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Medical school commencement marks beginning of new era in health-care reform

- By Tracie White

Norbert von der GroebenAtul Gawande

Surgeon and author Atul Gawande, the commencement’s featured speaker, told graduates that the practice of medicine had to change. “The truth is, the volume and complexity of medicine has grown beyond our capacity,” he said.

Physicians can no longer be what they once were: individual craftsman. In today’s complicated health-care world of overwhelming scientific discoveries and technological advancements, doctors have to work together with a health-care team to provide optimal care to patients.

And to control costs.

This was the message that the commencement speaker, writer/surgeon Atul Gawande, MD, whose recent works have influenced the political debate surrounding health-care reform, delivered to the School of Medicine’s 2010 graduating class on June 12 under a giant white tent on the Dean’s Lawn.

Given that 2010 is the year of “health-care reform,” Dean Philip Pizzo, MD, said that having Gawande as the medical school’s commencement speaker “is particularly relevant and meaningful.” Controlling spiraling health-care costs and the implementation of health policy reform are big issues facing the medical school graduates of 2010.

“There are areas for celebration as we start toward this process of health-care reform,” Pizzo told the crowd of graduates, family and friends. “In some ways it’s up to you to make a difference.” The year’s class, composed of 100 medical students, 97 PhD students and 43 master’s of science graduates, marched across the grass outside the medical school led by the dean to the applause of several hundred people in the audience, with cameras flashing and babies crying.

For the first time, the class included six graduates with a master’s in the new specialty of human genetics and genetics counseling.

Following words of congratulations and encouragement from student speakers Kenneth Schulz, PhD, and Ian Chua, MD, Gawande delivered his message of how best to navigate the new and changing world of health care as the graduating scientists and physicians finally leave school and enter the medical field.

 “The truth is, the volume and complexity of medicine has grown beyond our capacity,” said Gawande, associate professor of surgery at Harvard University Medical School who studied biology and political science as an undergraduate at Stanford. (He also mentioned to the crowd of graduates that he met his wife while a sophomore living in the dorms at Stanford.)

“When we talk about the uncontrollable rise in health-care costs, the problem is rooted in scientific complexity. There are now 13,600 diagnoses — different ways that our bodies can fail. There are 6,000 drugs, 4,000 medical procedures and growing.”

Norbert von der Groebengrad

Jeremiah Ray, before he received his MD degree, with his cousins Kristen Shaw of Sacramento and Holly Shaw of Sutter Creek, CA. He is one of 100 medical students, 97 PhD students and 43 master’s of science students in the Class of 2010.

The result has been that increasing numbers of doctors are now specialists, each concerned almost exclusively about their particular niche, he said. Health-care costs have spiraled out of control because it’s become difficult for individual practitioners to see the larger picture.

Gawande reiterated the message that he delivered in his New Yorker article, “The cost conundrum,” which President Barack Obama recommended as a primer for understanding the problems in the U.S. system: Those patients getting the most expensive care are not always getting the best care, Gawande told the class. That is happening, he explained, because too much emphasis is placed on the individual parts of health care and not the whole.

“You come into medicine and science at a time of radical change,” Gawande said. “No technology will be infallible. No individual will be either. We need entire packages of care. We need teamwork.” Physicians will still need to exercise their judgment, but will be doing it in a new framework, he said.

Many of the graduates were scheduled to start their residencies on the Monday morning following graduation, but Saturday was a time for celebration, hugs and laughter.

“This whole crowd is going out to celebrate,” said Jennifer Pretz , MD, 30, waving her hand to the group of friends clustered around her, each dressed proudly in cap and gown.

Norbert von der Groebengrad

Among those graduating on June 12 were the first students to complete the medical school’s new program in genetics counseling. From left: Sarah Bannon, Debbie Barragan, Ellyn Farrelly, Diana Darcy, Amanda Knoth and Melissa Mills.

Pretz, who worked as a biomedical engineer prior to heading to medical school at Stanford, was scheduled to start a residency in radiation oncology at Harvard on June 14. “My mom can’t stop crying,” Pretz said. “She just keeps repeating, ‘I’m so proud!’”

Her friend and classmate Jayson Morgan, MD, 26, standing next to her, said, “Everybody’s here. Both my parents are here, my grandma and my grandpa are here from Columbus, Ohio. Everybody’s here.”

Morgan, who is headed off to UC-San Francisco for a residency in internal medicine, said he was particularly excited to have Gawande as the commencement speaker.

“I first started reading Atul Gawande when I started thinking about medicine,” Morgan said. “He influenced me. There’s so much technology today, people forget medicine is so much more than that.”

And learning to make the best use of this medical technology is the challenge that  Morgan and his classmates will face in the years ahead.

“All of you will spend the next three to 10 years in subspecialties of medicine,” Pizzo said. “When you emerge, the health-care world is going to be a different place.”

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

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