Doctors are important science communicators

Speaking to the MD graduates at UAB Medical School Commencement

I had the honor of speaking to the MD graduates at the University of Alabama at Birmingham. I am so impressed with their medical school. It is outstanding in all respects. Before I do a graduation speech, I have a zoom call with some of the some of the students to get the inside story. The UAB students were some of the best I ever talked to. They were so appreciative of the training they got and the fact that they did it in Alabama where they saw so much of the reality facing our country.

It was really fun to be able to speak at a commencement where it was just the MD graduates, so I got to tailor my speech to the practice of medicine in these challenging times. I hope they left knowing that they are more important science communicators than any talking head on tv or some guy who writes op-eds like me.

Also, I didn’t bring my regalia, so they provided it and I got an MD hood with Caltech colors. Didn’t know Caltech had started a medical school, and no, I didn’t prescribe any medicine while I was wearing this thing. But it was fun to be a “real doctor” for two hours.

Here is the video (starts at 43 min in) and speech below.

Congratulations, graduates!

In the next hour or so, you’re all going to be doctors!

Eight years ago, you sat in a college lecture hall learning general chemistry from someone like me. You toughed out limiting reagents and polyprotic acids so you could go to medical school and get to this moment. You did it. It was a long road, and you should be proud!

When you got to the UAB medical school, you found a different world. You came to campus on the first day so excited with optimism and idealism, and the first thing you did -- was wait for an elevator.

For a long time.

You got very good at it.

And as the days wore on, you learned to search. Not for the meaning of disease or the soul of Osler or Hippocrates, but for a parking place.

Some days you broke down and paid for the Princess lot.

Soon you figured out that you didn’t need a parking place when you could just watch your lectures at home in your sweats.

On 1.5 speed.

Or make that 2.

And you didn’t have to worry that you wouldn’t get your questions answered, because Cole Garrison and Ben Rogers were always there to ask them for you.

Pretty soon you started learning about medicine. Sure, there were some scary moments, like worrying about Dr. Fuller’s GI exam.

It was a great way to learn about inflammatory bowel disease and contract it at the same time.

Thankfully, whenever you had a big exam, you could count on Kenneth Hurd from IT to tell you to “get ‘er done.”

And soon it started making sense. The science of medicine and the practice of medicine came together. You saw how it played out with your patients who came from all over Alabama.

You learned important things that your peers in the big cities in the Northeast didn’t learn. You saw how what Dr. Harada taught you about social determinants of health played out in real life.

You became physicians.

Thank you for doing that.

We really, really need you.

OK, graduation speeches have three ideas in 12 minutes, so I’d better going moving.

Nobody’s Normal

I don’t think I can stand in front of this many students and not mention the fact that we are in a mental health crisis among young people. As many as 50% of college and graduate school age students have sought mental health services. That’s a lot of people here today who are hurting, and I can understand it with the stress of medical school and the political environment. Lots of pundits want to tell you why this is happening, but actually only you know. For sure, part of it is an outdated and biased idea of what it means to be ‘normal’ that most of us can’t conform to.

Since you completed your psych rotations, you may notice that my hand movements and the lack of modulation in my vocal tone are a little unusual. That’s because I’m autistic. Lots of famous and successful people have had this diagnosis. But far more autistic people -- and those who had autism but were never diagnosed, and therefore never given the supports they needed -- were much less fortunate, sometimes requiring constant care and exhibiting much higher rates of anxiety and depression than the general population. And that’s partly because, particularly in some sectors of society, our awkward traits come with significant stigma.

Fortunately, you had strong support for mental health from UAB. You might not have that as residents. But with the support you’ve had so far, with what you’ve learned about mental illness in medical school, and with what you know about compassion in medicine, you’re prepared for the stresses of the next steps.

You just have to apply that compassion to yourself.

Now one reason I’m telling you this is so you know that if you have mental health struggles of your own, you can still be the speaker at UAB Medical School commencement one day. In fact, all of us up here in our robes with our fancy degrees may look completely together, but every one of us has had challenges just like you may be having. So as my GW colleague Richard Grinker says, remember that if you look closely enough, nobody’s normal.

Institutions aren’t perfect

There’s an elephant in this big room. Actually, a donkey and an elephant, because we just had a very divisive election and a dizzying start to the administration. And the numbers of votes for the two candidates were so close that for every person who is disappointed and scared about the future, there’s someone else who is happy and excited. You’re being handed quite a big challenge with all of this. And my advice is not to listen to any pundit who tries to tell you why someone voted.

But we do know that part of the story is a big loss of trust in institutions. Medical science lost a lot of trust during the pandemic because many of us thought that scientific principles should take precedence over everything else. And we were too strident about expressing that. And too reluctant to admit when we made a mistake or had to change our views on the basis of new data. It’s no wonder that 47% of Americans think scientists feel superior to others.

Ouch. That’s on us to fix.

And because all of you will leave here to work for one of these institutions, remember that none of them is perfect. Be part of helping them reform and engage their critics. These institutions have made immeasurable contributions to success for all, but they also owe everyone an explanation when they fall short, an acknowledgment of their shortcomings, and a plan to do better.

Take the UAB medical school. Sure, you learned a lot of great stuff, but how can they teach you the latest on the uses of AI in medicine while Examplify continues to crash your iPad during exams?

Some may say that’s highly ironic, but you’re more likely to say it’s esoteric.

And sometimes when you raised problems more important than Examplify or the faulty elevators, they evaded giving you a straight answer and talked about vague things like how committed they were to your community.

Well, bad news. This is how most institutions respond. Powerful people and organizations usually only do hard things when they have to – that’s how we got in this mess. So at your new institution, insist that they be straight with folks when they mess up and give direct answers to questions from stakeholders and reporters. When they don’t do those things, it’s completely in bounds to press them to do better. It’s also essential.

Go love these institutions so much you that you help them improve – we need them to be stronger than ever right now. And hold everyone there to a higher standard, including yourself.

Do the work

In a few weeks, you’re going to show up for your first day of residency. You picked perhaps the most contentious time in the history of American medicine. The bad news of attacks on medical research and public health seems to never stop. Funding is threatened, careers are uncertain, and skepticism is rampant. But you’re prepared to deal with it, because you trained here. You learned that every patient brings their entire selves to the clinic, that they are unique individuals shaped by their highly variable situations. They have access to lots of different sources of information, many of which are incorrect and highly manipulative. But their views of medicine are also shaped by larger patterns in history, sociology, economics, religion, and politics.

Most of them cannot afford the Princess parking lot.

And some may be for Drake – and some may be for Kendrick.

But you learned how to approach them with humility. You know that you have no idea what difficulties they might be dealing with.

And remember that the American people are not the same as the American politicians. A full 77% of the American people oppose the administration’s cuts to medical research, while only 21% are in favor.

To honor their financial support of medical science, we owe all of them our best.

During this extraordinary time, a lot of people who object to the changes brought by the administration wonder about the best way to respond. Well, unless you’re planning to run for office or become a constitutional lawyer, the answer to that is easy.

Just do the work that’s right in front of you. Compassionately and patiently sharing the best medical science with your patients is a radical act of courage and justice. You will get a lot of resistance from the Dr. Googles and the podcast crowd, and you won’t convince everyone. But with trust in short supply, you’re on the front lines of getting it back.

And you won’t get it back with politics. You won’t get it back with tweets, op-eds, TikToks, or cable news hits. You’ll get it back in the clinic.

One patient at a time.

That’s a lot to put on your shoulders. We know. But you learned from the best. You learned from passionate professors who cared as much as Theresa Wilborne. You passed that gut-wrenching GI exam from Dr. Fuller. You got here at o-dark-thirty for your heme-onc rotation because you were needed. And eight years ago, you learned to do chemistry problems that have nothing to do with medicine just so you could be here today.

So, you don’t need to ask yourself what to do to help. Tune out the news, stop the doomscrolling, get up on July 1, and: Do. The. Work.

As Kenneth would say, get ‘er done, UAB.

You’re right where you’re supposed to be

Despite all of these daunting challenges, today is a day for celebration. A recognition of your accomplishments and your preparation for what lies ahead.

Will residency be even harder than medical school? Yes. But you’re ready for that. You have the knowledge, the compassion, and the mission: aka, the brains, the heart, and the courage.

You’re absolutely ready for defying gravity.

And that’s certainly something to celebrate.

And hey, when things get really tough, you can still come back to Birmingham and have a Naked Pig Pale Ale at the Back 40.

Or go see whether the elevators are fixed yet. (Spoiler alert: they won’t be.)

So that’s my talk.

Nobody is normal.

Institutions aren’t perfect.

Do the work.

There is no doubt that you are right where you are supposed to be. If you’re anxious, it makes sense. In my religious tradition, when the Thessalonians were afraid, Paul gave them a bunch of advice and then said, “Therefore, encourage each other and build each other up, just as in fact you are already doing.”

Wise folks in other traditions have said similar things for centuries.

And you’re doing just what they advise.

Y’all got this.

Thank you.

Get ‘er done.

And remember, no matter what life throws at you, there’s one thing you can always cling to: you will never have to memorize the Krebs cycle again.

Congratulations to the class of 2025!