(Editor’s Note:  Dr. Carlos Roberto Jaén is the Dr. and Mrs. James L. Holly, MD Distinguished Professor of Patient-Centered Medical Home, Professor and Chair of Family and Community Medicine, University of Texas Health at the Health Science Center San Antonio School of Medicine and Adjunct Professor of Public Health at the School of Public health Regional Campus.  Your-Life-Your-Health columnist, Dr. Holly, is an Adjunct Professor in Dr. Jaén’s department.  The following is an address Dr. Jaén gave to the graduating class of the Medical Doctor & Master of Public Health program in San Antonio.  This address is published with his permission.)

“Good evening.  Dean Cooper, MPH graduates, family members and friends of the graduates and other distinguished guests.  It is an honor and a privilege for me to be given the opportunity to give you a few exhortations as you complete this phase of your training.  Tonight let’s celebrate your accomplishment of completing both degrees in 4 years, thank you for your hard work and commitment to this goal.  Family and friends thank you for your support during these difficult times.  Please join me in recognizing these accomplishments (Applause).

“My name is Carlos Roberto Jaén, and I am Professor and Chair of Family and Community Medicine at the Health Science Center and Adjunct Professor of Public Health at the School of Public Health Regional Campus.  I am a family physician, epidemiologist and health services researcher but my primary core identity is that of a politician, with politics understood as a noble calling:  making the necessary possible.  During my more than 20 years of practicing and making things happens I have learned a few lessons, seven to be precise, that I would like to share with you tonight.

“First always remember that HEALTH is the goal.  As Wendell Berry reminds us ‘Health is membership.’  Expanding on Michael Fine’s definition ‘Individual health is the ability to function in the relationships appropriate to our culture and our place in the life cycle.’  Population health is the ability for all to function.

“Health includes biology, genes and complex systems, includes thoughts and actions (dispositional optimism, perceived self-efficacy, emotional disclosure), includes social engagement (social networks, social support, love, altruism, ‘personage,’ social capital, moral net, sense of belongingness, trust/security, job satisfaction), includes social status (relatively speaking), includes a personal lifestyle that is healthy, includes the environment (think ancient forests, whole foods, microbe ecology), includes faith and meaning (including religious participation), and also includes absence of negative emotions (no depression, fear/anxiety, anger/hostility, stressful life events as makers of challenge).   Health is so much more than the absence of disease.

“Second, remember that we are called to be healers, BE WOUNDED HEALERS.  Patients are individuals who have fallen out of membership, or are at the risk of doing so.  They have the condition of ‘patients.’  They have gotten caught in the whirlpool and experience of being sucked out of life.  They come to us fearing or already separate from others that matter.  Their body tells them so and us!  We see people whose bodies are speaking of the broken, cracked places in their lives. 

“We are broken.  Our talk can widen the cracks or bridge them.  We can ignore them.  We must say “YES” to integrity.  We musts remember these simple rules for healing relationships:

1. Find something of value in each colleague and patient you encounter
2. Give your full attention in every interaction
3. Try to strengthen and encourage every person your encounter in your practice
4. Always respond, that is stay in dialogue
5. Never do all the relational work in any relationship, as the ‘Prayer of Maimonides’ reminds us patients also have obligations in the healing relationship.

“Third, you now know that the health care system is unsustainable as currently structured, GO AND CHANGE IT.  Be proactive about changing oppressive structures or social structures that are toxic to the communities you serve.  Keep in mind the TRIPLE AIM: improving the experience of care, improving the health of populations and reducing the per capita cost of health care.  Pre-conditions for achieving this triple aim include: enrollment of identified populations, commitment to universality for its members, and the existence of an organization (integrator) that accepts responsibility for all 3 aims for that population.  For this integrator to work it must partner with individuals and families, it must redesign primary care, coordinate population health management, provide financial management and provide for integration of the larger system.  As you begin the journey you will soon find allies and affirmation from corners that you did not expect.  You have been given many gifts, you have a responsibility to use them.

“Fourth, LEARN TO BUILD EFFECTIVE TEAMS.  Effective teams have leadership that is distributed and inclusive.  They are relationship-centered, focused on we not me, with particular attention to how and when communication happens.  They have clarity/awareness of teams roles and shared patient-centered goals.  Effective teams have capability and time for reflection and improvement (learning organizations).  They are adaptable and do not shy away from healthy conflict.

“Fifth, CARE FOR YOURSELF AND YOUR FAMILY BEFORE YOU CARE FOR OTHERS.  Practice what you preach when it comes to wellness.  Put first things first:  make time for building and growing the relationships most important in your life.  You can’t love what you don’t know.  Stay personally connected to your family and friends.

“Sixth, remember MEDICINE IS A PROFESSION, A CALLING.  The Oath of Hippocrates is our promise to patients and our obligation to each other as healers (as a ‘profession’) - a covenant.  Your added studies in Public Health expanded your perspective and provides you with tools not available to your colleagues without your training.  Use your knowledge and tools wisely.

“Seventh, BE TRUE TO YOURSELF - DO NOT COMPROMISE YOUR PRINCIPLES.  Your integrity is priceless.  Do not sell-out.  No amount of money or power can buy or restore your integrity once you lose it.  Stay alive.

“Finally, I want to leave you with a quote that I find particularly inspiring and hangs on my office door.  It is from Howard Thurman a theologian and civil rights activist: ‘Don’t ask what the world needs. 

Ask what makes you come alive and go do it.  Because what the world needs are people who have come alive.;

“Thank you and congratulations again”.

Side Bar

The Prayer of Maimonides

Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.

Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.

Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.

Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of officious relatives and know-all (colleagues) nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.

Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.

Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!

Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.

Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed. - Translated by Harry Friedenwald, Bulletin of the Johns Hopkins Hospital 28: 260-261, (1917)