Graduation ball speech 2013

  • I would like to start by thanking Vanessa Hewitt for the invitation to talk to you tonight. When the phone rang, I was actually sitting at my desk holding one of those letters from Prof Fardy that introduces your next PRINT student, with a little spiel and a color photo. Funnily enough, that student was Vanessa, who I hadn’t met up to that point and now I was looking at her and talking to her. Which of course made me feel paranoid wondering how she could choose that exact moment to call when she said she was in Orange or Wagga. Anyway, it demonstrates one of the truisms of a career in medicine – you never know what you might be doing in 10 minutes from now. I am very grateful for the opportunity.
  • I must also thank the last PRINT group to come through who gave me advice on how I should pitch this speech. On the five point scale from frivolous, to semi-frivolous, through neutral, to semi-serious, and serious there was a range of views. Interestingly, there were some at both extremes but most were somewhere in the middle. There was though a distinct lean toward the semi-frivolous side of the bell curve and I will do my best to cater for that market without forgetting my core constituents at the serious end of the spectrum.
  • In any case, in a few weeks’ time you will be addressed at your graduation by a truly wise person of immense character and well-earned reputation. I predict it will be a speech worthy of the formality of the occasion and that it will reflect all that you have achieved. It will also mark the beginning of your career in medicine and if I’m right, then it will leave you more aware than ever of your potential and also of your newfound responsibilities. It will be the right speech at the right time and that time is not tonight.
  • So where does that leave me? I wasn’t sure so I did what I normally do when seeking inspiration and plucked a page out of the little fliptop calendar on my secretary Lisa’s desk. The quote at the bottom of the page was from Buddha and he said:
  • Your work is to discover your work and then, with all your heart, to give yourself to it.
  • Now initially, this had me writing a serious philosophical speech to inspire you to follow your passions and to seek some inner truths about what it means to be a doctor etcetera but really, you’ll get that at your graduation. So instead, to help you discover your work, I’ve come up with the Boutlis guide to choosing a career in medicine. I only realised afterwards that I should have put up a slide like a tree with different branches, my wife calls that a flowchart, so try and conceptualise that in your minds as I go:

The Boutlis guide to choosing a career in medicine

  • Early on, you have to make an important choice – do you love patients or hate them? If listening to peoples’ woes isn’t for you then choose an NPC specialty (that’s non-patient care) and don’t worry, there are plenty to choose from.
  • If you got lots of sun as a child and you know that your vitamin D is way above normal then you probably have what it takes for a lifetime indoors in radiology. Otherwise, choose radiology and you’re just choosing osteoporosis, with a big risk of getting a non-traumatic fracture just carrying all the money you’ll make out of the hospital. I’m not jealous, really, but be careful.
  • Then there’s pathology. No one does pathology any more so if you’re one of those people who prefers the solitude of your own company then this could be for you. But I have been reminded by my friend Al Lochhead that we all need pathologists, so I shouldn’t bag them too much otherwise I might not get a lift home.
  • You could go straight into medical administration of course but most administrators wait a while until they’ve got a few scores to settle. There’s no hurry, in the end you’ll get even.
  • Finally, you could do public health, which is the noblest NPC profession of all. At this point I should pause and thank my wife Pip (who’s a public health physician) for helping me to write the speech.
  • For everyone else, patients will be part of your life for ever more but there’s different ways of going about it.
  • I remember being told once about a female GP married to a physician who was introducing herself at a party. When she was asked “What do you do?” she proudly said “I’m a general practitioner”. “And your husband?” “He’s a limited practitioner”. That does describe my wife and I (Pip is also a GP) but I can assure you that she’s not the one who said it.
  • So that’s the first distinction you have to make – if you’re not capable of much then you won’t be any good at general practice. Or paediatrics (if you find yourself drawn to kids and anxious parents). Or geriatrics (if your inclination is exactly the opposite). Or maybe even general medicine. Prof Yeo is here tonight and can help you.
  • That leaves the limited practitioners and I will start with those in private practice
  • Now, they say that everyone is mad, bad or sad and if that describes you but you don’t know which one you are, then you could spend a lifetime finding out. In that case, do psychiatry.
  • If you’re a chronic insomniac who doesn’t believe in the refreshing power of sleep then your career will choose you. Look no further than obstetrics.
  • You will already know if you are destined to be an ophthalmologist; these people were wired to be fascinated by eyeballs from birth and nothing, or nobody, will stop them.
  • My wife said that superficial people choose dermatology, which I thought was a slight, but apparently it’s a pun. If you’re not going to be a dermatologist, then make sure you get to know one. One day you’ll develop spots yourself and you don’t want to have to wait 6 months for an appointment.
  • We’re making our way into the hospital now and there are fundamentally two types of people. Those who like the freedom to be able to just drop everything and travel whenever they want and those who will be forever constrained by their back catalogue of patients.
  • If you like to travel and you love chaos, then the ED or ICU is for you.
  • But if you love travel and you need some structure in your life, then pick anaesthetics.
  • We’re down to the big two – medicine versus surgery. Perhaps the distinction can best be summed up by a story I was told over lunch in the cafeteria at WarragulHospital in country Victoria by a vascular surgeon called David Merenstein in 1992.
  • David said, “I came home last night and my little girl said to me, “Daddy, what did you do today?” Well, I said, I got up at 5 am, did my rounds then went to the operating theatre and did 2 carotid endarterectomies, 3 femoral bypasses and some varicose veins before I was interrupted by an emergency ruptured AAA, which I fixed, saving a life, before finishing my list, doing some minor procedures in my outpatient clinic and then heading home at 7. And then she said, “Daddy, what did the physician do today?” The physician? He contemplated”
  • So if you are a doer rather than a thinker, then surgery is for you. If you’re as strong as an ox but can’t spell it, then do orthopedics. Otherwise, there is a range to choose from.
  • Which brings us to the contemplators.
  • If you’re disposed toward contemplation but don’t really have time for it because you’re too busy making money to fund your lavish lifestyle and your black Mercedes, then that’s why we invented angioplasty balloons and endoscopes. Cardiology or gastroenterology is for you.
  • If you read Kubler Ross’s 5 stages of grief – that’s denial, anger, bargaining, mourning and acceptance – and you thought that they were all about death and dying (rather than the interactions between ID physicians and surgeons, which is really what they apply to) then check out oncology, hematology or palliative care, they might be up your alley.
  • So that leaves only the true navel gazers and these can again be divided into two.
  • If you’re completely fascinated by diagnosis but don’t care much for treatment, then neurology is a perfect fit. Hasn’t changed, never will. But in truth, I’m in awe of them.
  • If you like diagnosis and you’re happy with treatment that doesn’t work very well (and you’re looking for an extended family of patients who will stick with you through thick and thin and never leave you) then renal, endocrinology and rheumatology fit the bill. There is little to choose between them.
  • But if you want to love ‘em and leave ‘em, then do ID.
  • That brings me to the end of the formal part of my speech. You might think that guiding you towards your chosen career path is an act of true charity on my part and it would be very kind of you to think that. It is of course all about my own self-interest – I’m not being frivolous when I say that I am acutely aware that I am standing here tonight looking out at my future GP, cardiologist, psychiatrist, and geriatrician. But hopefully not my future oncologist. And I wish you well in making these choices; you have worked hard and the world is your oyster.
  • If you will indulge me for just a moment more, then I would like to finish with a word to my core constituents, the ones who voted for a semi to serious speech. As you pass through your career in medicine you will be constantly reminded of mortality, even your own. So can I leave you with a quote from my mentor Professor Allen Yung, who was the ID Physician’s ID Physician. Allen once said to me that “Medicine is but one dying man caring for another”. As the cartoonist Michael Leunig once said about Love, “It’s as simple and as difficult as that.”
  • So make the most of the time that you have and do follow your passions.
  • Bask in the frivolity. And don’t take it too seriously.