As you go out into the healthcare world…listen to Berwick, Gawande and Topol

"You've boarded a boat, and you don't know where it's going," Dr. Donald Berwick told Harvard Medical School graduates in a speech published in the Journal of the American Medical Association, but, he added, you still made "a spectacularly good" career choice.

Berwick acknowledged the graduates' worries and noted that he's also worried. But he took a break from being inspirational to get in a dig at antagonists he encountered during his tenure as CMS administrator.

"I heard irresponsible, cruel, baseless rhetoric about death panels silence mature, compassionate, scientific inquiry into the care we all need and want in the last stages of our lives," Berwick said. "I heard meaningless, cynical accusations about rationing repeated over and over again by the same people who then unsheathed their knives to cut Medicaid."

After getting that off his chest, Berwick told how his career was affected by a 15-year-old called Isaiah, whom he met in 1984. Berwick confessed that he misdiagnosed Isaiah's discomfort as a back sprain, but later learned Isaiah had leukemia. They kept in touch through the years and, though he was cured of leukemia, Isaiah died about 24 years later from "uncontrolled diabetes and uncontrolled despair," Berwick said.

Other notable docs also gave commencement speeches.

Dr. Atul Gawande, in his address, published in the New Yorker, at Williams College in Williamstown, Mass., told of an 87-year-old Holocaust survivor who still worked part-time and did volunteer activities when she wasn't working.

"Mrs. C." came in to clear a blockage in the carotid artery in her neck, Gawande recalled, and the surgery went "remarkably well," but was followed by a complication that had her stomach winding "on itself like a balloon twisted too tight." A resident detected the problem, ordered an expedited scan, and Mrs. C was in surgery within two hours.

The lesson, Gawande said, is not to be paralyzed when things go wrong, but to be prepared for those times and act.

Dr. Eric Topol, who led the Modern Healthcare/Modern list of the 50 Most Influential Physician Executives in 2012, spoke at the Baylor College of Medicine commencement ceremony in Houston.

Topol talked about three patients, including a 5-year-old boy and 62-year-old man who now lead healthy lives because of modern technology and genetics.

The third patient was himself, and Topol's ordeal included a post-Christmas kidney-stone removal followed by placement of a stent between his left kidney and bladder. The stent caused severe pain, but Topol said his doctor didn't respond to six days of calls to his office and cell phone, or to texts and e-mails.

"Even though we have this exciting time in medicine—radical innovation—we need doctors with compassion, with empathy, bedside manner who are great communicators, who have healing touch," Topol said. "And those qualities will be all the more important in the digital medical era when we need to avoid treating the scan, the DNA, the lab test, and the biosensor data—to treat the patient."

Follow Andis Robeznieks on Twitter: @MHARobeznieks.



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