President Callender, Dean Anderson, Dean Thomas, Class of 2014, family members and distinguished guests, welcome to the 15th White Coat Ceremony at the University of Texas Medical Branch. I’d like to thank the School of Medicine Honor Education Council for inviting me to speak today.
WELCOME, CLASS OF 2014
I want to congratulate each of you on arriving at this milestone in your career. You have no doubt worked hard to achieve your goal of entering medical school. As each of you walks across this stage today to receive your white coat, your journey in medicine will begin. In the words of Sir William Osler, “The practice of medicine is an art, not a trade; a calling, not a business.” You have answered that call. William Osler revolutionized how medicine is taught. According to Osler, “Medicine is learned at the patient’s bedside.”1 The medical curriculum has indeed changed from a time when medical students spent their first two years in lecture halls and labs to a time now when students are introduced to patient encounters early in their first year.
WHAT IS THE PURPOSE OF THE WHITE COAT CEREMONY?
The White Coat Ceremony is a rite of passage, welcoming you as new medical students into the medical profession.2 As medical students, you are bound by the same professional commitments that bind all physicians. This ceremony will join the symbol of the white coat with the virtues of altruism, responsibility, duty, honor, respect, and compassion. In 1996, the UTMB School of Medicine instituted the White Coat Ceremony and called on medical students to always do their best for their patients as they received their symbolic white coat. The White Coat Ceremony is the result of a vision by Dr. Arnold P. Gold, who in 1993 instituted the first White Coat Ceremony at the Columbia University College of Physicians and Surgeons in New York.3 Dr. Gold believed that medical students should be given well-defined guidelines regarding the expectations and responsibilities appropriate for the medical profession prior to their first day of education and training. He believed that that a declaration of commitment, when students accept the obligations of our profession, should be taken at the beginning of medical school, not the end.3
WHAT IS THE PURPOSE OF THE WHITE COAT?
The white coat reminds physicians of their professional duties, as prescribed by Hippocrates, to lead their lives and practice their art in uprightness and honor. The white coat is a symbol of our profession. The donning of the white coat is a century-old tradition. The white coat originated in scientific laboratories and was adopted as the standard of dress by physicians in the late 19th century as physicians sought to incorporate scientific principles in the practice of medicine.4,5
There are, however, some practical reasons for wearing your white coat: ease of recognition and need for carrying medical items and reference books. Your white coats will serve as a repository for information. When all else fails, you can simply look in your pockets. Your white coats will soon be filled with spiral-bound reference books, reference cards, index cards with patient information, and folded journal articles. As medical students, your white coat will serve as a time capsule of each rotation. The reference books in your pockets will change throughout the course of your clerkships. Your white coats will also carry medical equipment including a stethoscope, penlight, tuning fork, and reflex hammer. As a result, your white coats will be heavy. Just ask any third year student.
As one’s training rank increases, however, the number of papers, pens, reference books, and instruments in the pockets decreases. According to one study, there was a significant association between increasing seniority and a reduction in the weight of one’s coat. Can you believe that there was a published study on that? The article is titled “Portable Knowledge: A Look Inside White Coat Pockets.”6
AS A MEDICAL STUDENT, WHY IS YOUR WHITE COAT SHORT?
In his book about reflection, Short White Coat, Dr. James Feinstein states that “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.”7
The short length of the white coat worn by medical students and the full length ones worn by most physicians is a long-standing tradition and remains a mechanism used by patients to identify the role of each care provider. This mechanism does not always work, however. In his book Dr. Feinstein reflects on a time during pre-rounds as a junior medical student at which a patient referred to him as a doctor. He quickly corrected the patient by saying “I’m just a medical student.” The patient quickly stated, “Medical student. Doctor. You’re all the same to me. Just tell me I can go home.”7
REFLECTION IS IMPORTANT
This reflection by Dr. Feinstein reminds me of a time in medical school here at UTMB when I was on call with my team as a third year medical student. My resident and intern had just finished placing a central line in one of our patients. They called for a stat chest x-ray and sent me down to Radiology to retrieve it. At that time in the pre-digital era, only hard copies of x-rays were available, and there was an unwritten rule in Radiology that medical students could not check out films. My team was aware of this. I approached the Radiology desk and asked the clerk for the stat x-ray on our patient. The clerk behind the desk peered down at my short white coat and I responded by saying, “I’m just a medical student.” She replied back by saying, “You’re not just a medical student.” Then she handed me the x-rays. As I returned back to my team, I felt that my mission was accomplished.
In this brief reflection of mine, I want to emphasize your importance here at UTMB in the care of patients. You will play a vital role in the care of your patients. Your team will depend on you. Reflection is important throughout your career. As I’ve cited from Dr. Feinstein’s book, Short White Coat, I have decided to obtain copies for all of you, not to read now but later, maybe during your senior year when all of your have secured your spots in residency programs and near the time of graduation. You must never forget your beginnings here at UTMB.
Since joining the UTMB family in 1990 as a first year medical student, I’ve had the opportunity to work with several great faculty members. After finishing my residency in internal medicine, I wanted to become a clinician educator here so that I could have the opportunity to give back to UTMB and uphold its strong tradition in medical education. It has been a pleasure to serve as a mentor and teacher to so many medical students.
THE WHITE COAT AND PATIENT CARE
As I was preparing for this address, I received an e-mail from a patient who asked that I give you some advice in regards to your white coat. I promised him that I would. A clean white coat can make such a difference in the care of your patients. My advice is ‘Keep them clean.’ Wash them often. Avoid pocket stains and consider having a spare coat available for that morning when you spill your coffee on your sleeve.
Your white coat is important to your patient care. In a recent survey of patients published in the American Journal of Medicine, three quarters of patients favored physicians in professional attire donning white coats, whereas casual attire was only accepted by less than 5% of respondents. Physicians wearing professional attire with a white coat inspired confidence and trust among patients. There was also a positive association with patients adhering to prescribed therapy.8
Not all physicians wear white coats, and some journal articles refer to white coats as harbingers of bacteria and a cause of hypertension in the clinic.9,10 Check with your attending physician on this as you start each new rotation.
FEAR NOT YOUR ATTENDING PHYSICIANS
In a reflective article published in the New England Journal of Medicine by Rachel K. Sobel, Ms. Sobel, a fourth year medical student at UCSF, talks about the stress of presenting patients to attending physicians. She describes how each attending physician has his or her own style and that the time to present is a chance to shine.11
Presenting patients is the culmination of everything that a medical student does for the medical team: elicit the history, perform a physical examination, gather lab data, and synthesize an assessment and plan. You will see patients early on in the curriculum. You will learn how to take a history and perform a physical exam. You will learn how to think clinically and arrive at a diagnosis in order to formulate a plan.
CONCLUSION
Our curriculum at UTMB is exciting, and I have no doubt that each of you will thrive in it. You will be well prepared for every challenge along the way. I look forward to working with each of you as you progress through medical school and I look forward to working with you as a colleague in the near future.
Congratulations again, Class of 2014 and welcome to the UTMB family.
References
- 1.Silverman M, Murray TJ, Bryan CS. The Quotable Osler. American College of Physicians: Philadelphia; 2003. [Google Scholar]
- 2.Gillon R. White coat ceremonies for new medical students. J Med Ethics. 2000;26:83–44. doi: 10.1136/jme.26.2.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Arnold P. Gold Foundation Website. http://humanism-in-medicine.org/intros/gWcc-checklist.html
- 4.Blumhagen DW. The doctor's white coat. The image of the physician in modern America. Ann Intern Med. 1979;91:111–116. doi: 10.7326/0003-4819-91-1-111. [DOI] [PubMed] [Google Scholar]
- 5.Branch WT., Jr Deconstructing the white coat. Ann Intern Med. 1998;129:740–742. doi: 10.7326/0003-4819-129-9-199811010-00012. [DOI] [PubMed] [Google Scholar]
- 6.Lynn LA, Bellini LM. Portable knowledge: a look inside white coat pockets. Ann Intern Med. 1999;130:247–250. doi: 10.7326/0003-4819-130-3-199902020-00039. [DOI] [PubMed] [Google Scholar]
- 7.Feinstein, JA. Short White Coat: Lessons from Patients on Becoming a Doctor. Bloomington, iUniverse, Inc. 2009.
- 8.Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor's attire on the trust and confidence of patients. Am J Med. 2005;118:1279–1286. doi: 10.1016/j.amjmed.2005.04.026. [DOI] [PubMed] [Google Scholar]
- 9.Treakle AM, Thom KA, Furuno JP, et al. Bacterial contamination of health care workers' white coats. Am J Infect Control. 2009;37:101–105. doi: 10.1016/j.ajic.2008.03.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Spruill TM, Pickering TG, Schwartz JE. The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med. 2007;34:1–9. doi: 10.1007/BF02879915. [DOI] [PubMed] [Google Scholar]
- 11.Sobel RK. MSL–medicine as a second language. N Engl J Med. 2005;352:1945–1946. doi: 10.1056/NEJMp048342. [DOI] [PubMed] [Google Scholar]