Berwick reminds next class of doctors of their responsibility

Several weeks ago I got an email from a Democrat on the Hill that said, “This might make you cry, right there at your desk.” She attached  an essay by Donald Berwick in the Journal of the American Medical Association.


Donald Berwick

I  saved the email but didn’t open it right away. It was a busy day  in a busy month; I’ve heard Berwick speak often, during and after his stint as the head of the Centers for Medicare and Medicaid and when I was lucky enough to attend Institute for Healthcare Improvement conferences and  hear  his soaring, provocative keynotes.  And I had just spoken to him myself a week or so earlier, after the Supreme Court ruling.  I promised myself I’d read this. But later.

August finally arrived, work quieted down (sort of) and as I was trying to slash and delete  my way through the email jungle, I found the Berwick essay.  I clicked.  The person who sent it had been right. I cried right there at my desk.

It was his commencement speech to the graduating class of Harvard Medical School this spring, and it seems on the 40th anniversary of his own HMS graduation.

“You will soon learn a lovely lesson about doctoring; I guarantee it. You will learn that in a professional life that will fly by fast and hard, a hectic life in which thousands of people will honor you by bringing to you their pain and confusion, a few of them will stand out. For reasons you will not control and may never understand, a few will hug your heart, and they will become for you touch points – signposts – like that big boulder on that favorite hike that, when you spot it, tells you exactly where you are. If you allow it – and you should allow it – these patients will enter your soul and you will,  in a way entirely right and proper, love them. These people will be your teachers.”

One of his teachers was a patient he called  Isaiah.

He was a tough street kid, in and out of jail, who smoked dope at age  5 and had a gun at 10.  A Roxbury kid who developed and survived leukemia, who went into and then came out of remission, who endured and survived a bone marrow transplant, who beat the leukemia  but not the streets.

“And Isaiah died. One night, 18 years after his leukemia was cured, at 37 years of age. They found him a on a street corner, breathing but brain-dead from a prolonged convulsion from uncontrolled diabetes and even more uncontrolled despair.”

Berwick’s point? Not that doctors have to do a better job at controlling diabetes. Not that Isaiah made bad choices (though he did). Not that doctors can’t always control what happens to their patients.  A much larger point.  That doctors, even young doctors starting out in the profession in  an era of worrysome change, must have a moral compass.  And that patients like Isaiah point the way.

“This is my message from Isaiah’s life and from his death. Be worried, but do not for one moment be confused. You are healers, every one, healers ashamed of miseries you did not cause.  And your voice – everyone – can be loud, and forceful, and confident, and your voice will be trusted. In his honor – in Isaiah’s honor – please use it.”

Here is a  link to a PDF of the  first page of his essay. AHCJ members can get free access to JAMA.


Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to

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