“You came to us as novices and you leave us as colleagues. Well done and congratulations.” Assistant Professor and PA Program Director Alexandria Garino, PhD, PA-C, shared these sentiments with Yale School of Medicine’s (YSM) Physician Associate (PA) Class of 2018, during their Commencement ceremony on December 10, 2018. Family, faculty, and friends gathered in Yale’s Woolsey Hall to honor and celebrate the 36 members of Yale’s 47th class to graduate from the school’s PA Program. The graduation is not aligned with the university’s May Commencement ceremony, because the PA Program, which matriculates a new class each August, lasts 28 months.
After welcoming remarks, Garino, humorously noted she was relieved she did not have to follow the Commencement speaker, before introducing Lisa Sanders, MD, FACP, associate professor of medicine (general medicine). Sanders told the soon-to-be graduates “in becoming a PA, you are entering one of the best careers in medicine,” adding, after referencing that the PA career is only 51-years-old, “you have filled a hole in medicine that we didn’t know existed until you arrived.”
In addition to her positions at Yale, Sanders writes the Diagnosis column for the New York Times Magazine and from 2010-16 wrote the Think Like a Doctor column for the New York Times blog Well. Her New York Times writing was the inspiration for the popular and long-running television show House MD, for which she was a consultant. Sanders drew on this experience for part of her Commencement talk, describing how the television show’s fictional main character, Dr. Gregory House, “had a determination to really get into a problem, to understand it, and fix it,” adding “that’s what our patients want from us, to get themselves back to how life was, to get healthy.”
She also shared a true story of a patient who was misdiagnosed for years as having celiac disease. Medical providers criticized the patient over the years for not obeying dietary restrictions when her symptoms persisted. It was not until her health declined rapidly, and the patient’s sister brought her to a different hospital where the doctor who saw her did not just assume she had celiac disease, but made an effort to get to the bottom of what she was suffering from, that it was determined she had a rare, but treatable, infection. Sanders explained that the patient’s suffering was able to continue for years because, as Sanders says she emphasizes repeatedly when she teaches, these patients pass before dozens of doctors “untouched by human thought.” Sander’s message from this example, “your application of thought can save a life.” She similarly shared a story demonstrating how well-functioning medical teams are critical to outstanding patient care, telling the class “your obligation as new graduates is to be part of that team.”
YSM Dean Robert Alpern, MD, spoke next, congratulating the Class of 2018 for choosing a career in health care and successfully completing the Yale PA Program, but also challenging the class regarding the responsibilities that lie ahead. He focused on the importance of having a commitment to every patient, explaining “when patients come to you it is not routine for them. They will see in you if you really care about them.” He also challenged them to strive to be leaders in the tradition of YSM and the PA Program, which has as part of its mission “to foster leaders who will serve their communities and advance quality health care.”
After Alpern officially conferred a Master of Medical Science degree to each member of the class, the recipients of two student awards were announced. The Dr. John P. Hayslett Award For Overall Academic Excellence, which is awarded to a student who has exhibited excellence through all phases of the curriculum and who has embraced extracurricular opportunities and performed with grace, was presented to Elizabeth Philbrick. The faculty noted Philbrick was top of the list in the didactic, clinical, and research parts of the curriculum.
The Yale Physician Associate Program Leadership Award, presented for going beyond the academic requirements to motivate and inspire others, was awarded to Matthew Drause and Yukari Suzuki. In conferring the award to Drause and Suzuki, it was noted “they say yes to everything we ask them to do.”
After receiving her award, Suzuki stayed on stage to deliver the student address. Rather than make a traditional speech, Suzuki movingly delivered a poem she wrote, “The Art of Medicine”, which concluded:
Be bold,
Take risks,
Trust your heart to guide you as it has led us here,
And help others see what we envision in our minds.
Together, we will help paint the future of medicine and our patients' lives.
So go ahead,
open your eyes
and let’s get to work.
The students then presented the following student awards:
Outstanding Didactic Course Award: Matthew Grant, MD, Assistant Professor of Medicine (Infectious Diseases); Director, Yale Health Travel Medicine
Outstanding Clinical Site Award: Yale New Haven Hospital, Inpatient Pediatrics
Outstanding Preceptor Award: Camila Odio, MD, Yale New Haven Hospital, Resident
Jack Cole Society Award (for significant contributions in support of the PA Profession): Richard Chen, PA-C, Lecturer in Emergency Medicine
Class of 2018 Award (for support and dedication to the Yale PA Program and the Class of 2018): Wynne Bottomley, Curriculum Coordinator, Didactic Team
Be bold, Take risks, Trust your heart to guide you as it has led us here, And help others see what we envision in our minds. Together, we will help paint the future of medicine and our patients' lives. So go ahead, open your eyes and let’s get to work.
Yukari Suzuki '18
Class President Jessie Mangs led her classmates in reciting the Yale Physician Associate Program Professional Oath, before Assistant Professor and Associate Program Director David Brissette, MMSc, PA-C, delivered closing remarks. Brissette’s voice choked up as he thanked the recent graduates “for spending the last 28 months with us.” Echoing one part of the Professional Oath that the graduates had just recited, Brissette emphasized to the students that their “self-directed learning will be critical.” And he noted “today is the day all comes full circle”, reminding the graduates of when they were applicants to the program with big dreams, and how just 28-months ago they began the program “perhaps not realizing how challenging it would be.” He closed warmly remarking “you have realized your dreams today to become clinicians and colleagues.”
Full text of "The Art of Medicine", by Yukari Suzuki '18
Medicine is often described as the intersection of science and art;
The first lesson is learning not to look but to see.
Like Leonardo Da Vinci and his fascination with anatomy,
We have come to admire the absolute marvel of life and the human body.
For example,
when we hear a heart beat, we see the metronome,
the dancing hands of the majestic maestro
keeping time,
setting the foundation
for this presentation
of the most intricate orchestra of elements,
coursing the border
between chaos and order.
An everyday experience of pure magnificence,
We see a living symphony
But we abandon myopia as mere spectators of the physical. Instead, we become storytellers.
Proceeding like archeologists unearthing clues,
surveying grid by grid in this systematic review.
Compiling information that transforms dots into plots,
plots into lines,
lines into forms,
recreating in our minds with a mission to understand
the very masterpieces that stand
before us.
In learning how to see, we have become more cognizant
Not only of our patients, but of the dissonance
between what medicine is and what it should or could be
Like how, from the outside, medicine is a transaction, a balance of revenue and expense,
where every minute, every hour, ever day - an allotment of reimbursements.
We look at our watches before we enter rooms not because we are actually curious of the time but to see the end of the appointment before it even begins.
Dali’s melting clocks
pressure us to minimize costs
as we overlook the tragic miscalculation of the value of each moment.
Inside, we see fractions, where unfamiliarity with our role yields way to assumptions
that our skills are inferior,
that others must be better.
Relegated to being delegated
by institutional inheritance of limitations,
we find a constant battle to promote ourselves against how others view our profession
Overall, we see a system of uneven distribution and access
where price, shortages, and stigma form mountains that thwart our patients’ progress.
Areas like mental health where, even here, reassurance for a follow up in two weeks crumbles to two years of waiting for an absent phone call.
At times, feeling the grasp of my own self slipping like sand through my fingers
clinging to the reminder that it’s all in my head,
and I know in all honesty that it is all in my head,
but that does not make the struggle any less real.
We all struggle at points in our lives, and in those moments what often helps us to heal the most is
to feel acknowledged,
feel validated,
and feel seen for everything that we are.
And we do.
We see you.
When we are with you, we do not look at faces of cases but we see people.
People whose significance in this world was not meant to be statistical,
People whose lives are not glasses half empty or half full,
But glasses with a purpose, holding onto something inside of them, and with room for more. And in potential,
we see hope.
Hope that together, we can help provide you with some relief,
That the world will be molded into what we want and need,
A place that sustains our capacity to believe
that there is a chance
And that change is possible.
And we see us.
Our voice, our vote, our presence, and our agency
to learn, educate
speak out, and advocate.
We are bound to make an incredible impact in this world.
Artists often speak of being struck by a vision and continuing to create until their vision is realized,
So I challenge all of us to ask ourselves throughout our lives,
“What do we see?”
Today, at this moment, our vision may be weak or incomplete,
But when we form a vision for how we want the world to be,
Hold on to it.
Hold on to it,
Be bold,
Take risks,
Trust your heart to guide you as it has led us here,
And help others see what we envision in our minds.
Together, we will help paint the future of medicine and our patients' lives.
So go ahead,
open your eyes
and let’s get to work.