Medical school graduates of 2006: "hooded, but not hoodwinked".

During medieval times, the hood was used by all classes of people as a head covering with a shoulder cape to protect from the cold. It was eventually adopted by monks and university students and by the 15th century, had became a token of graduation. The word "wink" originally meant to close one's eyes. To be hoodwinked was to have one's eyes covered by one's hood. Thieves would "hoodwink" their victims to rob them. Now we all understand it to mean, "to deceive by false appearance." You will be hooded today, but whether or not you will be hoodwinked by your new profession or by life itself depends on you, for there are strong forces in our world which may distract you from the noble life of service you have chosen as a physician. My plea to you today is, "Don't let them." Recognize and defeat them before they can hoodwink you.

All too soon it will be time to get down to the serious business of your life's work--being a doctor

One of your most important choices will be choosing how you deal with your patients as you begin your career as a physician. What tone will you set? Patients come in all sizes, shapes, colors and smells, and with all varieties of personalities and personality disorders. But some patients may make you seriously question your choice of a vocation: for example, the 54-year-old, morbidly obese, depressed woman who seems to actually enjoy poor health with her endless litany of complaints. Perhaps because of the way you took care of her, she'll soon be seeking treatment at the institution where you matched. She liked you as her doctor so much that she'll magnify whatever complaint matches your specialty and your on-call schedule, be it Medicine, Dermatology, Surgery, or Orthopaedics.

Or perhaps not. Perhaps she sensed that you, like most of the doctors she's seen this year, didn't care for her or could feel your impatience with her as you tried to hurry her through her history.

And what about the disheveled, belligerent drunk with rotten teeth, fetid breath, and cirrhosis who has ruined his life whom you will be called to see at 4:00 AM? When you enter his room, you will have a choice. Will you be his doctor?--or just a "healthcare provider" tired and irritated by him, by the hour, and by the fact that you are on call and you have already gotten five "hits" that day. How will you describe your patient to your fellow interns before morning report? Will you say your night was horrible and call him a troll, a dump from another hospital, a train wreck, or some other subhuman term? I hope not because here is an opportunity to reveal the goodness which led you to medicine in the first place--that brought you to where you sit now. However unlikely, your unexpected kindness and compassion at that hour of the morning might just turn his life around. On the other hand, your lack of these virtues could just harden him further.

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You have chosen a profession which has called you to reach out in genuine love and respect for others. Your profession will call upon you to try to relieve suffering regardless of the potential danger to yourself, regardless of whether, in your opinion, your patients brought their illness on themselves, regardless of the hour, regardless of their beliefs or their color, and especially regardless of whether they can pay you. You have a choice with patients: Will you be a force for good or just a force to be reckoned with?

Your patients are not the only ones who may test your mettle. You will inevitably encounter fellow interns who leave you with a lot of work as they check out to you; a few callous, hypercritical residents whom you can never seem to please, and overworked attendings who just want to get rounds over with and are not interested in hearing you present. How will you choose to react to the ward clerks, nurses, laboratory personnel, cafeteria workers, and department secretaries, all of whom have their own problems and may occasionally be less than considerate in their dealings with you? Someone in this group is bound to rub you the wrong way unless you are like St. Francis of Assisi, Mahatma Gandhi, Billy Graham, or Albert Schweitzer.

The fire of that goodness is not just in those of us who take care of patients; it burns inside us all. It is manifested in many different ways: working hard and taking pride in our work, not caring who gets the credit; being generous with our time; being modest and not showy; giving anonymously; desiring the well being, success, and prosperity of others; recognizing the importance of seemingly unimportant jobs held by others in our sphere; supervising others with truthfulness, patience, and good humor.

We all recognize that goodness. When others show it to us unexpectedly, we are touched and impressed by it. And we remember it. It is contagious and we often spread it to others and find that it brings out the best in them. Furthermore, in our humanness, we are likely to broadcast the good things we have done because it makes us feel good about ourselves.

On the other hand, we can also be weak, arrogant, cruel, prejudiced, lazy, and unfeeling. Unfortunately, these traits are also contagious, but we don't want others to see them because we instinctively know they are not right. Why else would we try to hide our dark side? The goodness in us wants out. The shame of evil stays within.

Some of us are very certain how that goodness got there; others not so sure. It would be wise to ponder that crucial question either way. But, regardless of how our intrinsic goodness got there, it remains an indelible part of the human life force. Some of us cover it up; but none of us can escape it. People who would lead you away from your goodness are often attractive, laugh at all your jokes, and shower you with all sorts of false flattery, but they are wolves in sheep's clothing--they are your mortal enemies. Do not let them hoodwink you.

The real joy in life does not come from a house at the beach or in the mountains, fine clothes, fine automobiles, fine country clubs, and valuable art work and possessions. It doesn't come from personal achievements or besting others. It comes from emptying ourselves of the goodness within and pouring it out on those with whom we share this planet. Why put off beginning to experience that real joy even one minute longer?

If medicine has lost some of its luster in the last 20 years, it is because we physicians are not the role models we once were. So be a role model. Let the light shine from your heart and out your eyes. You will notice a change in the people around you: your patients, your fellow house officers, the medical students you will be responsible to teach, your attendings, the nurses, the ward clerks, and even the housekeeping staff. But equally important, you will notice a great change in yourself. Once this philosophy has become part of you, you will no longer be doing good for selfish reasons, but simply because it is the right thing to do.

I leave you with some words which paraphrase what Ralph Waldo Emerson wrote long ago as he endeavored to define success: It is to laugh often and much, to win the respect of intelligent people and the affection of children, to earn the appreciation of honest critics and endure the betrayal of false friends, to appreciate beauty, to find the best in others, to leave the world a bit better, whether by a healthy child, a garden patch, or a redeemed social condition; to know even one life has breathed easier because you have lived. This is to have succeeded!

May God bless each and every one of you and may your coffins be built of 100-year-old oaks which I will plant tomorrow.

We adore chaos because we love to produce order.
--M.C. Escher

John F. Fisher, MD, FACP 

From the Medical College of Georgia, Augusta, GA.

Reprint requests to John F. Fisher, MD, FACP, Professor of Medicine, Medical College of Georgia CB 1831, Augusta, GA 30912. Email: [e-mail]

The following is taken from the keynote address to the 2006 graduating class of the Medical College of Georgia in Augusta, Georgia.

Accepted June 1, 2006.