|
||||||||
|
HMS/HSDM CLASS DAY In Keynote, Federman Calls for Students to Make Meaningful Change in Health CareAfter insisting that the Class of 2002 asked him to deliver the Class Day keynote address only because it could not persuade Bill Cosby to come, Daniel Federman, senior dean for alumni relations and clinical teaching, summed up his vision for the future, describing it as a process of translation.
"We need and deserve a system that takes the incredible promise of modern biomedical and social science and anneals to it ... the intelligence, sensitivity, morality, and dedication of doctors and dentists like these," said Daniel Federman. (Photo by Liza Green, HMS Media Service) He preceded his four recommendations with a stage-setting anecdote about a translator at Massachusetts General Hospital who remarked that getting the right word is easy, but getting the right meaning to the person you are talking to is not. "We are the meaning makers," she had told Federman. He called on members of the graduating class to be meaning makers, too, but in a different way. For the small number of students going into basic biomedical research, he said, "I ask you to translate the recent exuberant progress in basic science into a new medical physiology in which the basic processes of signal transduction and the organization of the cell cycle and the processes of inflammation and repair get melded into a single basic science that could be threaded through all of the medical students' experience, including into the clinical years." In making his next recommendation, Federman referred to the lack of medical meaning initially offered by the human genome sequence. He said, for the larger group of graduates going into clinical research, "The human genetic sequence has to be ... translated into medical significance in the development of drugs and other approaches for both medicine and prevention. So my second meaning of translation is to urge many of you to take clinical investigation seriously and bring a meaning to the genome project that doctors and patients can use." Most Harvard medical graduates spend most of their time taking care of patients. "The translation here," Federman said, "is between disease, which is what's in a textbook, and illness, which is the experience of a human being in trouble." All patients need to know what is wrong; what it means; and what it portends. "The words are easy. The meaning you create by understanding your patient." The senior dean concluded with a lament about the current health care system which, he said, has many shortcomings. He read an e-mail that an alumna had received and forwarded to him in which a calculation of her clinical productivity was detailed, concluding that she had too few billable units during a particular review period. To general applause, Federman said that a sick child and a troubled adolescent are not billable units. "Our system doesn't support preventive services; it doesn't pay for the medicines that elderly Americans need for their care; it doesn't care for everybody; ... and in many places, it allows people to profit by denying care," Federman said. Pointing to the graduates, he continued, "We need ... a system that takes the incredible promise of modern biomedical and social science and anneals to it, so they can't be separated, the intelligence, sensitivity, morality, and dedication of doctors and dentists like these. "So in closing, I call on every graduate before me to dedicate your life to that vision of medicine; and every citizen before me to join in the ... political action needed to translate that distant hope into an encircling reality." --Robert Neal |
