2012 Convocation Ceremony of the Royal College of Physicians and Surgeons of Canada

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Ottawa, Ontario, October 19, 2012

I’m touched to be made an honorary Fellow and delighted to join all of you for this wonderful celebration of achievement.

Congratulations to this year’s award winners, certificants and Fellows. As a newly minted Fellow myself—though a gratuitous one—I applaud you for the discipline, devotion and downright smarts you surely showed to become the Royal College Fellows class of 2012.

I wish I could say the same about my efforts. Unlike you, I took the easy route. All I had to do to earn my Fellowship was become governor general. Piece of cake.

As Canada’s governor general, I receive invitations from hundreds of organizations each year to speak at their gatherings. I must decline nearly all of these invitations. I simply don’t have the time or the resources to meet every request.

I accepted your invitation for several noteworthy reasons. To start, I respect the medical profession deeply. It’s a bellwether of our collective efforts as Canadians to build a smarter, more caring country. I believe we all agree that no measure is more representative of a society’s success than the physical and mental health of its people.

I also respect your profession because it attracts our country’s most talented men and women. I find it only natural that more members of the Order of Canada—our country’s most intelligent, accomplished, generous citizens—come from the medical profession than any other field.

Another reason I accepted your invitation is because of the importance to Canada of the health of your organization. The Royal College of Physicians and Surgeons of Canada is our country’s largest speciality organization—more than 42,000 Fellows from 60 medical and surgical specialities.

As our country’s leader in training and evaluating medical and surgical specialists, your influence extends well beyond the frontiers of your organization. Your decisions, actions and example resonate loudly and widely to other healthcare groups across Canada.

So, just as your profession is leading our efforts as Canadians to build a smarter, more caring country, your organization is one of a small collection of groups that stand at the head of the medical profession’s efforts to build a smarter, more caring profession.

For this reason, I hope that what I say here tonight will reverberate throughout the medical profession. Knowing that, I direct my remarks not only to you, Royal College Fellows, but also to all healthcare providers in our country.

I mentioned the Order of Canada a little earlier. The motto of the Order of Canada and the inspiration of recipients is, “They desire a better country.” Since my installation as governor general, I’ve been challenging Canadians across the country to give a gift to our country on the 150th anniversary of Confederation by imagining what a smarter, more caring country might look like in 2017, and then taking action to turn that vision into reality.

In that spirit, I ask you—the medical professionals here tonight and thousands of your colleagues beyond these walls—to make a gift to our country for its 150th birthday. I have a particular gift in mind: I want you to take steps to make the highest level of professionalism an explicit, living creed for all who practise medicine in Canada.

Why do I insist on provoking Canadian medical professionals to carefully scrutinize your understanding of professionalism and ensure healthcare providers demonstrate the highest level of professionalism every day of their working lives? Because you’re part of a social contract with Canadians.

This contract is founded on three elements: specialized knowledge that is taught formally and under supervision; the right granted to you by the state to control standards and competence; and a responsibility to society that obligates you to serve the public good.

This contract gives medical professionals in our country a monopoly. In return, you are duty bound to serve your patients competently, improve the practice of healthcare and enhance the common good. That’s the deal.

What happens if you fail to meet the obligations under the social contract? Canadians will change that contract and redefine professionalism for you. Regulations and changes will be forced upon you—quite possibly in forms that diminish or remove your self-regulatory privilege.

One of the best ways for you and for men and women in any profession to avoid having change forced upon you is to relentlessly embrace new ideas, tenaciously set and reach higher standards and, most importantly, passionately strive to ensure your profession serves the public good.

I can best illustrate this point with a story. Many Canadians will know of Dr. Thomas Roddick, a distinguished surgeon. The entrance gates at McGill University are named for him, as are the beautiful reading room and archives at your organization’s headquarters.

After studying at McGill in the mid 19th century, Dr. Roddick went to the University of Edinburgh to study with Dr. Joseph Lister, who pioneered the use of carbolic acid to disinfect bandages, surgical instruments, operating rooms and surgeons’ hands. Roddick returned to Montréal to open a third operating room alongside the two senior professor surgeons who had taught him at McGill before his Edinburgh enlightenment.

In his first two years of practice, Roddick’s patients’ mortality rate from surgery was less than two percent—all because of the germ-killing power of carbolic acid, with which he bathed his operating room. The two senior surgeons—who refused to use the substance—experienced mortality of more than 20 percent among their patients due to cross-infection.

At this point, Dr. William Osler, who Canadians know as a giant of your profession, then a young McGill professor, intervened and threatened to publish the comparative statistics in the local newspaper if the two senior surgeons persisted in their refusal to use carbolic acid. They relented. The mortality rates experienced by their patients dropped immediately and impressively.

We draw several lessons from Dr. Roddick’s experience. As medical professionals, you must remain open to best practices from other jurisdictions within the profession. You must be particularly encouraging at and receptive to the ideas and energies of younger members. You must continuously promote evidence-based practice. You must use new knowledge to renew and raise professional standards. And you must always keep the public good foremost in your minds.

With respect to that last point, you must regularly ask yourselves what the public expects of your profession and how they interpret the actions of medical professionals. The trust of the public, like the trust of your patients, is vital to your work. And any member must stand prepared to use his or her judgment and intervene in any situation in which the public good is threatened or at risk. Remember: Osler, like Roddick, was a junior member of the profession when he made his call on carbolic acid.

My keen interest in your profession is a direct consequence of a cherished friendship and admiration for Sylvia and Richard Cruess—two extraordinary physicians who have spent the 15 years since their so-called retirements—Dick was dean of medicine at McGill and Sylvia was director of professional services at Royal Victoria Hospital—thinking deeply and writing compellingly for a global audience about professionalism in medicine.

One of my fondest memories of my time at McGill, where I was principal for 15 years, was the annual faculty of medicine convocation, at which Dick Cruess led the graduates in reciting their professional oath before their family and friends.

That oath and the Fellowship Declaration we affirmed this evening touch the core of my being. You must make sure the professional vows you take as physicians and surgeons are more than words uttered once in a lifetime. You must translate those words into practice every day of your working lives.

I commend the Royal College for living that declaration and making an enormous contribution to professionalism in Canadian medicine. Your leadership is most evident in CanMEDS. Through it, you’ve made professionalism a core element of accreditation standards, training objectives, final in-training evaluations, exam blueprints and maintenance of certification programs.

I’m thrilled to learn that your work is taking hold not only in Canada but also in many countries around the world, validating its worth and cementing your standing as a national and international authority.

I’m also delighted to see that you’ve taken additional steps to deepen and expand professionalism. You’ve spurred medical schools to designate champions of professionalism. You make lifelong education a reality for Fellows and embrace the potential of new technologies to expand learning. And you’re reaching out around the world to share what you know and receive the wisdom of others.

My question, my challenge to you, then, is straightforward to say but profoundly difficult and absolutely vital to achieve: What else can you do as an organization to deepen and expand the finest tenets of professionalism? What else can you do as a leader in your profession to promote and embed these tenets within all healthcare organizations and among all healthcare providers in Canada?

As a teacher by trade, I can’t help but make a couple of suggestions. Continue your efforts at home and internationally to share with other groups in Canada and medical authorities in other countries how you’ve used CanMEDS to embed professionalism in training, teaching and certification.

Reach out in particular to individual speciality societies in Canada and representatives of family medicine in our country. Many physicians, surgeons and practitioners have close allegiances to their specialty groups. Some of these groups aren’t pursuing professionalism with the necessary vigour. Make a determined effort to help them adopt CanMEDS for their members—for all physicians must aim for the highest professional standards.

Need proof? The journal Open Medicine reported last year that Canadian physicians who were disciplined recently had been in practice for an average of 29 years before the disciplinary action—a fact which suggests to me that Canadian medicine must place greater emphasis on professionalism among practicing physicians and not just trainees.

I also have a suggestion for the new Fellows in this room—my peers in the Royal College class of 2012. Use the energies of your relative youth to be catalysts within the Royal College and within medicine to ensure your profession continuously strives to serve the public good.  Constantly remember young Roddick and young Osler. Have your spiritual conversations with them. They are very good company.

The way healthcare is delivered is changing rapidly and profoundly. As emerging leaders of both the Royal College and your profession, remember that for most generations of medical professionals, what mattered weren’t any fancy tools or special pills they carried in their black bags. More often than not, the ailments of their patients were beyond any curatives. The foremost role of generations of medical professionals was to bring comfort, support and reassurance to their patients—an infinitely more difficult and delicate task than administering treatment. To do so, doctors relied on the most human of professional qualities: altruism, care, compassion.

In an era in which the primacy of technological and pharmacological treatments and the drive for cost-effectiveness and efficacy threaten to overwhelm your humanism, I urge new Fellows to uphold those essential values and behaviours. As you do so, bear in mind the words of Osler.

His legacy to the profession remains profound nearly a century after his death. He well knew the weight of the humanistic qualities of professionalism in medicine. “The practice of medicine is an art, not a trade,” he said. “A calling, not a business; a calling in which your heart will be exercised equally with your head.”

New Fellows—my classmates—heed Osler.   Use your heads and your hearts in equal measure. Never cease in the cause to make the highest tenets of professionalism a living creed for you and for all who practise your noble profession.