Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The complexity of the white coat

Chiduzie Madubata, MD
Physician
December 3, 2016
90 Shares
Share
Tweet
Share

I remembered staring at the computer screen with the radiologist hoping that by staring at the images, they would change in some way. It did not seem fair that a nice lady that I was evaluating in the emergency room would be consigned to such tragic images. I was rotating through the emergency room during my second year of residency, and one of the patients had come in just for a cough, and part of her evaluation consisted of a CT scan of her chest.

As one of my assigned patients, I was responsible for evaluating things from her lab reports to her imaging, and then informing her of any important findings. While I was talking to her, the radiologist called me to review the images with her. As we were scrolling through the images, instead of seeing healthy lung, we saw one nodule, then another, and then another one of many. By the time we finished reviewing the imaging, we realized that this was consistent with cancer, and that this would be a new diagnosis for her.

I was 27 years old at the time, and it did not seem right that someone as young as me would be conveying such sad news to a patient that was about as old as my mother. In medical school, I had this image of doctors as people who were able to find a solution to any medical problem, and that these solutions would be used to help prolong life, and in some instances save it. The white coats they wore seemed to be a sign of hope and possibility, and that is why my white coat felt a little heavier as I was walking back to this patient’s room to deliver this news that seemed to go against this spirit of hope and possibility. With each step, the coat felt like more of a burden, an unexpected feeling from a coat that seemed lighter at the beginning of my shift before this particular news.

When I arrived at her door, I asked her how she was doing. She said that she still had the cough but otherwise had no other complaints. Then, bracing myself for the potential reaction, I said that I wanted to talk to her about her imaging. To be honest, I don’t remember what I said next; all I remember are some of the questions I had in my mind during this conversation. How do I say this to her? Am I being too loud? Am I speaking too fast? Similar questions went through my mind and probably at some point, through some mangled way, I conveyed the news to her with as much sensitivity as I could muster while being a little flustered. As expected, she looked shocked and disappointed, but then what surprised me was that she then thanked me for this information. All she was asking about afterwards was what would the next steps be.

As I have gone through my medical training, I started to realize that the medical knowledge I was learning was a double edged sword. With this information, in one respect, I could provide patients options in terms of treatable illness, but in another respect, I could tell patients that there was nothing further to do about their illness if it was terminal. It was the latter portion that made it difficult to see the white coat as a source of hope for people, but what was confusing to me at first was that because I was wearing this white coat, I was also obligated to convey information to patients related to a poor prognosis, depending on the amount of information that they wanted to hear.

In those moments, the coat felt like a burden at first, but then as I had more of these conversations, this piece of clothing started to change in front of my eyes in terms of its symbolism. It started to reflect the complexity of medicine, and that in this complexity, there would be moments of triumph and moments of sadness. The white coat just happened to be a part of all of those moments and in a way became a necessary piece of clothing in my mind when it came to medical conversations, particularly when it was regarding disappointing news. In that particular complexity, the white coat itself became complex.

Since that particular interaction, I have had more difficult conversation with patients with regards to prognosis.  In every single conversation, I was wearing a white coat with the thought that wearing it conveyed a sense of seriousness to my words, particularly when it came to a poor prognosis, and that this information had to be discussed with absolute honesty and compassion. What surprised me was that after I stated the situation, patients, and their families would then ask me about next steps, particularly when it came to patient comfort. I started to realize that somehow, with seeing me in the white coat, patients felt comfortable enough to ask me about what they should now expect with this news in terms of preparing for an ultimate progression of the illness to a terminal end. They showed me that even in their pain, they could believe that they could ultimately find comfort, and as such, the white coat became a source of hope and possibility to them again.

For me, with each similar interaction, the white coat becomes more complex, like an intricate puzzle that becomes more fascinating as new medical pieces are created through conversation.

Chiduzie Madubata is a cardiology fellow.  

Image credit: Shutterstock.com

Prev

When you place your faith in another surgeon

December 3, 2016 Kevin 0
…
Next

The uncertain diagnosis is difficult for everyone involved

December 3, 2016 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
When you place your faith in another surgeon
Next Post >
The uncertain diagnosis is difficult for everyone involved

More by Chiduzie Madubata, MD

  • The coronavirus cost that no one can count

    Chiduzie Madubata, MD
  • A physician sees end-of-life care through a religious lens

    Chiduzie Madubata, MD
  • Veterans deserve our full attention

    Chiduzie Madubata, MD

Related Posts

  • The white coat symbolizes 2 important commitments

    Efrain Talamantes, MD
  • The white coat serves as a daily reminder of the Hippocratic oath

    Julia Tartaglia
  • The day when the white coat can be worn with no hesitation at all

    Shadi Ahmadmehrabi
  • Doctors aren’t just white coats without a face

    Devon Romano
  • Medicine vs. racism: white coats for black lives

    Divya Seth, MD, MPH
  • Deploring racism isn’t enough: Addressing white privilege in medical school

    Jessica Cranston

More in Physician

  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

    Montreh Tavakkoli, MD
  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Journal Shows Its Commitment to Exploring AI in Medicine
  • Do Away With 'Lockout' Period in iPLEDGE, FDA Advisors Urge
  • Cluster Headache, Migraine Linked to Circadian System
  • Smaller Liver Transplant Candidates Wait Longer, Less Likely to Receive Organ
  • A 'Double Whammy' for Gastric Cancer Risk

Meeting Coverage

  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...