To Our 2017 Graduates: You Have the Power To Shape the Future of Medicine

You have the power in your hands to shape the future of medicine, to reduce human error and improve diagnostic accuracy, to completely transform medicine from the practice that we currently know. Hopefully for the better, perhaps some of the human empathetic touch will be lost. I will be watching with interest to see how you will leverage this technologic explosion while not losing the ‘art’ of medicine – not dehumanizing the patient.

Keynote Address, May 25, 2017 Postgraduate Graduation Ceremony
Dr. Heather Ross, Department of Medicine Teacher of the Year, 2017

Wow what a day! I am completely intimidated up here!

Almost exactly two weeks ago I was finishing the last grueling 8 km of a 900km bike ride in Tibet, from Lhasa, up eight passes, five over 5000m, to the north side of Everest basecamp. I was riding together with a heart transplant and kidney transplant recipient as part of the TESTYOURLIMITS Program. We have been all over the world, skied to the North and South Poles, and climbed multiple mountains, almost dying on Vinson in 2006, to raise awareness and funds for heart failure research – truly an awesome life experience.

I know you probably won’t believe me but on the bike, waiting to get around that last corner and see Everest in all her beauty, I was actually thinking about what I would say today – perhaps because of the location, the inspiration, or maybe it was just the hypoxia…

What hit me the most was how did I get here from there, from where you are, where I was 21 years ago?

There were quite a number of starts/stops and hiccups along the way. I have no doubt you will experience obstacles at some point, some similar, and others will be more a reflection of the times. Perhaps small things like when my postdoctoral fellowship funding was withdrawn midway through my fellowship, to larger ones like no clear job in sight – I mean in 1994, who does heart transplant as a specialty?  

What I've come to realize through these experiences is that very rarely is there a straight line from there to here. It doesn’t follow the simple math equation of ‘if this, then that.’  In fact, when I started out I was totally going to be a PhD basic science researcher working on the west coast, hopefully Vancouver – and when I finished medical residency that was the actual plan. In fact, my postdoctoral fellowship at Stanford was 80% basic science, small animal echo based research. When I came to Toronto 21 years ago it was only going to be for three years. I mean, how can you possibly stay in the same town as the Maple Leafs? (Sorry I am a Montrealer).

So how did I get here from there?

I know they say it is better to be lucky than smart, but I think the ideal is a mix of serendipity, incredible mentorship, guidance and support (which I was lucky enough to receive in spades), and hopefully enough IQ to get through. This is the formula that worked for me.

Today, I look out with envy. There is so much ahead of you – so much promise and, no doubt, some very real challenges. For example, I can’t imagine what it is like to start your career in a world that has a doomsday clock that currently reads two and half minutes to midnight. These are challenges that are different than in my time. Medicine is evolving, the delivery, receipt, and acquiring of – in fact, all elements of medicine are changing.

At EBC I was emailed by a patient who wanted me to discuss his prognosis, now! He was completely comfortable with this notion and fully expected me to explain it immediately by email, while I wasn’t comfortable at all. First, I was at EBC! I wanted to meditate, say my mantra, contemplate the meaning of life; I mean I was on holidays in front of the queen of all mountains.

Second, how would I deliver this information, soften the blow of reality using email? How many of you have exchanged emails that were misconstrued or misinterpreted often resulting in unexpected and perhaps deleterious effects. The words are there but the intonations and inflections are missing. Normally for this type of discussion I would book extra time in clinic to sit and explain, choosing words so carefully, maintaining eye contact, reaching out as needed, how would I do that by email? A big worry with email is the potential for advice to be taken out of context, there is no real-time back and forth, no chance to observe how the patient incorporates the information given. No opportunity to read their nonverbal cues, posture, emotional distress, or hear the timbre of their voice: the types of cues we use to tailor our discussion with patients.

This is just one example. Moore’s law shows that technology is continuing to advance at a pace that we can’t possibly predict or imagine. How will you harness technology/change without losing relevance? I think this will be one of your greatest challenges and opportunities. Just look at what IBM Watson can do. Artificial Intelligence and Big Data will revolutionize your ability to streamline care, prioritize, reduce errors and provide real-time up-to-date prognosis and treatment plans. But the use of technology often inserts a layer between you and the patient. How will you use technology to benefit patients without losing the empathy that anchors the compassion contained within the physician-patient interaction? How will you use IBM Watson for example, to provide prognosis and treatment plans whilst still ‘caring’ for patients.  Will you be able to remain relevant as a caregiver in this new era, in the traditional physician-patient engagement equation, or will you change the dynamic?

We now have ample evidence that the USA can be led, in fact, governed by Twitter alone (just saying). Given the ubiquitous nature of social media, text, Snapchat, Instagram, etc. you will by definition be more available and accessible to patients than ever before. And yes, I know I was answering emails from EBC so I am totally the pot calling the kettle black. But how will you establish limitations in accessibility in order to maintain a work-life balance? By the way, this is a do as I say, not as I do moment.

Having said all this though, it is these unique challenges and opportunities that make me envious of where you are now. You have the power in your hands to shape the future of medicine, to reduce human error and improve diagnostic accuracy, to completely transform medicine from the practice that we currently know. Hopefully for the better, perhaps some of the human empathetic touch will be lost. I will be watching with interest to see how you will leverage this technologic explosion while not losing the ‘art’ of medicine – not dehumanizing the patient. See the opportunity in this challenge. I am so curious to see how you will manage to maintain or create compassion in this modern era of computers and the internet of things. 

And remember, you are members of the greatest profession, vocation, calling, and what a privilege it has been and continues to be for me. Be open to opportunities, doors will open for you and all you have to do is decide whether or not to walk on through and see where the road takes you. It may take you on unexpected adventures like I have been fortunate enough to experience – journeys of a lifetime that have shaped who I am both as a person and as a physician.

In closing, remember in the words of Winston Churchill, “We make a living by what we get; we make a life by what we give.” Congratulations and good luck!"