White Coat Ceremony May, 2011

Keynote presented by Elsworth H. Charles, MD
Chairman of the St. Vincent and the Grenadines Medical Board
Chairman of the Medical Accreditation Committee of St. Vincent

Medical Challenges of the 21st Century
This evening, I have chosen to speak on the topic “Medical Challenges of the 21st century”, as I strongly feel that it is important for our future doctors to be aware of the issues that would directly relate to their medical careers.

The true physician is an educator. He recognizes his responsibility, not only to the sick who are under his direct care, but also to the community in which he lives. He stands as a guardian of both physical and moral health. It is his endeavor not only to teach right methods for the treatment of the sick, but to encourage right habits of living and to spread knowledge of right principles.

The challenges to be faced by our future doctors are:

The Elimination of the term “Health Care Industry”
How sad is it to hear caring for the health of people referred to as an “industry”? Until the 1970’s, medicine was thought of as a social service, a profession, a calling, the “healing art”; never an industry concerned with profit. Viewing medicine as an industry definitely detracts from the caring aspect of the profession.

Balancing technological medicine with physical diagnosis
We can attribute much of the progress in healthcare to the advances made in technology. However, we must not depend solely on sophisticated tests to direct diagnosis and management. As medical students and practitioners always remember to first observe, examine and listen.

Correction of the inequities and disparities that generally exist in healthcare
Most medical organizations would agree that this problem needs more focus and active correction. A general surgeon from India, who trained extensively in England, was recently made Honorary Fellow of the American College of Surgeons. What he did, was to take the full spectrum of minimally invasive surgery, such as laproscopic and endoscopic, to several poor villages in India. As young doctors, you should aim at emulating this sort of practice, making technological advances universally available to all, inclusive of those in rural areas of developed countries, the so-called inner city areas and underdeveloped countries.

Demonstration of the traits that patients value in a doctor
In a recent Mayo Clinic survey, patients were asked “What traits do you want in a doctor?” The most significant responses were as follows:

Confident - “The doctors confidence gives me confidence”
Empathic - “The doctor tries to understand what I am feeling and experiencing physically and emotionally, and communicates that understanding to me”
Humane - “The doctor is caring, compassionate and kind”
Personal - "The doctor is interested in me as more than just a patient, interacts with me and remembers me as an individual”
Forthright - “The doctor tells me what I need to know in plain language and in a forthright manner”
Respectful - “The doctor takes my input seriously and works with me” Thorough- “ The doctor is conscientious and persistent”

Students who aspire to be good doctors should also acquire a broad base of knowledge inclusive of principles of healthy living and disease prevention.

The computerization of future practice
Doctors of the future will benefit from information technology by way of increased electronic communication with patients. The E-Pharmacy and E-visit have become a reality. Hawaii became the first state to offer insurance coverage for physician “visits” done online or over the telephone. It is important to remember that patients today are better informed and more knowledgeable than those of the past. Increasingly, patients use the Internet to seek medical information. Pew Research Studies show that each year 50-60% of adults in America use the Internet to search for answers to health problems. Of these, 70% said it influenced their health decisions and 48% claimed it improved their self-care. Acknowledging these facts, the physician will still have to communicate his/her views as gained from his/her professional experience and judgment to dictate care. Other specific issues that will become relevant at a later date in your career are:

• Physician Supply and Demand
• Perceived shortage of Physicians in the US predicted to be 200,000 by 2020
• Preparing surgeons for rural practice
• Perceived shortage of General Surgeons and
• Residency Duty Hour Regulations

However, this list is by no means exhaustive. You might wonder, with all these challenges, where-in lies the satisfaction? Well, it comes from giving that extra effort when the situation demands it. Several years ago, I had four young children in my practice that had severe deformities of the extremities. One child had a congenital deformity of the upper extremity involving hand and wrist. Two of them had congenital deformities of the ankle and foot and another with deformity of the ankle and foot secondary to a burn.

I wrote to the Hospital Administrator in a developed country outlining to him the interesting clinical cases that I had seen in my clinic. I had only visited that country once for less than twenty-four hours and I had never physically seen the hospital. I did not even know the Hospital Administrator personally. However, I asked him to consider these patients as charity cases. I also indicated that his orthopaedic surgical residents would be eternally grateful for this learning experience. Thankfully, the patients all had their surgeries performed and all hospital related services were free.

In closing, my advice to you is as handed down from Maimonides - may there never develop in you the notion that your education is complete, but always have the strength and leisure and zeal to continually enlarge your knowledge. I wish you all a long, successful and enjoyable career.

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