates also have challenges. My own most cherished and happiest memories, my greatest sense of challenge and achievement as a medical teacher dated back to November, 1954. The first class of young doctors from the University of the West Indies was about to graduate. Their graduation was, for all of us, their teachers and course instructors, a defining moment. For students and staff alike a wonderful experiment had now been accomplished. These young men and women will always hold a special place in my memories and affections. They had arrived five years before from Jamaica and several of the other West Indian islands as new undergraduates, like you today, at the recently established University of the West Indies. We, their teachers, had strived to train them to the highest standards and to inculcate them with the highest values of our profession. They, the newest of our colleagues, were now, as you yourselves will be in a few short years, about to embark on their own careers. In a life that later experienced many other professional rewards I still think of the graduation of that first medical class of the university of the West Indies as one of the highest points of my own professional career.

Let me early in my talk associate myself with the words of welcome and advice in Chancellor Modica’s message to you today: “As you begin your studies for this challenging career, you must weigh opportunity against responsibility. St. George’s University will equip you with all the right tools for the job, but how much you take away will depend on how you approach the experience and how much effort you invest in it. I wish you every success”.

For success you will need special competences and skills. Their achievement can be summed up in one word: “work”. Professor William James, Harvard psychologist, had this message for young undergraduates: “Let none of you have any anxiety about the upshot of his education, whatever line it may be. If he keeps busy each hour of the working day he may safely leave the final result to itself. He can, with perfect certainty, count on waking up some fine morning to find himself one of the competent of his generation, in whatever pursuit he may have singled out.” Students too often settle for a concept of education that is little more than instrumental, that contents itself with course work, with passing examinations. But, although this may be a by-product, it can’t be a goal. The goal must be something larger, more fulfilling, more substantial; something that will not only provide a context for what you do know, but will tell you how to use it; something that will chart a course for what you might become rather than merely validate what you have learned; something that will enable you not only to adapt to tomorrow’s changes, but to play leadership roles in effecting them.

Indeed a measure of the success of your education will be the capacity it will give you not only to adapt to change but to manage and direct it, to be aware of the gap between what can be done and what is being done, to be willing to challenge assumptions about the current reality, to shake things up, to persevere and to give leadership.

It is you, the younger people, who provide the vital links between a community’s aspirations and its achievements. It is you who will have a significant influence on future medical orientations as you practice your professions. It will be up to you to have the courage and self assurance to resist distractions from medicine’s highest ideals, the confidence to do things differently, the optimism that what you do can make a difference. It is at the undergraduate stage of your careers that first steps in this direction, the preparation for these roles, must be taken.
Medical professionalism

Let me take this opportunity to remind you of some of the obligations, responsibilities and commitments the practice of medicine will entail. In his message to you today Dean Weitzman urges you to “recognize that in entering the field of medicine, you join a community, wherein the team is as pivotal to success as individual effort. To this end, you must strive for excellence in your pursuit of knowledge, for you can only give your best when you fulfill your potential. As you don these white physician coats, you pledge an oath of professionalism and service. Professionalism is a commitment to integrity, altruism, competence and ethics in the service of others.”

A description of medical professionalism from London’s Royal College of Physicians sets out these values, behaviours and relationships at greater length: “Medicine is a vocation in which a doctor’s knowledge, clinical skills and judgment are put in the service of protecting and restoring human well-being. This purpose is realized through a partnership between patient and doctor, one based on mutual respect, individual responsibility and appropriate accountability. These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of health care on which our collective human dignity depends.”

I must hasten to add, however, that the practice of medicine is more than the performance of a set of ritual medical duties, the meeting of formal codified historical obligations. For most of you, I predict, it will also prove, as it has for me, a privilege to be able to be of such personal and continuing service to others; a pleasure to have an opportunity on a daily base to share a common humanity with so many people; to give encouragement, to share confidences, to be of assistance when needed. Dr. Chaudry notes that “while the field of medicine is challenging, the rewards and personal satisfaction are immeasurable.”

Medicine: its global reach

I must refer briefly to medicine’s global reach. In his 1983 commencement address to the graduating class of St. George’s University School of Medicine, the late Lord Pitt stressed that “Medicine is international. The fight against disease and, more important, the securing of good health, cannot be confined within national boundaries.”

In sharing certain basic interests, values, educational standards and goals, medicine functions in a field that has no inherent barriers. It is an international guild or brotherhood, where members can take up their calling in any part of the world and find colleagues whose traditions, methods and objectives are identical with theirs.

This privileged position for doctors as world citizens carries with it globally accepted understandings and accords that extend beyond national to international health concerns. The doctor’s role in the protection and promotion of health, his acceptance of standards of competence, professional ethics and responsibilities have a worldwide extension; remain the bed-rock of medical practice everywhere.
Some unresolved medical issues

You might also wish me to share with you some of my own perceptions about a number of anomalies and contradictions that litter today’s medical landscape and cloud the horizons against which you will work during your professional lives. Practices related to medical drug usage and disease prevention are examples.

The tactics of the international pharmaceutical industry has led to a global hypochondria about how disease should be approached – ‘a pill for every ill’. It must bear much of the responsibility for the intellectual astigmatism with which so many doctors and so much of the public currently views issues of health and disease; in Britain today half of the adult population and a third of children take some form of medication every day. Two centuries ago Philippe Pinel, French psychiatrist and physician, said: “It is an art of no little importance to administer medicines properly: but, it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them.”

Disease prevention is also an aspect of health on which there is not likely to be much disagreement. For most medical disorders prevention is clearly cheaper, more humane and more effective than intervention or treatment after they occur. This observation is hardly new; but it gives us the opportunity to look back critically at the past and forward to opportunities for the future.

The diseases that kill most people worldwide – the so-called non-communicable diseases, diseases caused not by infection but by how people live their lives – could be avoided by preventive action, by modifications of lifestyle, by activities that would make individuals more effective custodians of their own health than they have been in the past; that would make them more self-reliant, less dependent on doctors and other specially trained health professionals. Progress will continue to be made by improvements in the treatment of diseases and by the provision of more and better facilities for health care; but the opportunities for improving health by the prevention of disease are even greater.

I invite your reflection, even at this undergraduate stage of your medical careers, on why prevention has failed so far to engage more fully the attention of the medical profession, on why prevention has not become a more important element in the health expectations of the public; on the distinction between medicine as a social institution and medicine in its more limited role of caring for the sick; on how in its larger role medicine could come to grips with the wider issues that influence health; on the meaning of health and how this meaning might be made more central to the concerns of both medical education and medical practice.

Sir Ian Kennedy’s comment is relevant; “If we were to start all over again to design a model for modern medicine, most of us, I am sure, would opt for a design which concerned itself far more with the pursuit and preservation of health, of well being. What we have instead is the very opposite, a system of medicine which reacts, which responds, which waits to pick up the broken pieces – a form of medicine, in short, concerned with illness, not health. A moment’s thought demonstrates the folly of this.”
Concluding comments

Let me conclude, as I started, with advice especially for you, the undergraduates. I will quote for you a comment from Sir William Osler’s “Aequanimitas” – ‘Peace of mind’, which, I will add, each doctor should strive for. Sir William was the best-known physician in the English-speaking world at the turn of the 20th century. He has been called the “most influential physician in history.” I recommend the reading of Osler to undergraduates and graduates alike. He emphasized the need for a renewal of emphasis on human values. “Medicine”, he pointed out, “is the only one of the great professions engaging, equally, head and heart and hand. To an inquisitive mind the study of medicine may become an absorbing passion full of fascinating problems, so many of which present a deep human interest.

”More than two thousand years earlier the Roman orator, Cicero, in his treatise, “De Senectute”, (On Old Age) gave advice to older people: “Remain interested and never stop learning.” This advice is as relevant for you and your generation as it has been for me and mine.

I should like to link for you Osler’s comments to Cicero’s advice. Together they mean that a good beginning for each of you might be, as a personal responsibility, to ensure, firstly, continuity of the medical education you will receive in the coming years and, secondly, that your continuing medical education, whatever form it takes, should have human values as a central objective. Senior citizens like me can provide valuable experiences from the past and useful guidelines for the future. Much of the responsibility, however, of meeting tomorrow’s challenges will rest on your shoulders; and many of these challenges will have not only scientific but highly significant human dimensions as well. This is why the human perspectives of the period of training you are now about to embark on will be as important as the scientific – and not only for the success of your future practice as doctors but also for the quality of the benefits you will both bring to, and derive from, the communities and specialties in which you elect to work.