Commencement Address to the Class of 2010 De La Salle College of Medicine

Br. Gus L. Boquer – President of the De La Salle Health Sciences Institute-Hermano (San) Miguel Febres Cordero Foundation, Members of the Board of Trustees, Vice Chancellor Dr. Ramona Luisa P. Santos – (Academics), Vice Chancellor Dr. Mel Victor G. Frias (Research), Vice Chancellor Dr. Charles Y. Yu (Mission and Linkages), Vice Chancellor Dr. Alvin D. Crudo (Shared Services), Vice Chancellor Sr. Francesca San Diego (Hospital Operations), Associate Dean of the College of Medicine Dr. Josephine Carnate, Mr. Reynaldo G. Cruz our Registrar, Executive Director of the De La Salle Alumni Association Mr. Benjie Uichico, Esteemed Members of the Faculty of the College of Medicine and Non Medical Staff, Distinguished Graduates of the Class of 2010, alumni and alumnae, parents, friends.

Twenty-one years and many many pounds ago when I was a 2^nd year surgical resident I was asked to deliver the Main Remarks as Guest Speaker of the High School Honors Assembly of La Salle Greenhills, my elementary and high school alma mater. There I met my old grade school principal, the late great Brother Rafael Donato, who was I believe President of Greenhills at the time. Upon mentioning that I was a surgical resident he informed me Emilio Aguinaldo College of Medicine had recently become part of the La Salle system, and that I should visit Dasmarinas, Cavite sometime. Well, two decades later, here I am Brother Rafe, not only visiting, but addressing De La Salle’s College of Medicine Graduating Class of 2010. I could not ask for a greater privilege.

How did I deserve to face you, the Class of 2010 as commencement speaker? I cannot fathom any reason except that I, too, swore to the Hippocratic Oath just as you will a few minutes from now. What wisdom can someone surgically trained in private hospitals, engaged in purely private practice, teaching formerly and currently at private medical schools and at the cusp of middle age possibly impart to medical students graduated by their school a few minutes ago? Nothing profound, I assure you; just simple, practical tips from a not-yet-so-senior medical practitioner.

First, you cannot thank your parents enough for what you are and what you have accomplished today. When I was in fellowship training long ago and far away, aside from surgical residents I would handle medical school students as part of their clinical training. These bright, incisive young people from Ivy League pre medicine programs would castigate me no end when they learned I was an overseas medical school graduate. They would first ask me how I paid for my medical school education. When I would tell them my parents paid for medical school they would tell me: “you are too fortunate, Doctor Montemayor. We had to take out a bank loan just to pay for medical school.” I did not know how to react; whether to feel guilty Filipino medical students such as I never had it so good - and how different the resulting motivation to study hard, to learn as much, to make the most of one’s medical schooling would be between someone who had to borrow money versus someone given money to become a doctor. How fortunate we all are indeed. The perception is true. Most of us had our medical education served to us on a silver platter. These last four years, dear graduates, how did we manifest our gratitude to our parents? How did we translate our thanks for this tremendous sacrifice they made into something palpable or valuable or worthwhile? How did we for our part honor their sacrifice and effort to allow you to sit where you are today in your toga and masons cap? Never forget what they had to do by being the best you can be. As a parent myself it would not be as much expected as appreciated.

Secondly, help La Salle--the school that educated you. The La Salle physician is both a teacher and healer, as the DNA of a La Salle School is education for the least fortunate. St. John Baptist De La Salle made it his commitment to teach the poorest of the poor, without compensation. He taught others to become teachers in the same way, without compensation. As a La Salle medical school graduate do not forget not only to heal, but to educate as well. Remember St. La Salle’s commitment to the poor. Teach your patients both rich and poor as you doctor to them. Teach them not only what to do when they are sick, but more importantly teach them how to be well. Promote concepts of wellness, for that is the springboard of preventive care.

Your school and its teaching hospital is expanding to enhance the ability to connect with our intended market --- the most deprived and unfortunate of Filipinos who cannot or barely can pay for their medical care. When you are financially fortunate enough, do not forget La Salle. The physical environment you immersed yourself in the last 4 years is a lot different from whence you started your medical schooling; it has become, by leaps and bounds, a better environment for you to learn: new buildings, new library, new facilities. For the institution’s expansion to proceed we need financial help and we look to you our new alumni to help La Salle and its teaching hospital serve all the more patients.

Thirdly, know right from wrong, the truth from the lie. As a Filipino citizen we see our environment clouded all the more not in black and white but in a gray haze of untruths and distortions of reality. You must stand your ground, and ferret out the truth. As recent history shows, the La Salle community has emerged as one of the very few beacons of truth, calling corruption by its very name, protecting the truth tellers and whistle blowers, demonstrating to Filipinos who still care that political stability should not rest on a bedrock of lies and untruths.

As for the medical field, further the truth by considering research for those of you inclined to it. Research confirms and reveals truths. Your school is committed to research. Research is sorely lacking in Philippine Medicine. Enhance Philippine medical research; organize it, lead it, fund it. Not all western medicines work well with Filipino patients, not all western algorithms can be applied here in the local setting. Our economy cannot support too many currently emerging but expensive diagnostic and therapeutic technologies. Local research injects more relevance in patient care, resulting in better patient outcomes for Filipinos at more reasonable cost.

Fourth, fulfill the needs of your country. When I graduated from medical school 24 years ago, we had just deposed an overstaying president. We as 4^th year medical students were part of medical teams stationed at Mendiola Bridge that fateful February night. We cut our hands feet and legs pushing away the barbed wire as we inched closer to Malacanang upon news of the flight of its long time occupants, first as a hesitant walk, later graduating into a giddy run as others scaled the once forbidden gates. I will never forget the feeling of being part of history. People were not only happy, they were euphoric. As I contemplate the past, examine our tumultuous present and pray for our nebulous future as national elections near I sense that great change is afoot; we must stop betraying each other, work together and echo our desires into productive action.

How do you as young physicians help your country? Being helpful certainly is embedded in doctoring anyway, you so rightly may claim. What do we need to do as physicians aside from doctoring? Will you be less patriotic if you treat foreign patients if you decide to relocate overseas, or if you decide to confine your practice, as I, to pay patients in an urban setting, knowing well enough that large numbers of our countrymen reside in rural areas and barely have or do not have access to a physician? The short answer to this difficult question is that there is none. There are thousands of permutations to helping our underserved countrymen. Choose a path that works for you. If living and working abroad would become your chosen path realize that because of technology the world has shrunk to the size of a town hall, a barangay, and the physical boundaries of the Philippines have forever dissolved in the face of email, social networking, SMS and cellular phones. The Philippines because of its citizens and new technology has become a nation without borders—a worldwide nation. We will technically never leave our country anymore. The sooner we realize this and get our act together as a worldwide country, the better things will become.

Fifth, you will not be happy in work you do not love. There is a world of difference between aptitude and passion, about knowing what you are capable of doing from what you enjoy doing. Some of you are already decided what they want to do, others not so. Discern what your passion is early on, and follow it. What particular aspect of medicine are you most passionate about? You are currently at a crossroad – many paths lie ahead but you have to choose one. Unfortunately as you advance in your medical career one will definitely encounter more crossroads, each become busier and busier, making one’s decisions harder and harder to make. Choose something that ignites a fire within you, a fire that burns brighter with each day.

Sixth, as you further your training and start your practice, the tried and tested qualities of availability, affability, affordability and being amiable will always be desirable. However, know also how to properly sell yourself. Everyone is a salesman. Somebody always sells something. It may be a physical product, a technology, a service, a skill, an image, a perception, attitudes and values. Doctors are not exempt from selling their skill. I do not mean this in an unethical way. Connecting to your intended audience lies not merely in the non-medical realm but is totally relevant in your future medical practice. Learn the concept of differentiation. Ask yourself: what will make a patient choose you as his physician? What will differentiate you from the other doctor with the same skill set?

Seventh, be fearless. Success they say is a series of mistakes. Mistakes are for the learning. Do not be afraid to err, as long as you learn from them. There will be mistakes you will make, mind you, in the course of your medical training and practice that will result in the unintentional injury and death of those under our care. These situations will happen and will be difficult to bear, but that is the stark reality. To honor these patients we must learn to be the better and wiser for the errors we unintentionally make. The climate in Philippine medical practice is not as litigation happy (yet) as that of other countries. It may very well become so, but as long as you appraise patients of all the possible complications of tests and treatments, when you allow patients to take part in their medical care and communication lines are always open, you will be spared the bane of litigation. Take good care of your patients, and your patients will take good care of you. Fear, though a great motivator should not make us cower, but soar to greater heights. Observe Manny Pacquiao when he climbs the ring prior to a fight. Observe his face and countenance…absolutely fearless. Stay clear up here--supratentorially; never allow people or situations to get into your head and affect your actions and thinking.

Eighth, learn to handle politics, especially in the medical workplace. The sooner you realize politics is everywhere and in everything you do even as MDs, the better you will be able to handle what I term “people situations.” As you further your training and glide into your practice you cannot avoid being associated with people younger and older who share your goals and respect your ideas. You will as well encounter people or groups of them that disagree with you or do not share your ideas. This is a reality, so one must deal with it, as it cannot be avoided. Be solid with your beliefs, stick to the truth, seek the happy compromise. You cannot please everyone, so at least try to get along with everybody.

Ninth, your patients are children of God just as you are a child of God. Behave like one and treat your patients accordingly. Respect their dignity, their humanity. This we must do always, even in the face of Medicine’s commercialization and the degradation of the doctor-patient relationship by businessmen and corporations. When we were graduating medical students twenty-five years ago I read an article in the New England Journal of Medicine foretelling the invasion of health maintenance organizations and managed care into medical practice and how it would affect the doctor-patient relationship. Indeed it is upon us, and twenty-five years later, the value of the care you give your patients has been commoditized into price schedules that doctors have to subscribe to. Doctors are no longer as independent as they once were, as they rely on patients provided by these HMOs for sustenance. With this reality what are you young doctors to do? Becoming financially savvy is not a sin to a doctor. If corporate middlemen have taken over medicine, doctors can just as well take it back from them. Become medical entrepreneurs. Organize yourselves. Get into business courses. Learn accounting. Learn how to read a financial statement. Doctors are inherently trusting people, and this is taken as a motivation for their deception by marauding businessmen. Your clinical-technical knowledge, skills and attitudes should not only be your equity on the business table when dealing with corporate medicine. One must be adept at finance, accounting, and management as well.

Tenth, let Jesus live in your heart forever. La Salle students implore this at the start and end of every classroom session. The answer to the question “What would Christ do if He was in this situation?” should animate your everyday life. Pray and desire Jesus always remains in your hearts, despite the humdrum, the everyday routine, the stress, the challenges, the sorrows and joys of doctoring.

Congratulations to the Class of 2010. Enjoy the rest of the evening. Thank you and Animo La Salle!