It is the best of times for today's medical graduates

A message to all physicians from Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

By Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Ky., is president of the AMA. She served as chair of the AMA Board of Trustees during 2010-11 Posted April 18, 2011.

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My column this month is dedicated to medical students who are graduating this spring and realizing their dreams and aspirations.

This is a wonderful time to be crossing the threshold from being a medical student to becoming a physician. However, that process has been under way for some time, and you are ready for the challenges and responsibilities that go with this dedication and commitment.

Recently I had two opportunities to engage with medical students at my alma mater, the University of Kentucky College of Medicine. The first was a discussion of the role of the physician and medical students in organized medicine, and how important it is for us to define what health care should and must look like in years to come. The second was an opportunity to meet with medical students in their first through third years and to talk about career choices. Why did I decide to become an infectious disease specialist, why did I join a large multispecialty clinic, what is my workday like, what do I love about what I do?

I realized as I was talking with a variety of groups of young, enthusiastic and very bright men and women that I love talking about being a doctor and what it really means to me and ultimately my patients. As physicians, we have the opportunity to find ourselves in a very special place, and for that I am very grateful.

To those of you who are becoming physicians this spring, I offer my congratulations, and a bit of envy, as I think what it would be like to embark on a medical career in the second decade of the 21st century.

Today's graduates take as a matter of course amazing opportunities that simply did not exist when I graduated from medical school all those many years ago. I'm talking about the map of the human genome, imaging capabilities, surgical technology, pharmacological advances, understanding the cultural aspects of disease, quality of care initiatives, and -- in just this past year -- the promise that everyone who needs it will, finally, have access to medical care. It's easy to talk about the issues and challenges in the practice of medicine today. Indeed, the world of medicine has many flaws -- but it always has had flaws, and there will always be more.

Rather, this is a time to consider the positives. In my field of infectious diseases, the treatment of AIDS and HIV has seen a great leap forward -- so much that where we once only could stand by and make people comfortable while they died, we now can offer an almost normal life. Advances in molecular biology and other basic research have given us hope of finding ways to circumvent the HIV virus.

Innovations in chemistry and pharmacology have given us psychiatric drugs that enable previously institutionalized people to live in the real world. Advances in medical technology have more than equaled those in medical science. Endoscopic and replacement surgery have become commonplace. And we see a future for more and more significant advances enabling longer and healthier lives for our patients.

Development of autoimmune suppressants and innovation in surgical techniques have meant that organ transplants are simpler, last longer and better serve the recipients.

Biotechnology has given us tools to understand disease processes and to develop new therapeutic procedures. We are able to address cancers and other diseases that once were considered simply not treatable.

In the day-to-day world, advances in medical understanding have been tied to societal changes that have saved lives: Simply the existence of trained paramedic teams that bring victims of coronary heart disease and strokes to hospitals more quickly than in the past has allowed for far better chances of a positive outcome.

New emphasis on palliative care means that we are better able to serve our patients with chronic and progressive diseases, and give them more and better choices that affect their quality of life. We are seeing improvements in quality on an almost daily basis. Organizations like the National Quality Forum have brought emphasis and improvement in diminishing medical errors, reducing unnecessary procedures, correcting under-treatment, and preventing disease. As part of that movement, the AMA-convened Physician Consortium for Performance Improvement has brought the medical community together to identify gaps in health care quality, develop and test measures, and facilitate adoption of new approaches that have resulted in and will continue to affect quality improvements.

This is only a short list of the thrilling world waiting for our new medical graduates. What opportunities you have before you -- and what hope you can offer your patients!

Of course, there is a flip side. Each development has a caution. We see that our technical ability to prolong life has not always resulted in a better life for patients. We wrestle with what to do with our ability to test a person's genetic propensity for diseases for which there are no cures. Even with medical care available to all, there are still the questions of how much care can reasonably be delivered.

Yet when we wrestle with the dark side of medicine's future, we come face to face with what it means to be a doctor. Because after all, the achievements that have come through basic science and technology and chemistry and electronic advances -- marvels that they are -- are only tools. Amazing tools, but tools nonetheless.

A successful medical practice in the 21st century depends on the same thing that has always been the most important, and that is the one-on-one relationship between physician and patient. Knowledge is valuable -- and you who are today's medical graduates are the most knowledgeable the world has ever seen. Science and technology are important and have provided today's physicians with medical miracles. But it is understanding and trust and the ability to use all that knowledge and those miraculous tools wisely that are the keys to a successful medical practice.

That is really the thrill of practicing medicine for me. And it is the same thrill I wish for every man and woman in every medical school: I wish for you -- after your years of grueling hard work, large tuition bills and little sleep -- that feeling of wonder and honor that comes with being someone's physician.

Congratulations to the medical graduates of 2011.

Ardis Dee Hoven, MD , an internal medicine and infectious disease specialist in Lexington, Ky., is president of the AMA. She served as chair of the AMA Board of Trustees during 2010-11

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