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Dr. Dexanne Clohan Delivers Commencement Address at Ross University School of Medicine Graduation Ceremony

06/08/10

Dexanne Clohan, MD, one of Modern Healthcare’s 50 most powerful physician executives in healthcare for the past three years and chief medical officer and senior vice president for HealthSouth, delivered the keynote address at Ross University School of Medicine’s 54th commencement ceremony on June 4th at The Theater at Madison Square Garden. Below are her remarks as prepared for delivery.

Commencement Address
Ross University School of Medicine
June 4, 2010               
New York City


President Shepherd, Dean Coleman, faculty, friends, family and—in less than 30 minutes—fellow physicians.    
Thank you for the tremendous honor of being invited to share in this celebration recognizing your accomplishment:  achieving your goal of becoming a physician.

My personal route to my current medical career was far from direct. Some of you may feel that your route to this moment took some twists you weren’t expecting.  I can attest to what you’ve probably already concluded:  indirect paths can lead to the most interesting destinations, and no experience along the way is ever wasted. 
   
When President Shepherd invited me to speak today, I was surprised to learn your commencement was being held in Madison Square Garden. I hadn’t associated this famous place with prestigious academic occasions. I’d thought of the Garden as the site of sporting and entertainment events.  

I consulted my husband and Wikipedia to learn what was voted the greatest moment in the history of Madison Square Garden...until today, that is.

It took place almost exactly 40 years ago, on May 8, 1970, in the seventh game of the NBA finals when the NY Knicks were playing the LA Lakers.  

Willis Reed played for the Knicks.  Picture him: 6 ft 9 in and 240 lbs. He was voted the Most Valuable Player for the whole league that season. But he had experienced an injury that kept him completely out of game six.  And his torn thigh muscle was so severe that he wasn’t expected to play in the championship/deciding game seven.
Willis Reed’s surprise appearance on the court during the warm-up caused an explosion of applause.

He started the game, and he scored the Knicks' first two baskets on his first two shots. Those four points were all he scored in the game, but it provided the inspiration for Walt Clyde Frazier to score 36 points and the Knicks to win the game and bring New York City its first NBA championship title.

But it wasn’t the victory, or the awarding of the team rings, or even the recognition of Willis Reed as MVP of the series, that made history with the fans. What was voted the greatest moment in the history of Madison Square Garden? It was the moment Willis Reed walked on to the court.

So what’s the take-away? Any number of lessons might be drawn:  

Reed was a hero despite scoring well below his own average. Perhaps there’s a message that consistent performance outweighs the occasional lapse that will befall all of us. So, keep up your track record of being consistently diligent and you’ll win yourself a supportive community.  

Perhaps another lesson is that sometimes inspiring others to be their best can be even more effective than carrying the whole burden ourselves. So support your colleagues—medicine is a team sport.

There are, undoubtedly, many morals to the story.  But while I have you thinking about a tremendous pro in the all-important game, let me make three game-related points that might be useful to you as you enter the professional ranks yourself today.

First, let me warn you against two pitfalls that trip up some doctors , and I’ll call them both “game face errors”:

• We sometimes give the “woe is me” appearance of people who have undertaken an overwhelming job. That matches with Wictionary’s definition of game face as “the serious face or grimace of a person about to undertake a difficult or unpleasant task.”  

• And we’re also tempted to fall back on the MD credential to disguise our actual feelings of uncertainty or sadness.  That’s the second game face definition of “an expression designed to conceal emotion.”
I hope you can avoid both of these risks.

I won’t try to kid you and pretend you’re not facing hard work.  But being a physician is a privilege, not an unpleasant grind. Find fulfillment, not drudgery, in the trust your patients place in you to attend to their needs.  And do it in the context of a healthy life for yourself and your loved ones.

• Birthdays, soccer games, dinner time with family.

• Travels, spiritual pursuits, the arts — all are vital to a life well-lived.

There’s an analogy in literature where I’ve heard it said, “Non-fiction gives you the facts, but fiction tells you the truth.”  Take time to enjoy the fruits of your labors and let your face show that you’re happy.

Avoid the grim looking game face, but also avoid the mask designed to conceal your emotions. While this might work in poker, it’s a bad strategy for a physician. Watch your facial expression, body language, tone of voice, and choice of words.  

If you try to disguise your inexperience or insecurity with an expression that says, “I’ve got my MD so I’m large and in charge,” you’ll alienate people who could be your allies and make mistakes when you could have learned.  
Don’t let the turn of your tassel  today, well deserved though it is, become a barrier between you and non-physician colleagues with whom you’ll be privileged to work.

And don’t go overboard concealing all emotion from your patients, either. Of course you have a professional responsibility to maintain a certain control, but that shouldn’t prevent you from empathizing with patients.  
Patients appreciate a doctor with whom they feel personal rapport, and they’re more likely to follow that doctor’s advice. As a profession, we’ve got room to improve. Sadly, half of young adults say that doctors don’t always listen, explain, show respect, and spend time the way they’d want.  

But here’s one practical tip: in establishing rapport, don’t say, “I know how you feel.” We can never be sure we know how someone else feels.  But we can help our patients confide in us with phrases like “tell me how you’re reacting to this” or “you probably have questions.”

Bottom line: don’t adopt a game face that makes your family and friends think you view your chosen profession as a grind.  And don’t put on a game face that makes your colleagues and patients think you’re a heartless robot. My best advice for a game face?  How about a smile!

A second sports-related phrase that’s worth remembering: “Bring your A-game.” You’re ready because of the excellent classroom and clinical experiences Ross University and its faculty and administration have provided for you.  

But here’s a little secret: wherever you trained, however much you know, it’s never enough. There will be moments when you don’t know the answer; more than just your memory will be required. You will need help to bring your A-game.

Here’s what I mean by “help.”  My medical specialty is physical medicine and rehabilitation.  Often, complete cure is not an option for our patients and they’re left with some functional impairment.  We have a term for techniques to help patients get past these barriers; we call them “compensatory strategies.”  Picture a hemiplegic person using a little device designed to make buttoning a shirt a one-handed task.  Imagine a brain-injured student who relies on an electronic, alarming pocket calendar.  Or perhaps it’s the spinal cord injured athlete who can sky-dive by using a buddy harness.  These little tricks of the trade allow a person to do more than would be possible without employing these techniques.

So what are some compensatory strategies that allow physicians—new or old—to bring their A-game?
Here’s one: Make sure you’re really communicating with patients and colleagues and your own families, for that matter.  A great strategy is to repeat, or have the other person repeat, the crux of the message to make sure accurate communication takes place.  There is nothing worse than wasting a great answer on a question that doesn’t match.

Making lists to prioritize your tasks is another helpful technique. I used to pooh-pooh index cards and check boxes, but I came to appreciate the technique during my own internship.  Whether your reminders are old school or high tech, you’ll be more effective if you take a “first things first” approach.

Here’s an important A-game strategy Ross students and graduates have already developed a reputation for: “Getting there earlier and working harder.” You’ve worked so hard and accomplished so much, so don’t stop now.

Don’t ever forget you’ve signed up for a life of service to your patients and to your profession.   Serve them well.  
Use all the resources available to you help you bring your A-game:  

•    Learn from patient feedback.
•    Confer with your colleagues.
•    Be attentive to the professional journals.
•    Adopt professionally endorsed clinical guidelines.
•    Hold yourself accountable to well-founded quality metrics.

On that last point—quality measures imposed by government and payors—medicine is too important to allow our personal egos or political inclinations to prevent us from adopting good ideas just because the good ideas weren’t originally our own.

Here’s the reality: whatever entity is paying the bill is going to demand a voice in the process.  My advice to you would be to resist the temptation to mutter under your breath. Instead, spend your time and effort on figuring out how to make things work for you and your patients.

You’ll practice for the specific benefit of your patients, but you’ll do it in a society that expects quality and value.  It will require our A-game every day to fulfill these expectations.

And that brings me to the last game-related phrase I’ll offer you today.  Well beyond just sports, analysts refer to all types of events as being game-changers. Online you can find examples of the term:

• MacBytes.com said when Apple's App Store scored 800 million downloads in its first eight months –  it was a complete game changer for mobile telephones.

• The Hill Blog said: "Cash for Clunkers" is a game changer and Detroit finally seems ready to change its game.
Here’s what I propose:  equipped with your new academic credentials, you can actually be the person who changes the game.  For example, your diligence, style, and skill can change the game for people who previously were unaware of Ross or might have underestimated its graduates.  

You can embody the fact that Ross is a school that believes the practice of medicine is not just an art and a science, but also an act of will. A school that says: If you bring talent and show up with a will to work, to learn, to be committed to making yourself the best you can be, Ross will help you find your way and give you the tools you need to become an excellent doctor.  You can blaze a trail that forges new opportunities for graduates who will follow in your steps. Ross has served you well. Now serve it well.

Some game-changers do it alone. But you can increase the likelihood of being a game changer by developing allies.  For example, I’d urge you to serve on hospital or practice committees. This is a great venue for advancing the practice of medicine.  

Another way to find allies is to involve yourself in organized medicine. I write dues checks to the American Medical Association, the American Academy of Physical Medicine and Rehabilitation, the Medical Association of the State of Alabama, and the Alabama Society of PM&R.  

Yes, it costs me a few bucks and yes, I don’t always agree with everything they do. But it’s my way of investing in my own, my patients’ and my profession’s future.  

And don’t stop at writing the check. Check out their meetings, get involved in their programs, get to know your colleagues.  The bonus, of course, is that they will get to know you—and you can magnify your ability to bring about change by leveraging the strength of the group. And, as cynics would say about organizational and national politics, “If you’re not at the table, you’re on the menu.”

Some of you might be thinking that to be a game changer, you would have to cure AIDS or develop genetically targeted drugs.  Actually, you can have an impact by looking for connections others haven’t noticed and finding innovative ways to do routine things.  Maybe you can figure out a way to:

• Decrease patient waiting time.
• Help patients communicate their histories more effectively.  
• Fight childhood obesity with some clever way to engage parents and children.  

Any of these activities, and a million others, could revolutionize how medicine is practiced. Your class can—and will—do such things.  

But perhaps right now, at this crossroad between the minor leagues and the pros, you’re thinking you’d be happy just to get through your internship without a lot of drama.  

Let me tell you the truth. Perhaps the miracle of this profession is that by listening intently to your patients and serving them well you have the opportunity to be a game changer in their lives each and every day, one patient at a time.

Remember, you can revolutionize a life even if you don’t revolutionize the overall practice of medicine. You can be a tremendous healing force even when you cannot cure.  

A colleague told me about going into the room of a new spinal cord injured patient who was so angry and difficult that he’d terrorized the whole staff.  She went in his room and said, “I know you’re not happy with the way things are going.  What can I do to help?”

With a flurry of expletives, the patient gave as one example of his misery that, because of the nature of his injury, he’d never be able to reach or feed himself some candy he’d been brought as a gift.  He ended his tirade with, “What are you going to do about that?”  

She said, “I’m going to reach the M&Ms for you and stand here and feed them to you as long as you need me to.”  For the next while, she patiently fed him the candies, letting him pick which color he wanted next and talk about his frustrations and concerns.  

More than a few tears were shed in that room, and she reported that the patient was a changed man from that point on. But the real clincher of that story is what she told me next: “I was a changed person, too.”  

Today, by virtue of this graduation, you’ll be forever changed. Your patients will depend on you.  Your neighbors will frequently give an extra measure of respect to your opinion. Your family will be proud, but somewhat concerned about whether they’ve somehow lost you to a higher calling. You can handle all of those challenges.

Forty years ago, Willis Reed limped onto the court in Madison Square Garden for the NBA finals and became a game changer. When you walk across the floor here in the Garden and receive your diploma, commit yourself to being a game changer.

You have worked, studied, practiced, and trained. You are ready. It is my very great pleasure to welcome you to the ranks of the pros!