New interns: Get ready to be fleeced

This one’s for the new interns.

You’re excited, you’re about to start residency. You’re a doctor. No more short white coat. You’ve got the long white coat that you’ve been waiting for. You’ve arrived.

But actually, there’s one more thing you need before you really feel like you look like a doctor. It might be a few months. There’s going to be a long process. Someone in your program, maybe the chief residents, are going to organize an online ordering bonanza. You’ll pay more than you ever thought you would for a jacket (or vest). But it’s so worth it. You’ll wait weeks for the custom embroidery. And then you’ll get an email that they’re ready, and you’ll go to pick yours up. Hopefully, they spelled your name right. And then you’re in it, and it’s as good as you thought. You really feel like a resident. You’re home.

You’re in your custom residency fleece, probably Patagonia or some off-brand sports fleece, with your hospital logo and your name across the breast (or on the arm — that’s fun too!).

A lot’s been written about the white coat. That doctors used to wear black. But in the age of antisepsis, they switched to blazing white to advertise their germ-free essence. The advent of the White Coat Ceremony to codify the acceptance of the role of healer and humanitarian in young medical student minds and souls. The inducement of sky-high systolics in those normally pumping along at a cool 110/70. Many studies show patient preference for a doctor in this coat.

There’s even been a little bit written about that other heavy-hitting doctor’s attire, scrubs. In one study, scrubs (more than professional clothing) made patients ready to open up about their personal preferences and feel confident in their physician. Perhaps scrubs are, as “one writer describes, “a metaphor for modern medicine: pragmatism and expedience stripped of all vestiges of romance and mystique.”

But what does the fleece mean?

Is it just utilitarian? It’s machine washable and dryable. There’s nothing you can get on it that you can’t get off (think coffee, blood, vomit — your own or others). Not so the unforgiving white coat with her yellowing neck, pen-marked pocket and coffee-stained lapel.

Is it just comfortable in a way that a stiff starched white coat can never be? You’ve worn jackets, like, on the reg, not so much with the knee-length cotton, so it’s not such a stretch to feel like this is a role you were meant to play.

Is it advertising? Wearing it out after work for drinks and eyeing the others who maybe have that same fleece, someone who might be a colleague but could become a friend?

Is it a status symbol? Wearing it out after work for drinks and eyeing the others who don’t have the same fleece and feeling superior?

Is there gender at play here? The white coat has not substantially changed in cut or styling despite the gender gap closing (my first year in medical school was two years after the peak of gender equity in medical school graduation at 49.3 percent to 50.7 percent). I still can only button the top two buttons on an appropriately-fitting white coat, making my hips the hold-out for me in otherwise inhabiting the role of an old-school physician. But the fleece comes in men’s and women’s, and it’s fitted and flatters just about everybody.

Is it a safety blanket? At night, it’s there when your internal thermometer drops because you’re supposed to be sleeping. And when there’s nothing else familiar around, you’re ensconced in something that says your name and the name of the hospital you work at, so naturally, you belong here, right?

You might ask: “Why is she making such a big deal about this? I already have a med school fleece, and I love it.” And I would, in trying to answer, realize that it really is a members-only jacket and that this is the most important professional club you’ll ever be a part of. Because at no other point in your training is solidarity more important. And no other training environment so keenly informs your development as a physician (and I speak authoritatively, having completed residency about five minutes from now).

What do the patients think? It’s not formal like a white coat. It’s not as non-descript as scrubs. Should we do a study to see if there’s less office-visit hypertension? I can imagine it feels friendly to them. But I’ll never know how they see it. Because I can only ever see it as I first did, on one of my residency interviews, someone wearing a Patagonia women’s Better Sweater fleece vest in birch white with not one but two colorful yet serious embroidered crests: the name underneath followed by M and the casual pride that the wearer had a sense that there was work to do, and it was going to be hard, but she was ready and came dressed to do her very best.

Interns, we welcome you, and we want you to know, you’ll be getting an email soon to order your fleeces.

Sharon Ostfeld-Johns is an internal medicine physician.

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