To begin, I want to congratulate each of you on arriving at this important day in your career. You have all worked to achieve your goal of entering medical school, each of you proving to be adaptable and resilient while in Brisbane [Australia] for the past 2 years, and as each of you walks across this stage in a few minutes to receive your white coat, your journey into clinical medicine will begin.
Sir William Osler once said, “The practice of medicine is an art, not a trade; a calling, not a business.”1 Each of you has answered this call. The White Coat Ceremony has taken on a pseudo-religious significance that symbolizes the conversion of a lay person into a member of the healthcare profession and is similar to the rite of ordaining a new minister. However, the wearing of a white coat is actually a century-old tradition as white coats originated in scientific laboratories and were adopted as the standard garb by physicians in the late 19th century as physicians sought to incorporate scientific principles in the practice of medicine. The coat has contributed to the social understanding of what it means to be a healer; adding the cultural significance of whiteness reveals a broad spectrum of meaning surrounding the healing encounter of which the most important aspects are the authority and cognitive powers of scientific physicians and the protection of their patients. As medical students, you and I are bound by the same professional commitments that bind all physicians. This ceremony will serve to join you and the symbol of the white coat with the virtues of professionalism, compassion, altruism, duty, responsibility, honor, and respect.
There are, however, many practical reasons for wearing your white coat: ease of recognition and the need to carry medical items and reference books—or an iPad mini. Your white coats will always serve as a repository for medical information. When all else fails, check your coat pockets! Your white coats will soon be filled with spiral-bound reference books, notecards, index cards with patient information, and maybe even a folded journal article or two. As third- and fourth-year medical students, your white coat will serve as a type of time capsule of each clinical rotation, with the various reference books changing throughout your clerkships. Your white coats will also carry medical equipment such as a stethoscope, penlight, tuning fork, and a reflex hammer—just to name a few. As a result, your white coat will be heavy; so remember to remove it before stepping on the scale. The good news is that as your training rank increases, the number of papers, books, pens, and instruments will conversely decrease.
In Dr James Feinstein's book from 2009 entitled, Short White Coat: Lessons from Patients on Becoming a Doctor, he writes, “…the short white coat has come to epitomize the role of the medical student: the coat is barely long enough to carry all of the educational tools and books of a medical student, but plenty short enough to remind any onlooker of the novice within.”2 In the book, Dr Feinstein reflects on a time in which he was prerounding as a third-year medical student and a patient referred to him as “doctor.” He quickly corrected the patient by saying, “I am just a medical student.” The patient replied, “Medical student. Doctor. You are all the same to me. Just tell me when I can go home.”
Some personal advice from the past 38 years is that a clean white coat makes a difference in the overall care of your patients. I advise you to keep it clean. Avoid pocket ink stains or coffee and food spots. Have a clean spare coat available, just in case. In a 2009 paper in the American Journal of Medicine, 75% of patients surveyed favored physicians in professional attire wearing their white coats, whereas more casual attire was accepted by less than 5% of respondents.3 Physicians wearing professional attire with a clean white coat inspire confidence and trust among patients, along with an improved adherence to using prescribed therapy.
In the next few weeks, you will be asked to present patients to your attending and other members of the team. Presenting a patient is the culmination of everything that a medical student does for the medical team: elicit the history, perform a physical examination, gather pertinent lab and radiographic data, and synthesize an assessment and plan for each patient. In the coming months, you will learn how to perform a general and specialty-specific history and physical exam. You will also learn how to think clinically and arrive at a diagnosis in order to formulate a plan.
Some days it is harder to put on your white coat than others. As chair of ENT at Tulane for more than 10 years and then at Ochsner for 7 years, I learned very early on that every day in clinical practice will not go well. In fact, there were days that I returned to my office in the early evening only to wonder, What did I accomplish this day? Why am I here doing this? Where is the “joy” in practice that I had relied upon so many days prior to just get me through? Then around that time in my career, I began to receive thank-you notes and messages with best wishes from a few patients and even some notes of encouragement from family and friends, along with holiday greeting cards and an occasional birthday wish. Eventually, I received many of these messages by email, slightly less personal but still equally effective. I began to save and cherish each of these messages in an old cigar box that I began to refer to as “My Box of Pearls.” After a difficult day, I would often return to my office, pull out My Box of Pearls and reach in for one message from a grateful and thoughtful patient. And after completing the read, I would once again remind myself why I would return the next morning and put on my white coat. I suggest you too create your very own Box of Pearls for similar effect.
I would like to share with you one such message from a patient who describes his recent care at Ochsner, and the content is particularly meaningful for each of you as you begin your clinical clerkships. The note goes something like this:
Dear Doc, I hope this message finds you happy and well! I suffered a stroke in April of 2017, was admitted to the hospital for the first time ever in my life, and was cared for at Ochsner as both an in- and out-patient undergoing many months of neuro-rehab. One of the highlights of my ordeal was the wonderful third-year medical student who helped care for me while I was in the hospital. She entered my room early the first morning of admission following a knock on the door, calling out my name, and asking first if she could come in. After this introduction, she entered the room, foaming her hands profusely while apologizing for the early-hour disturbance. Her politeness and courtesy were equally impressive. She acknowledged me and the presence of my wife and next proceeded to ask me a ton of questions before embarking on a thorough (and I mean thorough) neurologic exam which again she asked permission of me to perform. She explained every assessment and its results in terms that my wife and I could both understand. As she summarized her findings to us, she stated that the stroke team of which she was a member would be by to round on me with several trainees, including a neurology resident, physical and occupational therapists, and a vascular neurologist who was the team lead. She said that the team would return in about an hour and asked if we had any questions for the team which she might prepare them for. I was taken aback by her thoroughness, courtesy, and most of all her genuine eager professionalism. I anxiously awaited her return an hour later with the entire team, just as she had prepared us for. She led the team through my history and physical findings of left-sided ataxia, fine motor impairment, and dysarthria along with associated impaired functional mobility, balance, gait, and endurance. What a mouthful!! The staff vascular neurologist confirmed all of her findings as he once again examined me. Personal confidence and trust in my team immediately began to grow as did the confidence of the medical student. My wife and I looked forward each day to her visits, her positive, cheery demeanor, her excitement about being in the clinical arena and helping to care for while learning from her patients and the team. We were both very impressed and thought you should know about this as we are aware that you have something to do with academics at Ochsner. All the best to you and yours!
Sincerely,
And now in the words of the late, famous radio broadcaster Paul Harvey, I offer you “the rest of the story.” I do have a Box of Pearls and suggest once again that you create one soon. However, the letter I just read to you is not in that box. Instead, it is my gift to each member of the Class of 2019. You see, I was that patient and I stand before you today thanks to a lot of hard work and prayers, the support and encouragement of a loving wife, and because of teams that worked with me enabling me to walk and talk again—teams composed of students like each of you. I wish to emphasize your importance here at Ochsner in the care of our patients. You will each play a vital role in the care and healing of the patients you are privileged to interact with. As I look out into the audience, I once again see so many eager, enthusiastic, and idealistic medical student faces. And yes, some of you appear to me to be understandably anxious about what lies ahead. Your proud families and friends surround you and support you today as they have always and most certainly commit to doing so in the future. Thank you all for supporting our Clinical School students!
I too am anxious for you, wondering about the future of our profession. I personally believe that despite the evolving stresses and strains surrounding the practice of medicine in this country, the time has never been better to join the profession. The future is brighter than ever in terms of our increasing potential to make a real difference in health, not only for our patients and families, but for our communities as well. In the coming years at Ochsner, you will learn to Serve, Heal, Lead, Educate, and Innovate; each of these is a valuable lifetime skill that will serve you well.
In closing, it is my desire to see you once again walk across this stage in November 2019 as you each receive your medical degree and progress in the continuum of graduate medical education. By the grace of God, I plan to be there for that event to celebrate once again with you and your families. I have no doubt that each of you will thrive in our clinical curriculum. I know you will be well prepared for every challenge along the way. I look forward to working with each of you as you progress at Ochsner, and I equally look forward to working with you as a physician-colleague in the not too distant future.
Good luck, thanks for your attention, and welcome home. Welcome to the healthcare team at Ochsner!
- © Academic Division of Ochsner Clinic Foundation 2018
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