New Zealand Medical Students' Association Conference

I begin by greeting everyone in the languages of the realm of New Zealand, in English, Māori, Cook Island Māori, Niuean, Tokelauan and New Zealand Sign Language. Greetings, Kia Ora, Kia Orana, Fakalofa Lahi Atu, Taloha Ni and as it is the afternoon (Sign)

I then specifically greet you: Oliver Hansby, President of the New Zealand Medical Students’ Association and your executive, notably conference convenor Rupert Nelson; Robert Marshall, President of the Australian Medical Students’ Association; Distinguished Guests otherwise; Ladies and Gentlemen. 

Thank you for inviting me to give the closing address to the 2011 New Zealand Medical Students’ Association annual conference here at the University of Auckland.

My own career—as a lawyer, Judge, Ombudsman and now Governor-General—as might seem clear has had strong legal thread, but the work of those in the health sector has always held an abiding interest for me. 

This is perhaps because my parents were both health practitioners—my mother being a Karitane nurse, and my father a general practitioner in Ponsonby and later in Glen Innes here in Auckland and, in due time, a fellow of the Royal College of General Practitioners.

Secondly, it is perhaps because the law was not my initial career choice.   My own plan "A" was to follow in family footsteps and pursue a career in medicine.  So in 1964, I enrolled as a medical student at the University of Otago Dunedin.   I soon, however, realised that medicine was not a calling in which I would flower, and I returned home before then commencing study towards my law degree at this University.

While I abandoned that initial plan, throughout my subsequent career I have had the opportunity to remain connected with a great many contemporary medico-legal matters.  One example is the 16 months I spent chairing, six years ago at the Government's request, the Confidential Forum for Former In-Patients of Psychiatric Hospitals. This was a first for New Zealand, adding a 'truth and reconciliation' element into dealing with issues that people wanted to raise about their experiences with psychiatric hospitals – as patients, family members or staff. 
 
Upon being appointed Governor-General in August 2006, I agreed to become Patron of a number of organisations that actively work in the health sector including the Royal New Zealand College of General Practitioners, the Royal Australasian College of Dental Surgeons, the Royal Australian and New Zealand College of Psychiatrists, the Plunket Society, and the AIDS, Heart, Kidney and Asthma Foundations, to name but a few.  On reflection, I suspect there are only a few parts of the body or its maladies that are not covered by Governor-General patronage!    

I also speak today as a former patient some of it having been “full-on”. After a road accident in July 2002 and an odontoid fracture of C2, I spent three months in the "derrick round the head" environment of halo traction equipment.  The indentations in my forehead are constant reminder of that time!

These layers of perspective have provided me with some considerable appreciation for the work undertaken by health professionals.  Having, hopefully, thus established a place to stand before you, I want to emphasise some of the challenges and opportunities medical students face as you head toward a career in medicine.

As medical students, you will no doubt be posed the question going “Are you going to be a specialist or just work in general practice?”  That is a question which some think may verge on the insulting.  If I could offer a view, as the son of a GP, and from my own professional experience as a lawyer, it is to not be rushed into making this sort of decision.  An internationally recognised strength of New Zealand’s medical education is the depth and breadth of training it provides.  It gives a wide appreciation of many aspects of practice, without forcing students to choose a career option too early.  Medicine, like any profession, offers many career choices, some of which may not be immediately apparent when one begins training.  It is important to remember that all forms of medical practice have their reward.

Whether working as a specialist or in general practice, medical practitioners face growing expectations from society.  The standards expected from a professional—whether doctor, lawyer, nurse, accountant, or business person—are higher today than they were even 20 years ago.

Those expectations include being knowledgeable of the latest developments your field and accordingly continuing professional education is important in any field.  As a lawyer and judge, I was involved in a number of initiatives in this country for continuing legal education and judicial education. When I was appointed as a Judge in 1982 there was almost no training at all.  It was expected in accordance with a traditional view that having worked as a lawyer, by osmosis you would know how to be a judge.  Thankfully those days have past and those early initiatives have been formalised into an Institute of Judicial Studies, which provides education programmes as well as promoting judicial excellence.

Promoting excellence in medicine is particularly important where, as a scientific endeavour, the boundaries of knowledge are growing at an exponential rate.   

Promoting excellence in health also means being conscious of your own wellbeing.  In just the same way that no lawyer will ever do their case justice by representing themselves—because they cannot always see the issues before them dispassionately—no doctor should ever be seen to self-diagnose or self-medicate.  I was therefore interested to learn that at this conference the New Zealand and Australian medical students associations are jointly launching a comprehensive resource for the wellbeing of students.  I commend the associations on this initiative and urge everyone here to heed its salutary advice, particularly about arranging your own GP who can be a trusted and independent adviser, away from ones peers, colleagues and senior clinicians.

Doctors are some of our society’s most trusted professionals.  When The Reader’s Digest  undertook its annual survey of the professions whose members New Zealanders trust in 2010, doctors, along with nurses, firefighters and ambulance officers, were the among top five most trusted professional groups.  As an aside, judges were just outside the top 10 in 11th place, and I won’t say where lawyers were placed—except to say they were ahead of taxi drivers, domestic cleaners and fast food servers!

That matter of trust, should never be taken for granted.  It rests on maintaining the highest levels of professional standards, respecting the rights of patients, their culture(s) and background.  As the diversity of faces I can see in this room testifies, New Zealand has become a highly multicultural nation.  The last census, for example, found that about 23 percent of New Zealanders were born overseas.  This demographic statistic brings with it issues related to language, religion and cultural practices that need to be understood and acknowledged.

From another perspective, as Chairman of the Confidential Forum I have mentioned, I heard moving testimony from people who had suffered in our psychiatric hospitals.  Some had been treated in ways that were unacceptable by any standard and at any time.  The experience underscored how easy it can become in an institutional setting to neglect the rights of the most vulnerable members of our society—children, adolescents and those with mental health issues. Everyone deserves to be treated as a human being, regardless of how challenging their behaviour may be.

The trust that doctors engender also rests on wider service to the community.  A career in medicine bestows many privileges and benefits.  But those privileges come with obligations to the community.   In addition to your own personal efforts, your family and the wider community are investing heavily in your education.

I bring to mind a prominent figure in Auckland at the beginning of the 1970s – the foundation Dean of the Medical School here Professor Cecil Lewis.  I encountered him as a young courtroom lawyer attending a Medico Legal Society meeting.  Lewis advocated two things – combining more than one thing in one’s everyday professional life and moving on in a career to new professional horizons not later than once every ten years. 

I for one took his advice and subscribe to the view that it is good for all professionals to offer their knowledge and skills to their community in a general way.  I also realised that many opportunities present themselves for this.  In my own case, I pitched up to work as a volunteer in New Zealand’s first Citizen’s Advice Bureau, which was established in Ponsonby in 1970.  As a newly qualified lawyer, working in the CAB exposed me to a variety of general legal issues, from tenancy disputes to consumer law.  This was different from my day to day connection with a diet of taking criminal cases.  It also widened my understanding about New Zealand society and the issues which people outside of my circle dealt with on a daily basis.  It was an experience I have never regretted.  I also opted to become a Judge and become an Ombudsman when opportunities to do presented themselves. 

I note that Professor Lewis left Auckland  when the first students of his Medical School graduated and he started another Medical School in Hong Kong.  I believe also that in lieu of retiring he went and worked in a general practice in Cardiff in Wales from where he had started.

In conclusion, ladies and gentlemen, as medical students you are New Zealand’s future doctors.  Regardless of whether you are a first year student or in your last year of training, you are all entering a profession that offers much, but from which society increasingly expects much in return.  The rewards are significant, but so too are the demands placed upon you.  Balancing these competing interests is never easy, but as one who has more than once draen down upon the life-saving abilities of New Zealand’s health professionals, I thank you for choosing a career in medicine and wish you all the best for your careers.

And on that note I will close in New Zealand’s first language Māori, by offering everyone greetings and wishing you all good health and fortitude in your endeavours. No reira, tēnā koutou, tēnā koutou, kia ora, kia kaha, tēnā koutou katoa.