Sunday, June 3, 2018

A Commencement Address by Dr. Atul Gawande

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Environmental & Science Education
Edward Hessler

Atul Gawande is a general and endocrine surgeon at Brigham and Women's Hospital. He probably needs no introduction but if he is new to you, Gawande writes relatively frequently about the practice of medicine generally for the New Yorker and is the author of best-selling book on the end-of-life, Being Mortal: Illness, Medicine and What Matters in the End.

Gawande delivered the commencement address at the U.C.L.A. Medical School, June 1, 2018. It is a thoughtful reflection on what he learned while he "sewed and listened," to a patient he didn't much like or understand. He worries about the relatively recent attack on curiosity--scientific, journalistic, artistic, cultural--which he says is the beginning of empathy.

Below is a sample of Gawande's remarks which follow directly from a story he told about an experience he had on his surgery rotation when he was in medical school.

Graduates, wherever you go from here, and whatever you do, you will be tested. And the test will be about your ability to hold onto your principles. The foundational principle of medicine, going back centuries, is that all lives are of equal worth.

This is a radical idea, one ultimately inscribed in our nation’s founding documents: we are all created equal and should be respected as such. I do not think it a mere coincidence that among the fifty-six founding fathers who signed the declaration of our independence was a physician, Dr. Benjamin Rush. He was a committed revolutionary and abolitionist precisely because of his belief in the principle. 

We in medicine do not always live up to that principle. History has been about the struggle to close the gap between the aspiration and the reality. But when that gap is exposed—when it turns out that some people get worse or no treatment because of their lack of money, lack of connections, background, darker skin pigment, or additional X chromosome—we are at least ashamed about it. We believe a C.E.O. and a cabbie with the same heart disease deserve the same chance at survival.

Hospitals are one of the very few places left where you encounter the whole span of society. Walking the halls, you begin to understand that the average American is someone who has a high-school education and thirty thousand dollars a year in per-capita earnings, out of which thirty per cent goes to taxes and another thirty per cent to housing and health-care costs. (These Americans are also told, by the way, that people like them, the majority of the population, have no future in a knowledge economy, because, hey, what can anyone do about it, anyway?) Working in health care, you also know, more than most, that we incarcerate more people than any other economically developed country; that thirty per cent of adults carry a criminal arrest record; that seven million people are currently incarcerated, on parole, or on probation; and that a massive and troubling proportion of all of them are mentally ill or black.

Here is the talk and here is additional information about Gawande.

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