A Reel Doctor to Real Doctors

Alan Alda's Commencement Speech to Medical School Graduates

Bouncing up from my seat, and walked away happily, I know then that this
pieces of paper, a photo copy of Alan Alda speech which I still kept (I took it
from a book at TAR library, ITM Shah Alam, about 28 years ago) should be
a fine material for the next posting in my blog. Found it! Still intact but
insect wastes here and there distorted some words and sentences. Never
mind! This should be a good alternative to preserve such a fine material,
yeah, in a blog.

Many people must have wondered why Alan Alda was called to address the
210th graduating class of New York Columbia College of Physicians and
Surgeon in May 1979.

For some of us who is from a younger generation must have not known
Alan Alda. Maybe, an older generation like me, Alan Alda is not just any
actor. He is known as Army surgeon Captain Hawkeye in a classic
television series M*A*S*H. He won Emmy awards as an actor, writer and
director.

But the question is still “why get someone who only pretends to be a doctor
when you could get a real one?” Note how skillfully Alan Alda answers this
question.

Ever since it was announced that a non-doctor, in fact an actor, had been
invited to give the commencement address at the most prestigious medical
schools in the country, people have been wondering – why get someone
who only pretends to be a doctor when you could get a real one?

Some people have suggested that this school had done everything it could
to show you how to be doctors and in a moment of desperation had
brought in someone who could show you how to act like one.

It’s certainly true that I’m not a doctor. I have a long list of non-
qualifications. In the first place I’m not a great fan of blood. I don’t mind
people having it. I just don’t enjoy seeing them wear it. I have yet to see a
real operation because the mere smell of a hospital reminds me of a
previous appointment. And my knowledge of anatomy resides in the clear
understanding that the hip bone is connected to the leg bone.
I am not a doctor. But you have asked me, all and all, I think you made a
wonderful choice.

I say that because I probably first came to the attention of this graduating
class through a character on television that I’ve played and helped write for
the past seven years – a surgeon called Hawkeye Pierce. He’s a
remarkable person, this Hawkeye, and if you have chosen to associate his
character with your own graduation from medical school, then I find that
very heartening. Because I think it means that you are reaching out toward
a very human kind of doctoring – and a very kind of doctor.

We didn’t make him up. He really lived as several doctors who struggled to
preserve life 25 years ago during the Korean War. In fact, it’s because he’s
based on real doctors that there is something especially engaging about
him.

He has a sense of humor, and yet he’s serious. He’s impertinent, a yet he
has feeling. He’s human enough to make mistakes, and yet he hates death
enough to push himself past his own limit s to save lives. In many ways
he’s the doctor patients want to have and doctors want to be.

But he’s not an idealization. Finding himself in a war, he’s sometimes angry,
sometimes cynical, sometimes a little nuts. He’s not a magician who can
come up with an instant cure for a rare disease without sweating and
ruining his make-up. He knows he might fail. Not a god, he walks gingerly
on the edge of disaster – alive to his own mortality.

If this image of that very human, very caring doctor is attractive to you – if
it’s ever touched you for a moment as something to reach for in your own
life – then I’m here to cheer you on. Do it. Go for it. Be skilled, be learned,
be aware of the dignity of your calling – but please, don’t ever lose sight of
your own simple humanity.

Unfortunately, that may not be so easy. You’re a special place in our

society. People will be awed by your expertise. You’ll be placed in a
position of privilege. You’ll live well. People will defer to you, call you by
your title – and it may be hard to remember that the word “doctor” is not
actually your first name.
I know what this is like to some extent because some ways you and I are
alike. We both study the human being. And we both try to offer relief – you
through medicine, I through laughter; we both try to reduce suffering. We’ve
both learned difficult disciplines that have taken years to master, and we’ve
both dedicated ourselves to years of hard work. And we both charge a lot.

We live in a society that has decided to reward my profession and yours,

when we succeed in them, very highly. It can sometimes be easy to forget
that the cab driver also works 14 to 15 hours a day and also drained of
energy when he’s through. It’s easy to think that because our society grants
us privilege we’re entitled to it.

Privilege feels good, but it can be intoxicating. As good doctors, I hope

you’ll be able to keep yourselves free of toxins.

It’s no wonder, though, that people will hold you in awe. I know I do.

You’ve spent years in a grueling effort to know the structure and process of
human life. I can’t imagine a more difficult task. It has required the
understanding of complexities within complexities, and there has been
more pressure placed on you in four years than most people would be
willing to take in a lifetime. I stand here in utter amazement at what you’ve
accomplished. And I congratulate you.

I only ask one thing of you: Possess your skills, but don’t be possessed by
them.

Certainly your training has encouraged you to see the human side of your
work, and you’ve examined the doctor-patient relationship. But still, the
enormity of your task has required you to focus to such an extent on
technique and data that you may not have had time enough to face your
feelings along the way.

You’ve had to toughen yourself to death. From your first autopsy, when you
may have been sick, or cried, or just been numb, you’ve had inure yourself
to death in order to be useful to the living. But I hope in the process you
haven’t done to good a job of burying that part of you that hurts and is
afraid.

I know what it’s like to be absorbed in technique. When I write for M*A*S*H
I’m always writing about people in crisis with what I hope to compassion
and feeling. And yet one day I found myself talking to someone who was in
a real crisis and real pain – and I remember thinking, “This would make a
great story.”

Both of these things – becoming set apart and becoming your skill – can
make it tough to be a compassionate person.

All right, that’s my diagnosis of the problem. Here’s my prescription.

I’d like to suggest to you, just in case you haven’t done it lately, that this
would be a very good time to give some thought to exactly what your
values are, and then to figure out how you’re going to live by them.
Knowing what you care about and then devoting yourself to it is just about
the only way you can pick your way through the minefield of existence and
come out in one piece.

It can be a startling experience when you try to rank your values, though.
Just ask yourself what’s the most important thing in the world to you. Your
work? Your family? Your money? Your country? Getting to heaven? Sex?
Dope? Alcohol? What? (I don’t need a show of hands on this!)

Then, when you get the answer to that, ask yourself how much time you
actually spend on your number-one value – and how much time you spend
on what you thought was number five, or number ten. What in fact is the
thing you value most?

It may not be easy to decide. We live in a time that seems to be split about
its values. In fact it seems to be schizophrenic.

For instance, if you pick up a magazine like Psychology Today, you’re liable
to see an article like “White Collar Crime: It’s More Widespread Than You
Think.” Then in the back of the magazine they’ll print an advertisement that
says, “We’ll write your doctoral thesis for 25 bucks.” You see how values
are eroding? I mean a doctoral thesis ought to go for at least a C-note.

The question is, where are their values? What do they value?
Unfortunately, the people we look for leadership seem to be providing it by
negative example.
All across the country this month commencement speakers are saying to
graduating classes, “We look to you for tomorrow’s leaders.” That’s
because today’s leaders are all in jail.

Maybe we can afford to let politicians operate in amoral vacuum, but we

can’t afford to let doctors operate under those conditions.

You know how we’re feeling these days, as the power and fuel monopoly
has its way with us. Well, you people graduating today are entering a very
select group. You have a monopoly on medical care. Please be careful not
to abuse this power that you have over the rest of us.

You need to know what you care about most and what you care about
least. And you need to know now. You will be making life-and-death
decisions, and you will often be making them under stress and with great
speed. The time to make your tender choices is not in the heat of the
moment.

When you’re making your list, let me urge you to put people first. And I
include in that not just people, but that which exists between people.

I suggest to you that what makes people know they’re alive – and in some
cases keeps them alive – is not merely the interaction of the parts of their
bodies, but the interaction of their selves with other selves. Not just people,
but what goes on between people.

Let me challenge you. With all your study, you can name all the bones in
my body. You can read my x-rays like a telegram. But can you read my
involuntary muscles? Can you see the fear and uncertainty in my face?

If I tell you where it hurts, can you hear in my voice where I ache? I show
you my body, but I bring you my person. Can you see me through your
reading glasses?

Will you tell me what you’re doing, and in words I can understand? Will you
tell me when you don’t know what to do? Can you face your own fear, your
own uncertainty? When in doubt, can you call in help?

These are things to consider even if you don’t deal directly with patients. If
you’re in research, administration, if you write – no matter what you do –
eventually there’s always going to be a patient at the other end of your
decisions.

Now, of course, everyone is for this in principle. Who’s against people? But
it gets harder when you get specific.

Will you be the kind of doctor who cares more about the case than the
person? (“Nurse, call the gastric ulcer and have him come in at three.”
How’s the fractured femur in Room 208?) You’ll know you’re in trouble if
you find yourself wishing they would mail you their liver in a plain brown
envelope.

Where does money come on your list? Will it be the sole standard against
which you reckon your success? How much will it guide you in relating to
your patients? Do patients in a clinic need less of your attention than
private patients? Are they, for instance, less in need of having things
explained to them?

Where will your family come on your list? How many days and nights,
weeks and months, will separate yourself from them, buried in your work,
before you realize that you’ve removed yourself from an important part of
your life?

And if you’re a male doctor, how will you relate to women? Women as
patients, as nurses, as fellow doctors – and later as students. Will you be
able to respect your patient’s right to know and make decisions about her
own body? Will you see nurses as colleagues – or as handmaidens? And if
the day comes when you’re teaching, what can young women medical
students expect from you?

Questionnaires filled out by women at 41 medical schools around the

country have revealed a distressing pattern. The women were often either
ignored in class or simply not taken seriously as students. They were told
that they were only there to find a husband and that they were taking the
places of men who would then have to go out and become chiropractors.
(Logic is not the strong point of sexism.)

They were often told that women just didn’t belong in medicine. And at
times they were told this by the very professors who were grading them.
They would be shown slides of Playboy nudes during anatomy lectures – to
the accompaniment of catcalls and wisecracks from male students. And in
place of discussions about their work, they would often hear a discussion of
their appearance. These are reports from 41 different medical schools.

I’m dwelling on this because it seems to me that the male-female

relationship is still the most personal and intense test of humane behavior.
It is a crucible for decency.

I hope you men will work to grant the same dignity to your female
colleagues that you yourselves enjoy.

And if you’re a female doctor, I hope you’ll be aware that you didn’t get
where you are all by yourself. You’ve had to work hard of course. But you’re
sitting where you are right now in part because way back in 1848, in
Seneca Falls, women you never knew began insisting you had a right to sit
there. Just as they helped a generation they would never see, I urge you to
work for the day when your daughters and their daughters will be called not
“A woman doctor,” or “My doctor, who’s a woman, “My doctor.”

It may seem strange to rank the things you care about. But when you think
about it, there isn’t an area of your work that won’t be affected by what you
decide doesn’t count.

Decide now.

Well, that’s my prescription. I’ve given you kind of a big pill to swallow, but I
think it’ll make you feel better. And if not – well, look, I’m only human.

I congratulate you, and please let me thank you for taking on the enormous
responsibility that you have – and for having the strength to have made it to
this day. I don’t know how you’ve managed to learn it all.

But there is one more thing you can learn about the body that only a non
doctor would tell you – and I hope you’ll always remember this: The head
bone is connected to the heart bone – and don’t let it come apart.