HMS & HSDM CLASS DAY

How to Stay Human in Medicine

A writer, psychiatrist, Rhodes scholar, and Harvard MD from the Class of 1973, Stephen Bergman, in his Class Day keynote address, issued a call to the graduating medical and dental students to aim their sights not at “Me” but at a newly emerging “We,” animated by an inclusive and global esprit de corps.

“When my first novel—The House of God, the story of my medical internship—came out 30 years ago, it was viewed as a radical book,” Bergman said, “and I was not always welcome in gatherings like this.” As much a warning as an introduction, the comment set the tone for Bergman’s talk. His book is an edgy satire about medical training, written under the pen name Samuel Shem.
From the novel, Bergman related several “Laws of the House,” including: “The delivery of medical care is to do as much nothing as possible.”

Photo by Steve Gilbert

HMS and HSDM Class Day keynote speaker Stephen Bergman (center) called for the graduating students to bring humanism and activism to clinical practice; with him are dental dean R. Bruce Donoff (left) and medical dean Jeffrey Flier.

“There’s something wise about this law,” he said. “The body has amazing healing properties. It’s saying: ‘Stay out of the way and let life heal.’ …The only interns who got into trouble in the House were too ‘aggressive,’ invading the body mindlessly.”
But the laws also included this: “The patient is the one with the disease,” a formulation that distances patients from care providers.

“In the years since, I’ve reconsidered this,” Bergman said. “It can be seen as ‘the doctor’s disease,’ which goes, ‘I, a doctor, am separate from, and different than, you the patient.’ Treating patients like objects—‘that liver in room 4’—was a symptom of our distress as interns.” It degrades both the patient and the doctor.

Broadening his focus, Bergman said, “My generation came of age in the ’60s. We grew up with the idea that if we saw an injustice and took action together, we could change things: we helped put the civil rights laws on the books, and we ended the Vietnam War.”

He recounted the tumultuous May of 1970, the end of his first year at HMS. “Four students were murdered by the Ohio State National Guard at Kent State for protesting the war,” he said, “and all over the country universities went out on strike. We at Harvard were just starting the kidney block, and had to decide whether to join the strike. …[Ultimately] we went. I never learned the kidney. In The House of God, it is a vaguely described organ, located somewhere between the back of the neck and the back of the knee.”

Upon entering internship, Bergman said, “we were idealistic young doctors, wanting to learn, dedicated to treating our patients humanely. But soon we were asked to do things that we thought were inhumane. We were caught in a profound conflict between the received wisdom of the medical system and the call of the human heart.”

Bergman then presented the graduating students with four suggestions for “how to stay human in medicine:”

• The first, he said, is to “stay connected. Isolation is deadly; connection heals. …Under pressure, we interns got isolated.” But, he said, “when you’re in trouble, do not withdraw. The way to stay human is to move toward others. Lean into life, not away.”

• “Number 2: Speak up. When we notice injustice or cruelty in the medical system—and believe me you will—speak up. Speaking up is necessary not only to call attention to the wrongs of the system, speaking up is essential for your survival as a human being.”

• The third is to learn empathy “…by putting yourself in another person’s shoes, feelingly … by living not just in the ‘I’ or the ‘You,’ but the ‘We.’”

“One of the most encouraging developments in medicine,” Bergman said, “is the increased number of women. In my class, there were less than 10 percent; now it’s over 50.”

• “Number 4: Learn your trade, in the world. You have to be competent to be compassionate. But the patient is never only the patient—the patient is the spouse, the family, the friends, the community…. The patient is the world. And here’s the good news: you graduates are totally awesome in one particularly important way that my generation was not: you are citizens of the world. …You are not isolated from, nor suspicious of, different people and cultures; you are with them—even if through tweets and twitters…. You are the hope of the planet, and I—and your families and friends here today—are so proud of you it brings tears to our eyes.”

But Bergman also shared some bad news: “You are about to enter a disaster area: the healthcare industry. The system is broken. It is worse for doctors, worse for patients and better only for the insurance industry.”

He asked, to great applause, “Why in the world should healthcare be for profit?”
The treatment he prescribed was a universal system of healthcare coverage, tort reform and federally supported medical education in return for national service.

“We doctors are privileged,” Bergman said. “We are present in this basic human journey; we are there in the realness of the vital events in people’s lives, from birth to death. Medicine is ‘caring,’ in the full sense, ‘taking care of,’ being with the patient—even being with the life-force itself. It is hard to care. …And even trying to care, sometimes is a hard thing to do; not only caring for patients, but caring for the others in our doctor’s lives.”

“Finally,” Bergman said, “that’s the challenge, the thrill, and the joy in The House of God: to become aware that the pain and suffering of others is the same as our own; to become aware that if we are ignorant of our neighbor’s sorrow, we bring sorrow to our own door; and with that awareness, to take anger and spin it to compassion; to give solace, to heal. For at our best, we don’t just doctor, we heal.”

—Robert Neal

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