What does the title “Doctor” really mean?

One does not absolutely need mentors to succeed in life (I stand corrected; see comments), particularly in scientific life, but a good mentor makes the process much easier!

I was blessed with four wonderful scientific mentors. Each of them taught me invaluable lessons on how to be the best scientist that I can be, and I hope that my professional life honors them. It is normal for a research scientist to list her/his PhD advisor as a mentor, and I am no exception. My PhD advisor at Cornell (Dr. George Paul Hess) was especially awesome and I have talked about him here, here and here. Sadly, he passed a few years ago.

However, I came to George pre-trained, quite well pre-trained, in fact.

I learned how to be a scientist at the Universidad Central del Caribe (UCC), a medical school in my native Puerto Rico. I spent nine years there working as a research technician and later as a biochemistry instructor once I earned my master’s degree. There, I had “three mentors for the price of one”. I will talk about two of them in a further post, but now I’d like to mention Dr. Richard M. Hann.

He was my direct supervisor during my nine years at UCC. We are both huge Star Trek fans, so (obviously) he was Captain Kirk, and I was (who else?) Mr. Scott, Chief Engineer, the Miracle Worker… (:-).

I learned from Dr. Hann how to (properly) design, perform, and analyze an experiment, pure and simple, and if this sounds succinct, let me tell you that this is the backbone of science, period.

He recently had the honor of being the speaker at a recent UCC commencement. He shared with me his address, and I wanted to share it with you, my readers. Thanks to his speech, I now fully know what my own title means. Dr. Hann graciously gave me permission to reproduce his speech in this blog.

I hope that regardless of your walk of life, you will find these words as inspiring as I do.

~~~~~

Address presented by Richard Hann M.D., Professor and Chairman of the Department of Biochemistry of Universidad Central del Caribe, Bayamón, PR, on the occasion of the 42nd Commencement Exercises of Universidad Central del Caribe held on June 1, 2013.

Good morning.

I am honored to have been invited to address the 2013 graduating class of Universidad Central del Caribe. You have all worked very hard to reach this day. I first of all want to personally congratulate each of you for your tremendous achievement.

This is the 42nd graduation ceremony of UCC. I attended the first UCC graduation 33 years ago as an Assistant Professor and since then I have attended most of the graduations. So I have sat through many graduation speeches. Some of them were very good and some of them were not very good. But there is one thing that I have learned sitting through all of those graduation speeches: A good speech is a short speech. Most historians consider President Abraham Lincoln’s Gettysburg Address in 1863 to have been the best speech that anyone ever gave in the English language. I believe that one reason the Gettysburg Address is so highly rated is that it was less than 3 minutes long.

Although I am no Abraham Lincoln, I have tried to be as succinct as possible in framing my words for you this morning.

I want to address my words this morning to our “doctor of medicine” graduates in particular. But what I say will be of interest to all of our graduates here today because all of you will spend your careers working in the health sciences alongside these doctors of medicine. So listen closely to what I say to the doctor of medicine graduates, because some day you may have the opportunity to remind them about what they heard this morning. If you do remind them, I will appreciate that very much. So please pay attention.

Four years ago I had the pleasure of teaching you a few things about the molecular and cellular basis of disease. Now In a few minutes you will receive a diploma that reads “doctor of medicine”. This morning I want to tell you what your new title “doctor of medicine” really means.

But first let me tell you what the title “doctor” does not mean. Almost everyone who hears that title “doctor”, or “doctór” or “doctora” in Spanish, thinks of a physician, un “médico”, a practitioner of medicine. People think of someone like you, who has been educated and trained to take a medical history, perform a physical examination, order and review laboratory tests, make a diagnosis, hopefully the correct one, and offer treatment and prevention to a patient.
But the title “doctor” does not mean physician.

This morning UCC is making history by awarding its first ever “doctor” of philosophy or Ph.D. degree in Cell and Molecular Biology. But the young lady, who hereafter will be addressed as “Doctor” (redacted), will not be a physician. Although you will receive the well-earned degree of “doctor of medicine” today, you are not yet physicians. As you well know, you will need at least one more year of education and training, after which you will be required to pass one more examination after which you must apply for, pay for and be awarded a license before you actually become a physician who may independently practice the science and art of medicine.

So what does this title of “doctor” that you are receiving today really mean anyway?

The word “doctor” is the agentive noun of the Latin verb docere (do-ke-re) which means “to teach”.

I repeat, it means “to teach”.

So the title “doctor” is actually a latin-derived word referring to anyone who is recognized to have acquired sufficient knowledge in a subject to be a teacher of the subject.

“Doctor” has been an honored academic title in Europe for over a thousand years dating back to the rise of the first medieval universities. The right to grant a licentia docendi or license to teach was originally reserved to the Christian church, which required the applicant to pass a test, take an oath and pay a fee to be able to teach theology. As the early universities slowly emancipated themselves from the church, university studies divided into theology, law and medicine, at which time the first medicinae doctor or “teacher of medicine” degrees were awarded. So the title medicinae doctor, which beginning today you may abbreviate after your name as M.D., really means “teacher of medicine”.

After today, every time that you sign your name and add that title “M.D.” after it, I want you to remember that.
Now I’m sure that you are all asking yourselves, “Whom does Dr. Hann expect me to teach?”

A teacher must have learners. Who will your learners be?

Over the span of your medical career you will teach three very different groups of learners. Your first group of learners will be medical students, like yourselves…up until today. These will be young people enrolled in a medical degree program who aspire to, but have not yet achieved, the degree of doctor of medicine.

I consider it a professional duty for a doctor of medicine to dedicate at least part of his or her time to the teaching of medical students. My role model for this physician-teacher was a general practitioner named Dr. Loyd Williams. Dr. Williams was the only physician in a small town in eastern Oklahoma called Wetumka. Wetumka only had about 2,000 residents. Yet Dr. Williams maintained a small modern hospital there staffed with nurses and xray and lab technicians. But he was the only physician. Although Wetumka was 200 miles east of the nearest medical school in Oklahoma City, every 5 weeks a new medical student would travel to Wetumka, move into the small furnished trailer that Dr. Williams kept at his own expense just for that purpose and spend the next 5 weeks learning the practice of medicine under the personal tutorage of Dr. Williams. Dr. Williams did this for over 20 years and taught a large number of University of Oklahoma medical students, including the one who stands here before you today. The medical school paid Dr. Williams $500 for each medical student who passed through his clerkship. But Dr. Williams always gave that money to the student as a gift for helping take care of his patients. I once asked Dr. Williams why he didn’t keep the money to cover expenses. Dr. Williams replied that he felt it was his duty to teach medical students and that he enjoyed doing it too much to be paid for it.

I cannot understand why any trained physician would not jump at the chance to share his or her large fund of medical knowledge with the hungry mind of the medical student either in the classroom or at the patient bedside. Teaching medical students is an extremely rewarding task. It is the task to which I chose to dedicate my life after receiving my “teacher of medicine” degree almost 40 years ago. I encourage you always to look for opportunities to teach medical students even if you do it only on a part-time or voluntary basis.

Your second group of learners will be your peers or colleagues. Here I include medical residents or physicians-in-training because they also have achieved, like you, the degree of teacher of medicine. Although you will all have similar foundational knowledge, each one of you will have a unique fund of knowledge in your chosen field that no one else will have. You will possess certain specific strengths in your knowledge and skills that others will not possess. If you specialize, this uniqueness will become even more profound. You should never turn down an invitation, either formal or informal, to teach what you know to your colleagues. Again I consider it a professional duty for a physician to share his or her unique fund of knowledge with their colleagues.

I want to let you in on a little secret. In addition to the reward of giving back or sharing your knowledge, there is a hidden benefit for you if you involve yourself in teaching. It is not the primary reason that one teaches, but it is a benefit nonetheless. It has been said that if you want to know something really well, teach it. Good teaching of a subject requires mastery of the subject. Subject mastery is one of the most important skills that a good teacher must develop. Mastery of a subject includes knowledge that you will gain as you prepare to teach the subject. In other words, if you teach something, you will end up with even more knowledge about the subject than you had before you taught it.

Finally, but very importantly, your third group of learners will be your patients. The Patient Bill of Rights of the American Hospital Association article 2 states: “The patient has the right and is encouraged to obtain from physicians…relevant, current, and understandable information concerning diagnosis, treatment and prognosis.”

This means teaching.

It will be your responsibility to teach each and every one of your patients, or their primary caregivers, enough understandable information that they can make informed decisions about their own medical care. The key words here are “informed decisions”. Here you will be faced with your most challenging group of learners because your patients and their families will be your most heterogeneous group of learners.

On the one extreme, you will have the patient who is unable to understand very much about his or her illness. This may be an uneducated patient or a patient with limited cognitive ability. Nevertheless, it is your responsibility to find the level on which you can communicate to the patient and their family enough understandable information that they can make informed decisions about their care. This is a challenge that you will face on a daily basis with some of your patients and their families.

At the other extreme, teaching the intelligent and well-informed patient will be no less challenging to you, but for a different reason. Today there is a tremendous amount of medical information on every disease available from many sources, but especially over the internet through such sites as WebMD and those sites run by specific disease-support groups. And this is generally a good thing, because a well-informed patient can make well-informed decisions. But always remember that, although your patient may possess a great deal of information about their illness, information is not the same thing as knowledge. Unless your patient is a health professional like yourself, your patient will not have the span and depth of human biology that you have acquired. Or to put it another way, your patient’s information will often be incomplete, confusing and out of context. In such cases, it will be your responsibility as their physician to place the patient’s information into context for them.

Let me give you an example. I have a friend who is an intelligent, well-educated man. His physician prescribed a medication for him. I cannot recall which one but that is not important. My friend saw the medication advertised on television along with all of the horrendous potential side effects that the FDA requires the manufacturer to include in the commercial. Seeing this commercial, my friend became frightened and refused to take the medication. I encouraged him to talk to his physician, who sat down with him and explained that the risk of those side effects was extremely low. His physician even pulled out some studies verifying the safety of the medication. Only after that “teaching” session did my friend agree to take the medication.

I realize that some physicians lack the time to personally educate all of their patients. This is especially true in the case of chronic diseases, such as diabetes mellitus, that require a large amount of ongoing patient education. In such cases, a professionally-trained patient educator should be employed by the physician or the medical group to teach their patients. The lack of time should never be an excuse not to properly educate your patient. Whether you do it yourself or you employ someone else who is trained to do it, it remains your responsibility as the patient’s physician to make sure that the learning process occurs. To allow a patient to leave the office or the hospital without the knowledge needed to make informed decisions about his or her own care is a violation of the patient’s rights and, therefore, constitutes unethical behavior on the part of the physician.

So today you receive a diploma that identifies you as a teacher of medicine.
While the medical profession always emphasizes that a physician must be a “life-long learner” of medicine, and indeed you must be that, I am saying that you must also be a “life-long teacher” of medicine. All I ask is that in the future, whenever you look at that diploma on your office wall that reads “doctor of medicine” or whenever you sign M.D. after your name, you will remember what I told you here today and you will enthusiastically share your knowledge of medicine with your students, your colleagues, and your patients.

The African-American poet Maya Angelou said it best when she once told a graduating class:

“When you get, give. When you learn, teach.”

Thank you for listening to me one last time and, again, congratulations to all of you.

~
Copyright © 2013 by Universidad Central del Caribe Box 60-327 Bayamón, Puerto Rico 00960-6032. All rights reserved. No part of this work may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission.
Dr. Hann and Dr. Baldscientist in 2013. We’re both (a little) thinner now…
~~
To get in touch with me or for more information, please go here.