The white coat can be an inadvertent barrier to care

Don’t wear the white coat; it scares the kids.

Most children stare at me with that wide-eyed look.  Thinking from their perspective, the six-foot something curly headed giant with big round glasses probably appears very strange to the little human that barely scrapes my knee.  They do not cry. They just stare.  I smile, and they gape. Parents laugh as I grin sheepishly.  Towering over the patients, I likely appear more with the disposition of a clumsy giraffe.  Clad with a lime green bow tie, and cuff links made out of Legos, I did everything I could to appear comforting.  Arriving at the pediatric clinic, I had my white coat draped over my arm.  As I entered the clinic, I quickly realized no one was wearing their coats. Snatching my name tag, my coat would remain on that chair the remainder of the evening.

Thinking back a year ago when I was accepted to medical school, that white coat was the ultimate symbol of accomplishment.  The short student coat was the one physical possession that would demonstrate that I had jumped through all the hoops, gotten the grades, and possessed the qualities to be a medical student.  Upon starting classes, the white coat dangled in front of me like a prize.  Through that first gut-wrenching block the white coat remained just out of reach, inching closer and closer as the days passed. My white coat Ceremony was a blur.  One by one, my classmates and I filed across the stage, were draped by the faculty, received our gifted stethoscope, and wandered grinning off the stage.  The electricity in the air was palpable as the sea of white in the auditorium expanded, as we joined the ranks of physicians in training.

The white coat has long been the symbol of our profession. In the eyes of hopeful physicians, it represents the knowledge and authority to heal. For patients, it represents hope that something can be done.  I wanted the coat, and perhaps at even some points coveted those who could wear it.  Upon receiving my coat I was elated. My name tag dangled just below my embroidered name.  I wonder if the redundancy of identification is for the patients or for myself, saving me when I become too nervous and possibly forget my name. Wearing my coat for the first time motivated and empowered me. The white coat would be my armor and my shield in the battle of disease.  Exposing the vulnerability of the student physician, it is also our security blanket, reassuring us of the supposed authority and knowledge we possess.

I would be lying if I said I do not love the coat.  However, I feel the coat can be an inadvertent barrier to care.  For the same reasons it distinguishes us and makes us a symbol of hope, it also sets us apart from our patients.  It establishes an us and a them.  Subconsciously, our garb establishes our roles. Though the coat can identify us and our roles to the patient, it is also a social barrier between us and those patients who are overwhelmed by that symbol.  For some those patients, no amount of rehearsed small talk or genuinely good people skills can overcome that initial impression. Coupled with a physician’s stress, the white coat can quickly become a detractor, decreasing the patient’s participation in the dialogue necessary to the healing process.

Growing up with a grandparent who valued lessons from his own poverty as a child, I have always been compelled to address socioeconomic inequality in all of its forms.  There is no way the work I have put into my life is solely responsible for all of my success.  There are forces beyond me that have cultivated the life and opportunities before me. For this reason, I feel no right to put myself above my patients. I believe in the justice and equality medicine provides. A.T. Stills called upon osteopaths to find health instead of disease, and keeping with this charge, I hope finding health is a path I take hand in hand with my patients as equals.

My coat hung on the chair unmissed that evening, and I became less attached to it.  After all, the power it represents radiates from within me and the joy my training provides. I know I will wear that coat often, and I hope when I do it comforts both my patients and I.  However, I also hope there are times I remove the coat, sit with my patients, and remind them and myself that we walk the path together.

Cullen Truett is a medical student.

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