Guest Commentary
UP FRONT
Advice for the Graduating Hematologist
Richard T . Silver , MD , has been a hematologist and scientist for more than six decades , spending nearly his entire career at Weill Cornell Medicine in New York . Still practicing at age 89 , Dr . Silver was invited earlier this year to deliver remarks to the 2018 graduating class of hematology / oncology fellows at New York-Presbyterian Brooklyn Methodist Hospital . We excerpt his speech below , in which he offers advice to new graduates from a lifetime spent in hematology .
hen I was asked to collect some thoughts to share with hematology / oncology trainees upon completion of their fellowship , I thought back on my experiences and the attributes that are essential to a successful career in medicine .
Later , when you reflect on what I ’ ve said , I hope you don ’ t discard it as “ the same old stuff .” However , if you do hear familiar points , that is not an accident . There are generational truths that are true now and were true for our forebears , physicians or not . And , if you hear something new , it is because my professional and personal life is colored by my own unique features – as yours will be in the coming years .
Hopefully – and more likely – you ’ ll find that the advice I offer is a combination of both , because the more things change , the more they remain the same . But they do change . As physicians and human beings , we all share a common core of values that is modified by our own personal experiences and beliefs . And that is as it should be .
The Three A ’ s
Through my years of observation , I developed a list of important attributes , what I call “ the three A ’ s ,” that I feel are necessary to lead a successful career and that I believe will sustain you as young physicians .
The first of “ the three A ’ s ” is availability . When a patient or colleague has a problem and asks “ Who should I call ?” the answer is to call the doctor who is always around and who is a nice person . No one ever recommends calling someone because he or she reads all the latest medical literature each month or graduated at the top of his or her medical class .
Recently , I tried to call one of our service ’ s busy gastroenterologists to discuss a patient she referred to me . I wanted her opinion about starting ruxolitinib in a patient who had myelofibrosis , splenomegaly , and ulcerative colitis . I am still waiting for the call back . I assure you that this is not a good way to maintain a consultation practice , let alone develop one .
The second attribute is affability . One of the most successful attending physicians I ever encountered as a young clinician was dapper , charming , and impeccably dressed . He had a huge practice ! He knew little about medicine , but he loved to practice it . He accompanied his patients to a consultation whenever possible .
Today , we would say he had a concierge practice : He was always available , and he was super-affable , but he really lacked the last “ A ”: ability . Of course , you all have ability – you wouldn ’ t be graduating if you didn ’ t .
Ability is related to “ smartness .” Never worry about whether people are smarter than you , or if you know enough . I guarantee you , there are many people smarter than you . You will likely never consider yourself smart enough to satisfy your own expectations . Indeed , in The New England Journal of Medicine , Suzanne Koven , MD , published a “ Letter to a Young Female Physician ” describing the problem as “ imposter syndrome .” This insecurity rears its head when young physicians are convinced that everyone else but them understands secondgeneration sequencing or the coagulation cascade . You may think you aren ’ t smart enough or you don ’ t know enough , so accept the fact that you will certainly never know everything .
Many years ago , I thought the guy who was constantly asking questions and admitting when he didn ’ t know something was the dumbest guy in my medical class . How surprised we were when he gave the AOA address as the top member of our class .
Just realize that you live in a world of ignorance , and don ’ t be frustrated by it . If someone makes a snide remark because you didn ’ t know something , don ’ t take it personally . No matter what your rank or position , never be afraid to say , “ I didn ’ t know that ,” or “ Thanks for telling me that .” I still do it all the time .
Never Stop Exploring
Remember that , even after all your great training , you are just at the beginning of your careers . And , one of the remarkable things about a medical career is the number of opportunities available to you . So , keep exploring and trying new things .
The best opportunities happen by chance and often you don ’ t realize they are coming . On the other hand , if you push too hard for things to happen , most often they will not .
For instance , when I was a second-year resident , I was absolutely convinced that I would become a great cardiologist . Mandatory military obligation for all physicians during the Korean War , however , led me to the General Medicine Branch of the National Cancer Institute ( NCI ). Because I was not able to serve in the armed forces , the compromise was that I serve as an intern on the leukemia service – an unpleasant prospect for a second-year resident from a hot-shot , white-shoe hospital who wanted to be a cardiologist . At that time , the NCI ’ s clinical program was considered the gulag of all the institutes , but it was a “ take-itor-leave-it ” situation , so I took the opportunity and worked hard . My mentors were Emil J . Freireich , MD , Emil Frei III , MD , and James Holland , MD .
It was the dawn of chemotherapy , and they were the fathers .
After I completed my training , I was asked to go to Salvador , Brazil , to help set up a residency program at the Federal University of Bahia . I had the opportunity to go to on an expedition to the Mato Grosso , the Upper Xingu region , where we discovered the third allele in the Kidd Blood Group system . Because of this , I was invited to join The Explorers Club , one of the most interesting clubs on earth . Here I ’ ve met Sir Edmund Hillary , all the astronauts , and the deep-sea divers who discovered the wreck of the Titanic . Through my adventures in medicine , a new unexpected dimension had been added to my life . So , remember that your lives are a series of experiences . Embrace and take advantage of new things as they occur , by chance or otherwise .
An Unavoidable Truth
As Mark Twain said , “ The only place where success comes before work is in the dictionary .” Obviously , you have worked hard to get to this point ; that hard work doesn ’ t end with fellowship .
If you want to build your career , be prepared to go through dark and painful moments . Engage in the struggle . Nothing comes out of easy days . Be very conscious of how you spend your professional time and try not to waste this precious commodity . Make your work meaningful and do not fool around . If you do any research as clinicians , plan how you will be included as a co-author – not as a footnote – and how your effort related to the paper will be included before you get involved .
Remember : Success is not a race . You should always feel that you are continually growing . In fact , I have done some of my best research work after I turned 60 . But , when you try new things , and you have done your level best and it is still not working , learn when to let things go – especially before you turn 50 .
In closing , if you believe you have found a meaningful calling , and you commit to it because of your enthusiasm for your work , all good things are possible in medicine . Nothing is more meaningful , and if you can adjust to the external trivia of today ’ s climate and its limitations , you will have a satisfying professional life . Not many folks can say that . ●
Richard T . Silver , MD , is professor of medicine , attending physician , and emeritus director of the Richard T . Silver , M . D . Myeloproliferative Neoplasms Center at Weill Cornell Medicine in New York .
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