Prof Michael B. Murphy - Dent & Nursing - June 22nd 2000

Address by Professor Michael Murphy, Dean of Medicine, UCC
at the conferring of Medical Degrees,
Thursday, 20 June, 2000 at 10.00 am

President, Members of the University, Guests,

The conferring ceremony at the University is one of the highlights of the Medical Faculty year. May I, on behalf of the Faculty and the University at large, welcome you to the University on this special year, the Millennium, for the graduation of the 146th class from the Cork Medical School. It should almost go without saying that we are all, here, congratulate our new graduates – and those being conferred with Doctorates in Medicine. I want to welcome particularly the parents, and in these days of political correctness and social change, partners and spouses of our new graduates.

Graduation Day is one of the most important days in the lives of most individuals. For the graduates, however, the receipt of the pay check, sometime in the next month or so, maybe of equal importance. For parents, today is a happy occasion marking the culmination of enormous investment in time, emotional support, financial sacrifice and shared angst. However, with a little bit of luck you can put those chequebooks away after today!

I would like to extend a special welcome and heartiest congratulations to our guests from overseas and to our new graduates from overseas for whom the challenges have been greatest. Unlike your Irish counterparts you have experienced much greater physical and emotional separation, more testing financial challenges and, probably, more uncertainty about the likelihood of success. We have graduates from Botswana, Brunei, Hong Kong, Kuwait, Malaysia, Mauritius, Oman, Singapore and U.S.A. Many of you have faced not only the rigour of a challenging curriculum but the challenges of strange language, strange culture, currency exchange rate fluctuation, and of course, the unique nuance of the Cork accent and idiom that you have mastered these additional obstacles is remarkable and we applaud you.

On occasions such as this the speaker is expected to deliver an oration, which is profound, uplifting and brief. I can only guarantee the brevity. To attempt profundity however let us reflect for a moment on what you have become today.

Sociological and technological advances are occurring at an unprecedented pace, changing, almost weekly, the value and the role of the doctor in society. Your antecedents of 150 years ago, graduated from UCC, primarily with a large corpus of knowledge, of medical facts, and some skills to apply that knowledge, in the service of patients. Those patients were accustomed to visiting the doctor, who sat at a large desk, surrounded by imposing medical tomes, not accessible to the common man. His, (doctors were exclusively male) proprietary knowledge was the basis for the power of the profession – a priesthood, with power to predict the duration of a person’s life, the likely mode of death, the power to prescribe remedies to sometimes alter the duration of that life or at least determine the quality of that life.

You are graduating in very different circumstances. You are no longer the keeper, the custodian, of medical knowledge. That power has been dissipated. Your patients (often referred to, nowadays, as your clients) have access to, or can have access to, through the World-Wide-Web the popular press and media, virtually all of the information that you have. The prognosis of disease, the range of therapeutic options, the complication rates for diagnostic or therapeutic procedures – all are openly available. Worse still, (if you think traditionally) the data are largely derived from countries which spend far more resources on health-care, with consequently better outcomes, than may be achieved in Ireland, (or Malaysia, or Mauritius). And this has potential for creating unrealistic expectations among the populace you will serve.

However, I am confident that none of you here today worked for six, long years at UCC to achieve the historical power of Medicine. Your real value to today’s society will lie, not in your font of factual knowledge, your capacity to recall facts - which, no doubt has been well tested, during the past month. Your real value to modern society will lie in your capacity to serve your patients – to listen to them, to identify their needs, to explain and interpret the information that you both now have access to, and to apply your unique (often manual) clinical skills. The power and influence of the medical profession during your lifetime, your career, will derive, as always from your value to society – but as the servant of your patients.

George Bernard Shaw’s comedy the “Doctor’s Dilemma” written in 1913 lampooned the pompous ignorance of many in the medical profession. It didn’t pose a threat to the power of the profession at the time, but today, 80 years later, I suspect that it would be interpreted more as a drama than a comedy. Quote the line “Let no one suppose that the words doctors and patient can disguise from the party that they are the employer and the employee”. 80 years ago that comment was hilariously funny; today it reflects a widespread pragmatic interpretation of the modern role of the doctor.

This is not a cause for pessimism or disenchantment. At a time when it is not available in many sectors of daily living, good service is highly appreciated. Good service is valued, and respected, and quality of service is becoming the main criterion for reward. In medicine, in whatever country you will practice, the power and influence on the doctor from this point on will be earned through service, implementing and applying evidence based medicine.

Perhaps a moment on the nature of the service. The graduate of 1852 was a sole practitioner, a “general factotum”, a diagnostician, a therapist, a pharmacist and so on. In 2000, however, you will practice as part of an ever enlarging diversifying team of health professionals. This team will consist of a large number of complementary professionals; nurses, pharmacists, physiotherapists, nutritionists, speech-therapists, social workers, occupational therapists and so on. The team will include managers and administrators many of whom will have trained in environments divorced from medicine and health care, informed by principles of economics and fiscal management. Patients will continue to expect that their individual doctor will do what is in the best interest of themselves, the patients. Resource managers, in the team, will expect however that treatment decisions will respect the fiscal stringencies imposed by limited national budgets which represent societal priorities. At the end of the day, the service to the patient will be determined by the quality of the management of this complex team, and the efficient resolution of conflict – conflict between the expectations of the patients, the expectations of health professionals, the expectations of society.

In the absence of clear definition of roles, in the absence of mutual understanding of the skills and responsibilities of the individual team players, the patients’ needs will not be well served. It is my belief that, at present, the patient expects that the doctor will be the leader of the team. Patients still believe that the doctor is their advocate and patients will not be satisfied unless it is clear that their advocate is managing the team. You must earn and embrace that leadership role.

This brings me to examination of conscience – still in pursuit of profundity! Are we in UCC, in health education in Ireland or indeed in health education in most countries, preparing future health professionals for their new complex roles? In truth, probably not very well. But in truth, also we are beginning to recognise that fact and taking corrective measures. At last year’s conferring the Chief Executive Officer of the Southern Health Board, Mr. Sean Hurley, made a significant statement recognising the interdependency of the education and health service sectors in educating and training health professionals. Historically, in most countries, doctors are trained in universities and hospitals at the expense of the nation Education budget. In training hospitals, medical students consume resources and are perceived as adding significant costs to health care delivery in teaching hospitals.

The universities and health services compete for scarce resources. Competition rather than collaboration have been the order of the day. We are only recently waking up to the fact that we both share the same mission, that is high quality service to the population. To be successful, we must collaborate in jointly acquiring resources for high quality training of the professional staff who will deliver future health care. Both educatrion and service sectors will benefit jointly from new investments.

Health professionals must be trained in a complementary fashion, sharing many of the same educational resources, and in close physical contiguity. These factors will be essential in ensuring that individual professionals will understand the roles of other disciplines, appreciate their unique contributions and allow diverse professions to participate more effectively as team players. Principle of team play, of leadership, of management and administration must be a crucial component of the medical curriculum. The management and application of knowledge rather than the retention of factual information must be a key focus. Why not open book exams?

We are moving in the right direction. Nursing education, long divorced from medical education has entered the university sector. Education and training of a large number of other health disciplines has been entering the university domain internationally and there are many new opportunities for UCC in this arena and we are committed to exploring rapidly the local and national needs in these sectors. As the whole health care delivery model changes, UCC, and this Medical Faculty will not be found wanting in its own mission to serve society, by continually adapting its educational methods. Darwinian theories of evolution apply to medical faculties as much as to biological species. We adapt or die!

To the graduates let me say that I hope that we have served you reasonably well. That we have prepared you for the challenges that you face in the immediate future, (facing that first heart attack victim on 01 July!). That we have given you the skills to continue learning and to continue to adapt, and that we have imbued in you some sense of loyalty to the institution, which we intend to test after a few years, as we solicit donations for new facilities!

On behalf of my colleagues in the Faculty and in the University I wish you well in your new careers. May you enjoy your work, may you find it rewarding and may your patients respect you. Congratulations to you all.

University College Cork

Coláiste na hOllscoile Corcaigh

College Road, Cork T12 K8AF

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