"Forty years ago next month, I stood where you stand today. As I on that day, so you today begin to incur a debt of gratitude to the state of Texas, your School of Medicine, your professors, your colleagues, and your family. That debt is for the privilege and honor of being a physician. From now, your life will be a collage of your efforts and of those who will contribute a part of their lives to yours. Make certain that you are a good steward of that investment.

"The debt of gratitude which you will incur over the coming forty-eight months and the years thereafter, can only be satisfied by the living of a life of honor, of nobility and of service to others

"All of you have the ability to succeed in medicine. Some of you have the ability to excel. Only you, with your diligence, devotion and determined persistence will determine into which group you will fall. Today, you would do well to remember the words which Charles Dickens put into the voice of David Copperfield: 'Whether I shall turn out to be the hero of my life or whether that station will be held by any body else these pages must show.'

"In regard to your medical career, you are a kind of tabula rasa, an empty slate, upon which you will write a story which will reflect credit upon your school, your teachers, your profession, your family and upon yourself. Only you can write that story. Write it well.

"Today, I charge you as the Master of Caius College, Cambridge University did the freshman class almost 100 years ago; he said: 'Let me exhort you. Examine yourself. Let each of you discover where your chance of greatness lies. Seize this chance. Rejoice in it and let no power or persuasion deter you in your task.'

"In four years, I or my successor will welcome you to the Alumni Association and to the opportunity for you to serve your School of Medicine with your reputation, achievement and with gifts of your monetary resources.

"Congratulations in being here today. Wear your white coats with dignity and pride. I and 6,000+ of your alumni colleagues wish you God speed."

"Good morning … and a warm welcome to the Medical School Class of 2013. What an extraordinarily exciting time this is to be entering the medical profession. One reason is the continued exponential growth in knowledge and opportunity. For those of you who are coming to medical school straight from college, you were middle school students 9 years ago when the Human Genome was fully coded. As science moves forward, genomics and the promises of personal and regenerative medicine are driving changes in how we practice.

"A second reason for excitement is that for the first time in seventeen years our Nation is having serious meaningful conversations about healthcare reform - our current system simply fails to meet the basic health needs of our entire population. From my perspective, we must train more primary care physicians and specialists in Geriatrics and Palliative Medicine to successfully meet the challenges ahead. We must re-emphasize the relational aspects of medicine - the joy, satisfaction, and quality-of-care that comes from serving as a patient's physician over long periods of time. Whatever changes are implemented in the next few years will directly affect each of us as consumers of health care and how, as physicians, we work with our patients.

"Over the next four years, as you build your foundation of medical knowledge, you will find that the Health Science Center is a great place to study, learn, and work. As I was preparing these comments, I wanted most of all to convey concisely some things that will be useful to you in your medical school careers. So here is a list of seven actions you can take that will help you succeed:

• One: Learn how to learn. There is simply too much information to master and it is constantly and rapidly changing. It will be essential for you to identify and develop strategies for finding information, evaluating its validity, and effectively incorporating it into your practice. Work on those learning strategies.
• Two: Make peace with not knowing everything. It is impossible to know all the facts and have answers to every question you will encounter. Avoid the tendency to make educated guesses about subjects you know little about and presenting them in assured answers as fact. When you don't know the answer to a clinical problem, especially when the question comes from a patient, admit it. You will be respected for your honesty and recognition of a knowledge gap. When these gaps occur, and they will, assure the patient that you will tirelessly investigate the topic and get the information for them. Do not be afraid to ask for help when you need it, especially when the welfare of a patient is at stake. The most valuable skill you can hone is the capacity to ask good questions.
• Three: Deal with mistakes constructively. You will make mistakes; we all do. Perhaps the major difference between you and me is that I've made more mistakes than you. When you make mistakes recognize them, acknowledge and take responsibility for them, learn from them, and don't repeat them. I don't mind honest mistakes, but I hate making the same mistake twice.
• Four: Pay attention to what resonates with you. Medicine is an increasingly diversified endeavor. Some areas will excite you, others will bore you. Some will feel natural, others will feel alien. As you participate in class and work through your rotations, when you find something that you really enjoy, something you can't get enough of, embrace that feeling. When your personality, temperament, and skills match an area and you feel fulfilled, pay close attention. That's likely to be a specialty that you can feel passionate about; a specialty that can sustain you across the span of your careers.
• Five: Take care. This operates on three levels. The first is simply the 'Golden Rule of Medicine' - take care of your patients the way you would want to be taken care of. Do your very best for them and never forget that one day you may need the skills and services of a physician to help you deal with illness. Second, take care of each other. Medical School is a formative experience and you are all in this together. This is not a competition - you don't get a Yellow Jersey at the end of Medical School - you get a diploma. Support your classmates and help each other out. Third, take care of yourself and your family. You will be physically and emotionally challenged by Medical School - you will work really hard, however you must be sure to sleep, eat, exercise, and have fun.
• Six: Don't be seduced by the dark side of the white coat. The white coat is a symbol of scientific knowledge, compassion, and professionalism. However, the white coat can also be a symbol of authority. Never use the white coat to become authoritarian; never let it become a barrier between you and your patients; never hide behind it and let it be a refuge when you are in difficult situations. Your uniform should always represent hope, trust, and honesty for the people you serve.
• Seven: Express Joy. Your professional lives will be crammed with human sights, sounds, smells, and experiences - many of them will be difficult, many will be uplifting. When something good happens, share your joy - take that positive energy and pour it back into your work and life. Patients and families need their doctors to stay engaged and to sustain them through life threatening times - even when the odds of recovery are long. You may not be able to cure someone; you still have the responsibility to care for them, and thus help them heal.

"Remember that each member of the faculty is intensely invested in your success; we all look forward to learning with you in the years ahead. Let me leave you with this haiku for your time in medical school and your careers as physicians:

Attempt with patience;
Achieve with humility;
Enjoy Medicine!

"Godspeed to all of you."