How Teams Are Built

Dr. Wayne Gandee gives the keynote address at the Class of 2015's White Coat Ceremony

Dr. Wayne Gandee, chief medical officer for Carilion Clinic, served as the event's keynote speaker. His speech's theme was "How Teams Are Built." (October 28, 2011)

Welcome to one of the unique events in your life. Today is a milestone in your journey through this world, a moment of acknowledgement, recognition, and elevation. You are on the verge of joining exalted company. Congratulations.

The White Coat Ceremony is an important event not only for medical students, but also for the families, friends, and supporters who have contributed to their safe and successful passage thus far. Whether your support teams came today from a long distance or nearby, or attend in spirit, they want to celebrate with you. Your journeys are measured not in miles or kilometers, but in accomplishments and gains over years and generations.

Speaking from experience, this is a celebration of mutual effort and mutual success. Six years ago, my wife and I were fortunate to attend our daughter’s White Coat Ceremony. We had contributed to her achievements, and we were eager to celebrate not only her success, but ours as well. So imagine our chagrin when, traveling north on Interstate 81 that day, we crested a rise in the highway, just past an exit ramp, to discover that both northbound lanes were completely blocked.

My wife has always been moderate, sensible, law abiding, and aversive to risk (none of which explains why she married me). But in that moment, fearful that she would miss the ceremony and celebration, she transformed: “Take that ramp!” she said.

“That’s not an exit ramp,” I replied. “It’s an entry ramp to the interstate.”

“Take that ramp, or I’ll stab this knitting needle into your good eye!”

I wasn’t worried about her stabbing me; I don’t have a good eye. But, because I, too, wanted to celebrate this life passage, I maneuvered between the stopped cars and trucks, and drove the wrong way up an interstate entry ramp, into oncoming traffic, and onto the adjacent secondary highway. A motorcyclist, stopped among the other vehicles on the interstate, just shook his head at the idiocy he was witnessing.

Now, I neither condone nor recommend this lawless behavior, but we did arrive in time to see our daughter receive her white coat. We cherish the memory of that celebration. (Two other couples from Roanoke, heading to the same event, remained stuck in the traffic jam and missed the ceremony.)

The white coat is emblematic of integrity, good character, honesty, compassion, and empathy. It represents the special knowledge and unique skills that set you apart. It conveys hope and reassurance.

Today’s White Coat Ceremony marks your inclusion in a hallowed group. Others will present your new white coat, and supportive mentors and models will enrobe you. The coat embracing you will signify inclusion in the noble profession of medicine extending to the time of Hippocrates. By willingly accepting the white coat, you also accept the fiduciary obligation to put your patient above self and to be an advocate for patients and their needs. Special knowledge begets special responsibilities. It is on the basis of this psychological contract that society grants you place, privilege, and respect.

Sometimes the white coat can erect a barrier between patient and physician, so be kind, be tolerant. Acknowledge your patients’ anxiety. There is an old adage in medicine: If you listen, patients will tell you what is wrong with them. Listen and learn to communicate with them. While we emphasize the science of medicine, the art of medicine is in overcoming that white-coat barrier to care for the patient while taking care of the patient.

With your white coat, your lives will change in ways that you can hardly imagine today. You will be accorded credit and blame, not always earned or deserved. You will make miracles—and mistakes. Yet you will carry on and learn from both. Have high expectations of yourself and others. The secret is to be willing to be bad at something long enough to get good at it. Patience is required because, as medical students, you are rookies on the health care education team. But you are not alone.

Health care education and delivery today are based on collaboration, communication, and coordination. Gone are the days of solo practice. No one practitioner can know it all. According to an Institute of Medicine report, “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team …” The term “interprofessionalism” means that two or more health professions or disciplines are working together to provide high-quality and high-value patient care. We all have a common purpose—to provide better patient care and better population health at a lower cost. By combining our different educational backgrounds and clinical experiences, we can achieve these goals.

Your lives changed when you were accepted into medical school. Commitment, sacrifice, and perseverance have brought you this far. Previous independent academic achievement now gives way to team-based learning.

I witness, on a daily basis, the benefits and joys of teamwork, based on mutual purpose, mutual respect, and mutual trust. Partners and teammates care about each other’s needs and interests, and they have each other’s backs. That’s how teams are built.

Interpersonal relationships form the foundation of interprofessionalism. I am blessed each day to work with wonderful people, many of whom are here today. For me, they provide the joy of work. Yet too often I forget to say, “Thank you”; “You really matter to me”; “I’m glad you’re here”; or “I am grateful to be working with you.” Healthy one-on-one relationships require personal interaction; civilized, shared conversation; and a willingness to listen and learn. Relationships are built and maintained one interaction at a time. Get into the habit of acknowledging and appreciating those around you. Let your colleagues know that you are aware of their efforts, recognize their goodness and good work, and demonstrate your respect. That’s how teams are built.

When we invite new members to our team, we are recruiting not just for a section or department, but also for the entire organization. We seek individuals of excellent character and integrity who want to work in a friendly, collaborative environment to be advocates for our patients, consultants for each other, and ambassadors for team-based interdisciplinary care in an integrated health care model. Clinical and academic compatibility are essential, but harmony of culture and values is paramount. That’s how teams are built.

How do you become a good team player? Articulate your concerns and questions, challenge each other’s assumptions, declare your biases, share your perspectives, and participate in great conversations. Be humble and be supportive. Let others preach your sermon, but give them something good to preach. Acquire confidence through education and experience. Avoid arrogance, even if you have a superlative academic or administrative portfolio. Don’t be the physician about whom others say, “You can tell him, but you can’t tell him much,” or “Not always right, but never in doubt.” We all have limits of knowledge. If you don’t know, ask. If you’re asked and don’t know, say so. Then seek the answer. You’re smart; you’ll figure it out. Tell the truth … it’s easier. Keep your pledges and promises. That’s how teams are built.

By integrating educators, physicians, hospitals, and technology with a common focus on patient care, we will collaborate to answer in the affirmative each patient’s fundamental concerns: Will you take care of me? Will you take care of my family? Will you help me learn to take care of myself?

Patients should not have to decide which specialty or specialist is best to provide their care. That is our job. We do that through multidisciplinary collaboration and coordinated, patient-centered care. That’s how integrated health care delivery systems are built.

Sometimes the concepts of collaboration and teamwork across disciplines necessitate a reevaluation of our expectations and, in some cases, a change in our behaviors. We become part of the whole yet remain individual. This dynamic process is reflected in several words and phrases: “we” not “me”; “ours” not “yours and mine”; “yes” instead of “no”; and “I will” rather than “I won’t.” That’s how teams are built.

Doctors tend to be competitive and perfectionistic. The work we have chosen is both gratifying and burdensome. The results we achieve are both uplifting and demoralizing. When you find you don’t like your circumstances, be careful to avoid self-destructive behaviors that will compound your misery. Find a confidant, friend, coach, or counselor. Exercise; listen to and play music; ride a motorcycle; enjoy a good meal with friends; take a hike or a hot bath; find someone good to love. If you choose something that you can do in public, and it’s okay for your parents and significant other to know about it, then you’re probably on the right track.

In other words, to quote Robert Fulghum from All I Really Need to Know I Learned in Kindergarten, “… it is still true, no matter how old you are—when you go out into the world, it is best to hold hands and stick together.”

Dr. Wayne Gandee is the executive vice president of Carilion Clinic, where he is also serves as chief medical officer.