The commencement address that nobody asked for

These two middling authors have long hoped somebody would ask them to deliver a commencement. The fact that this is unjustified has not stopped them from writing one. The following is based upon “Everyone’s Free (to wear sunscreen)”, attributed to Mary Schmich. We encourage everyone to reflect, to refine, and to rebut.

Ladies and gentlemen: be kind. If we could offer only one tip for the future, “kindness” would be it. The long-term benefits of sunscreen may be supported by more scientific evidence, but kindness is required at all times of day and in every medical location. Admittedly, these ideas of “kindness” are based on our own meandering experiences as much as empiric evidence. Regardless, whether doctor or nurse, allied health worker, giddy trainee, or burnout curmudgeon, we humbly dispense this advice.

Enjoy the incredible opportunities to learn, and to grow, even if you feel scared about what is ahead, or are counting the days to blessed retirement. Oh never mind, most of us are too sleep-deprived to truly understand how lucky we are. Trust us, you will look back at how much possibility lay before you and what a unique ride you went on; especially, if your pension still exists and the children still talk to you. You are not the imposter you imagine. You are good enough.

Don’t worry about the future, or if you do worry, know that constant worrying is as effective as trying to reverse terminal illness with CPR. The real troubles in your life are apt to be things that never crossed your distracted mind: Like those things that blindside our trauma patients at 4am on some idle Tuesday. Be grateful and find meaning in just being present. You do make a difference.

Do (more than) one thing every day that challenges you. Speak-up, but also be mindful. Don’t be reckless with other people’s hearts…or lungs or kidneys. Don’t put up with others who are callous or have lost the plot. Don’t waste time on jealousy: Sometimes you’re ahead, sometimes you’re behind, and often you’re underappreciated. Good healthcare professionals are simply good people, and ultimately, you only compete against yourself. Realise that you are more than just your job.

Remember compliments and forgive the insults. If you succeed in doing this, share how you did it. Keep your thank-you letters, and sit on angry emails. Laugh often but not at others expense. Don’t feel guilty if you don’t know what to do next with your career. The most interesting registrars didn’t know at thirty what they wanted to do. Some of the most interesting professors still don’t. Get enough rest. Build teams, and respect senior nurses, you will miss them when they’re gone.

Sometimes you win, sometimes you’ll learn.

Maybe you’ll become a clinical director, maybe you won’t.

Maybe you’ll publish in the New England Journal, probably you won’t.

Maybe you’ll finally tell administration where they can stick it.

Whatever you do, don’t congratulate yourself too much, or berate yourself either. Good choices include lots of dumb luck and teamwork. Bad choices require compassion from others and from yourself.

Enjoy your ability to influence the future. Write. Create. Don’t be afraid of what other people think of your ideas. Your mental dexterity is as important as your procedural dexterity. Accept that people cannot know what you are thinking unless you tell them, but understand nobody will listen unless you are respectful.

Exercise: even if you have nowhere to do it but your own office. Listen as actively as you speak. Celebrate the team even if you did all the work. Read complex journals not just easy tweets and blog posts. Remember that we still need proper science, and it still needs us.

Get to know your patients as people first: they need to know you care. Be nice to your teachers, they are your best link to your past, and they have lived much of your future. Accept that clinical fads will come and go (and come again), but patients will always need doctors and nurses who give a damn. Work hard to bridge the gaps between privileged staff and vulnerable patients. After all, the older you get, the closer you move from bedside to bed. Work in a University Hospital but leave if it makes you aloof. Work in a rural centre, but leave if you stop advocating.

Accept certain inalienable truths: None of us fully embrace changes, “it” is rarely entirely pointless or amazing, and none of us is irreplaceable. When you do retire you will fantasise that when you were young: change was easy, common sense reigned, and you were unique. Say “thank you” and learn the names of the cleaning staff. Be known as the person who delivers tea and empathy. Be a custodian of values not just a janitor. Create a legacy but don’t expect one.

Enjoy diagnostic challenges, but don’t expect patients to be interesting for your benefit. Maybe you will invest your money well, and maybe you will marry well. Regardless, you never know when either one will run out. Don’t tell people to leave you alone because they might do exactly that. Be careful whose advice you co-sign, but be respectful with those who offer it. Advice is an easier drug to prescribe than to swallow…but trust us on the “kindness.”

Acknowledgement: Our wives who support our goals and tolerate our hypocrisy.

Peter Brindley, professor of Critical Care Medicine, Anesthesiology and Pain Medicine, and Health Ethics, University of Alberta, Edmonton, Canada. @docpgb

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan