Sunday, June 28, 2015

White Coat Blues, Redux

Last fall, I wrote an essay called "White Coat Blues" on my conflicted feelings about transitioning from graduate to medical school, as embodied by my white student "jacket." With a year's worth of experiences under my belt, I find the tone of the piece plaintive but its content still essentially true. Being a dual-degree medical student (and resident) means being in an awkward in-between place between expectations and competency. I will continue to be older than most of the residents and some of the attendings; some of them will respect me as a scholar, and others will only care that I know less medicine (or surgery ::cough::) than they do. Good intentions get you far in the third year of medical school, but in the end results matter--especially in surgery and on board exams. In some respects that much is very much like graduate school, where one is not promoted merely because a year has passed; completing the program requires the production of new knowledge and a block of text to prove it.

I have been studying for my next two board exams. One is an 8-hour computerized behemoth, the other is equally long but involves encounters with simulated patients. When I bring my white coat to the testing center next month, I will have emptied the pockets (no more jingle-jangle), and the proctors will use white tape to cover my name (, PhD) and school insignia. I will be Anonymous Medical Student #12. We are not allowed to talk about the exam ("The first rule of fight club..."), so instead I will leave you the observations I have gathered over the last year about when and why one might (not) want to wear a white coat and its attendant paraphernalia (name tag, pins, pens, pockets full of stuff), as it is by no means a necessary part of the clinical experience.

When you do want to wear a white coat:
  • On morning rounds, so you can stash second breakfast in your pockets (yogurt +/- banana +/- granola bar +/- travel mug of tea).
  • In the summer when you're dressed for the walk to and from the parking lot, but not for the chilly conference room.
  • To warm up in PACU after 3+ hours of surgery--especially if you didn't scrub in. If you scrub in you wear one of those big blue wrap-around disposable gowns. If not, it's just you in your short-sleeved monochromatic pajamas. Students don't get long-sleeved scrub jackets like the staff do.
  • For the Step 2 Clinical Skills exam, the first time you're allowed to introduce yourself as a doctor (i.e. as an intern).

When wearing a white coat is equivocal:
  • At the pediatrician's office, where the parent sees the coat as a sign of authority, and the child sees the coat as a sign of authority.
  • When running an errand outside the hospital on a cool day when you don't have other outerwear on hand. Doff the jacket and hope you're not too cold, or keep it on and look plum out of place?

When you do not want to wear a white coat:
  • When your patient on the psych ward has a long history of bad encounters with physicians.
  • While delivering a baby.
  • When a father offers to let you hold his newborn son because his arm has gone numb.
  • At a summer camp for kids with disabilities.
  • When holding down a patient so the surgical resident can place a chest tube at bedside.
  • While delivering a Grand Rounds talk on your not-that-kind-of-doctor-al research.
  • When a young woman whose mother is about to be taken off life support needs a hug.

Updated 7/1/2015.

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