Dr Ratan is a Consultant Physician who graduated from the University College of the West Indies in 1955; He is a Fellow of the Royal College of Physicians of Edinburgh-1976. He also worked in the Ministry of Health from 1957 to 1988. At present Dr. Rattan is a part time lecturer in Medicine at University of the West Indies.

Chairman, distinguished guests, ladies and gentlemen, graduates in Medicine and Dentistry. I feel honoured to be asked to give the feature address to graduates of my own University, and I do so with pleasure, especially as I have participated in the training of some of those who have taken the Oath today.

I congratulate all of you who have graduated and all those who have won prizes.

I entered University College of the West Indies in September 1949. You can imagine the joy, the exhilaration of being in your twenties at a new university. This combination produced a fizz and excitement which remained with me throughout my student days. I trust that you too have enjoyed being a student and that you have had your share of fizz and excitement.

‘Now that your desire to become a doctor as soon as possible has been fulfilled, your desire should now be, to be as perfectly qualified as possible to do the work of a doctor.’ Let me remind you that the work of a doctor carries with it the burden of responsibility.

All of you, I am sure, entered medicine as bright, idealistic people with highly positive attitudes. I trust that your exposure to role models and to professionalism would have contributed to helping you remain that way.

You in your turn, as you go along and become senior, have a responsibility of shaping the doctors of tomorrow, and must therefore seek to influence your juniors - doctors and medical students - in a positive way, by yourselves being role models. Every doctor is given the opportunity of being a teacher whether it is of his juniors, medical students, or nurses, and so it is worth remembering that “our teachings reflect our attitudes, prejudices, honesty and humility. It is our example that will be remembered long after the differential diagnoses are forgotten”.

Some of you from early in your training would have decided what you eventually want to do. But those of you who have not yet decided don’t have to be disturbed.

Somewhere along the way “by accident, or swayed by motives of idealism, religion, ambition, materialism” you will choose your career. No doubt too, an important factor influencing you will be the dynamism and inspirational leadership of members of the profession. If your teachers have not inspired and motivated you then an important part of your medical education can be considered missing.

For the women graduates the choice of career can be even more difficult than for men, as they sometimes have to choose between having a successful career and a family life in which they find personal happiness and satisfaction.

Whatever career you choose and in whatever way you practice you will contribute to the debate between those who like Bernard Shaw see the profession as a conspiracy against society and those who like Robert Louis Stevenson see doctors as the flowers of all mankind. Your aim should be to conduct yourselves in such a way to earn the high esteem and trust of the public.

In some ways medicine may be fundamentally different from other professions but we all know that doctors have the same failings as the rest of humanity. It was Bernard Shaw’s view that “as to the honour and conscience of doctors, they have as much as any other class of men, no more and no less”.

There are issues that will cause you unease from time to time - financial insecurity, the encroachment on leisure time and family time, poor working conditions, inadequate remuneration, poor accommodation, long inhumane hours, fear of litigation, overall disappointment in the ethical aspects of the practice of medicine, fear of the responsibilities in matters of life and death. You may well at some time be asking yourself “Was medicine the right thing for me?”

But take heart. Lord Lister in his address to graduates in 1876 said “If we have nothing but pecuniary rewards and wordly honours to look to, our profession would not be one to be desired. But in its practice you will find it attended with peculiar privileges second to none in intense interest and pure pleasures.”

Someone else has put it another way “My time out has convinced me that for all its pressures, all its intrusions into one’s family, all its demands on time and peace of mind there must be little to equal the privilege of receiving the trust and confidence of fellow humans.”

In my nearly 50 years of practising I can tell you that medicine is fascinating, challenging and satisfying. Each patient is different; each encounter with a patient, even the same patient is different. Each encounter has so much humanity. Each day is a new learning experience and there is no room for being bored. There is a variety of emotions that confront you and you learn how to deal with them. But you are human, and you too will experience emotions which you will learn to control. There is laughter and there are tears. If you eschew pomposity and arrogance the encounter can be mutually beneficial.

Lord Horder in one of his addresses said the privilege of being exhortative is one of the few compensations allowed to those of us who have arrived at that stage in their professional lives when they are invited to give addresses like these, and so I give you a few of my exhortations.

You must go on learning all your lives. A healthy sense of ignorance is a saving grace.

No one can in 5 or 50 years learn all that one could wish about disease and its prevention and treatment. You have to keep on learning but you also have to learn to discard. Much of the knowledge acquired by doctors is deemed redundant a few years after they qualify. In learning medicine the task is never completed. You travel but never arrive. “Arrival is boring as is perfection. It is the journey that counts. I hope your road is a long one, full of adventure, full of discovery.”

Continuous learning is a necessity to ensure that your competence does not fall away. “The standard of Doctoring is the thing that matters and no one can maintain that except the doctor himself.” In this connection this is what Sir Douglas Black had to say: The most unethical thing a practicing doctor can do is to let his competence fall away; in other aspects of his practice he will sooner or later be pulled up by the law or by the judgment of his peers, but his ability to practice competently is primarily a burden on his conscience”.

However learned and competent you may think you are, you must be humble. Don’t be afraid to say to yourself and to others “I don’t know”, and by the same token don’t be reluctant to seek help in furthering the patient’s interest.

A doctor makes a hundred decisions a day; some are wrong some are right. You alternate forever between the ecstasy of a correct diagnosis and the crushing humiliation of a diagnostic blunder. But as Osler said: “Errors in judgment must occur in the practice of an art which consists largely in balancing probabilities” and because doctors deal with life and death and cannot avoid errors of judgment, they have to learn to live with their consciences. Humility will make that lesson easier to learn.

“A willingness to change or question an established diagnosis made by yourself or others is an invaluable attitude for a doctor to possess. Nobody can be expected to recognize every diagnosis every time, but it is vital to be able to recognize when we might be mistaken or in doubt”. Don’t play God. If you do you run the risk of being crucified!

In this age of science and technology and rapid access to limitless information I exhort you to pay attention to the art of medicine.

Be sensitive to the needs of your patients. Culture and sensitivity should not be confined to the laboratory. Industry can never be a substitute for sensitivity.

The motto of the Royal College of General practitioners is “Cum scientia caritas.” It promotes the value of a scientific approach but it also proclaims the importance of compassion and thus the art of medicine. When you are sick you want the science to get you better but you want some one to hold your hand “Be alert to your patients’ emotional needs and demonstrate an empathic attitude toward him, if the contact is to be therapeutic. Empathy is not compassion, not sympathy, and certainly not pity. It has been defined as an insightful, subjective, non critical awareness of the feelings and emotions going on inside another person.”

In Cancer Ward Alexander Solzhenitsyn writes “How many adult human beings are there now, at this minute, rushing about in mute panic wishing they could find a doctor, the kind of person to whom they can pour out the fears they have deeply concealed.”

The drama of the operating theatre and the intensive care unit, the miracle of cardiac resuscitation, the control of status epilepticus, the restoration of normal breathing to an asthmatic and all the other life saving manoeuvres are what stand out in your memory, but “It is not only the doctors who perform hazardous operations or give life saving drugs who hold the scales at times between life and death. To sit quietly in a consulting room and talk to someone would not appear to the general public as a heroic or dramatic thing to do. There are many ways of saving lives. This is one of them.”

“If a physician possesses gentleness of manners and a compassionate heart and what Shakespeare called the milk of human kindness, the patient feels his approach like that of a guardian angel administering to his relief, while every visit of a physician who is unfeeling and rough in his manners, makes his heart sink as at the presence of one who comes to pronounce his doom.”

Talk to your patients. Anxiety and fear are the inevitable consequences of poor communication between doctors and patients. Communicate with them about their disease, their fears, their wishes, their expectations and their hopes. Answer any questions they might have. But it will warm their hearts if you show an interest in what is going on in their lives.

There is a recurrent public disenchantment with doctors’ interpersonal skills, particularly in giving information and explanation, and so we must not be surprised at the rising popularity of alternative medicine, whose practitioners spend time with their patients. Doctors will have to learn especially in these days of rising litigation that a satisfied patient is as important as a medically improved one.

In closing let me leave you with two quotations.

The first is from Sir Robert Hutchinson:
From inability to leave well alone
From too much zeal for what is new
And contempt for what is old;
From putting knowledge before wisdom
Science before art, cleverness before commonsense;
From treating patients as cases; and
From making the cure of disease more grievous than its endurance
Good Lord deliver us.

The other is from Osler, the quintessential physician:
“You are in this profession as a calling which exacts from you at every turn self sacrifice, devotion, love and tenderness to your fellow men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breath of charity that raises you far above the petty jealousies of life.”