“If It Isn’t Fun.” – The Amenities
Abstract of the 1948 Tulane Commencement Address by Harold Cummins
(published with permission of The Bulletin of the Tulane Medical Faculty 7: 4, 1948.)
“As members of this class you have completed four years in the School of Medicine and, before that, two, three or four years in college preparation. You have studied subjects whose names run the gamut of the alphabet – from anatomy to zoology. But you will search the records vainly for someone who has had a course on “The Amenities,” for there is no such course. Each one of us must have learned whatever he knows of the amenities only by informal precept and by example in the home and in the school. That you are here today is evidence that you have satisfied the many exacting requirements of the School of Medicine, but there is one requirement of the profession your teachers have not tested. It is the practice of the amenities. Your friends and relatives know to what extent you possess these traits; your patients will know, and they will justly charge you with default or admire and respect you. They will lose or gain benefits from you in accord with your manner of dealing with them. Constant and searching self-examination is the only safeguard against infractions of the amenities. Their practice should not be merely superficial, or casual, but must be deeply ingrained and so much a part of every one of us that there can be no double standard of action – gentleness for some, and harshness and lack of consideration for others. The physician who affects graciousness in his relations with favored patients and particular friends, and who discards it in his dealing with others, will sooner or later reveal his true colors in quarters where he would wish to hide them.
What ideal do we set for the man of medicine? He must have knowledge and skills, of course, likewise character, honor, selflessness and devotion to the service of fellow men. Human frailties being what they are, perfection of the man is unattainable, yet only with perfection as the goal can one ever hope to near it. ….. The doctor above all must not be ignorant and inept in the prevention and treatment of disease. He must not be a man of questionable character and honor, or one who is unable to make the personal sacrifices demanded by his profession. The amenities cannot compensate for failings such as these.
It is generally realized that medicine is not only a science but an art as well. Practitioners exercise tact, discretion, judgment and other qualities that apply in life generally, but the situations in medicine are peculiarly demanding. It may be argued that observance of the amenities is part and parcel of the art of medicine, but I venture to claim that the amenities belong truly to the science of medicine. Their effects, and the harm that comes from disregarding them, are as observable and as well proved as the results of a therapeutic measure and the untoward consequences of its neglect.
And let it be emphasized that the amenities are expressed not alone in what we say and do, but in our very appearance and manner. Oliver Wendell Holmes [ Supreme Court jurist and physician], in a stanza of his poem, “The Morning Visit,” makes the point so tellingly that I bring it to you in his words:
And last, not least, in each perplexing case,
Learn the sweet magic of a cheerful face:
Not always smiling, but at least serene,
When grief and anguish cloud the anxious scene.
Each look, each movement, every word and tone,
Should tell your patient that you are all his own.;
Not the mere artist, purchased to attend,
But the warm, ready, self-forgetting friend,
Whose genial visit in itself combines
The best of cordials, tonics, anodynes…
A few days hence, President Harris will confer upon each of you in this class the degree of Doctor of Medicine. ….we have confidence in you. I hope fervently that your patients will have the same affectionate regard for you that I hold for a physician who has attended my own family. It has been said of him, “When he enters, a blessing descends upon this house.”
To Harold Cummins, science and the humanities were inseparable.