The recent graduation ceremonies for our medical students were certainly different this year.  The usual cheering and other outbursts were muffled by masks worn at some graduation exercises, while sporadic loud yells (or shouts) of excitement pierced through the masks at other ceremonies.  Some attendees screamed, clapped, and whistled –– despite instructions to maintain a solemn demeanor until the designated time.  The rest of us shot eyes at those trouble makers, unless we too were one of the disobedient ones. The graduates seemed half asleep secondary to a long night of celebration, combined with their feelings of nervousness and excitement. 

The future of a sixth grader going into the seventh grade depends on parents, teachers, and friends for support.  A high school graduate may now believe that the flipping of the tassel equals instant adulthood. What a rude awakening it is for the young adult who considers being “grown” at age 18 with instantaneous “big boy and big girl” responsibilities.  But who’s going to wake baby boy up after the party for class?

For the medical student transitioning to become a novice physician, mixed emotions might be full- blown: excitement, uncertainty, and even fear about being the next great scientist and caretaker of society. These new physicians have a lot to consider. After all, they must enter an agreement to uphold the high standards in our Hippocratic Oath of medical ethics. It’s a good idea for even seasoned physicians to review this sacred oath periodically.  Adopted over 2,500 years ago, the oath has been updated several times since. The late Dr. Louis Lasagna, while academic Dean of the School of Medicine at Tufts University, published an updated version in 1964.  The oath states: I swear to fulfill, to the best of my ability and judgement, this covenant:  I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly SHARE SUCH KNOWLEDGE AS IS MINE WITH THOSE WHO ARE TO FOILLOW. This excerpt from the oath highlights only a portion of its content, which reminds us of the sympathy and understanding with which we have sworn to provide patient care.

The advent of social media, electronic charting, and HIPAA compliance has caused us to lose some of the personal touch we swore to uphold in our oaths. Sitting with the patient face-to-face on the edge of the bed has diminished to a constant glance at the cell phone to view the most up-to-date information.  What does this have to do with DEI: diversity, equity, and inclusion?

Our highly diverse patient population requires having a passion for treating all patients equally, considering and respecting the differences of culture. Upon interviewing a 25 year-old male coach with hypertension in your clinic, you might greet him with, “Good morning man. What’s up?”   That approach might work for that situation, but not for one involving a 65 year-old college professor.  Using the same lingo would likely result in your last visit with the college professor.  Physicians cross many barriers, but we should never lose sight of human dignity. A listening ear, attentive touch in physical examinations, and differential diagnosis skills are the hallmarks of excellent patient care for everyone.  Are we guilty of providing inequitable care?

Consider this: between 11:30am-12:30pm, everyone without an NPO order gets a lunch tray placed on their bedside table. They all get a meal. Yet, only 70% can actually eat the meal. Why? Because some patients are paralyzed, have fractured extremities, or are too weak to hold utensils. The fact that all patients get a meal points to equal treatment, but inequity arises in the inability of all to eat the meal without help. Untouched meals picked up by cafeteria workers reveal this problem.  It’s easy to say that the fault lies with the nurse, cafeteria workers, techs, etc; however, let us remind ourselves that the physician is responsible for ensuring appropriate care all patients.

As physicians, we function best with team members. The patient’s case is discussed with the team to achieve the best results for the patient. We need everyone on the team to feel included.  Hence, as the M2s graduate to the wards as M3s, they become a part of the team. The intern’s responsibility is to teach the medical students. Residents manage the team with other residents and the attending physician oversees them all.  One simple aspect of a team is to at least know the names of the teammates.  A general conversation to make the person feel included will open doors for sharing ideas, which ultimately benefits patients.  If the attending physician asks, “whose patient is this?” the answer would not be the medical student, or the rotating resident, or the intern but John, Jasmine, or Nathan.  This is a simple inclusion technique.  If it works for a sports team, it will work for us.

For the new medical school graduate, following the oath that is pledged will allay fears during this transition period and maintain the excitement of learning, teaching, and caring for a lifetime.

Enjoy being lifetime students and teachers in one of the greatest professions of all time. It is an unselfish one.  Remember to think outside your norm.  Include others who look and act differently. In doing so, you will find that diversity, equity, and inclusion will become second nature.

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