You Have the White Coat. Now What?

Posted on Thu, Aug 21, 2014

EmCare’s CEO of Anesthesia Services, Dr. Michael Hicks speaks at healthcare events across the country. Recently, he had the honor of being the keynote speaker for the University of North Texas College of Osteopathic Medicine 2014 White Coat Ceremony. Below is the transcript of his inspirational speech.

“The white coat ceremony (WCC) marks a medical student's transition from the study of preclinical to clinical health sciences. WCCs typically involve a formal "robing" or "cloaking" of students in white coats, the garb physicians have traditionally worn for over 100 years.”  – 

I am honored and flattered to be part of today’s celebration and your formal introduction and welcome to the Texas College of Osteopathic Medicine and the University of North Texas. white-coat-image.jpgI am even more honored to be a part of your welcome to the profession of Medicine. You are now a part of a long and hallowed calling that leads to the privilege of serving as a physician healer.

I want to begin by congratulating you and your families for the achievement of becoming a part of this class and of this University. Along with the faculty and administration I look forward to your donning what is surely the recognizable part of the physician’s wardrobe, the white coat, that for well over 100 years has symbolized the scientific foundations for the practice of medicine. Today, in recognition of the next step in your journey towards the practice of medicine we will call on the symbolism of the white coat as your studies now begin to focus on the care of patients, which is the essence of who we are as physicians.

You likely believe that you are at the beginning this journey but in reality you have already accomplished much as evidenced by being accepted as a part of this distinguished class. However, there are still many miles and many challenges to experience and enjoy, or survive, on your journey as a physician. For example, one of the first challenges for you is to survive the next few minutes of listening to me.

As you may have noted I am an anesthesiologist — a physician skilled in providing relief and comfort to those in pain. It has been my clinical calling to watch over those whom cannot watch over themselves and to make the intolerable tolerable so that my surgical colleagues can provide cures and relief. In keeping with this I will try to keep this part of the ceremony from being too painful or making you too numb. Moreover, today, unlike most every other clinical day for me in the operating room, I will try not to put you to sleep. You will soon learn that every medical specialty has ways in which its physicians define success. President Williams and I, being trained as anesthesiologists, typically defined success as whether our patients lost and regained consciousness when we wanted. So in keeping with our anesthesiologist roots Dr. Williams and I today are going to define success for this ceremony at least partially as to whether you stay awake for most of it.

Another facet of being an anesthesiologist is that we work clinically with surgeons, which is really one of the high points of being an anesthesiologist. One way surgeons define success is by urging anesthesiologists to be more efficient. In other words, don’t waste any time. Therefore, since Dean Peska is a surgeon and there are other surgeons in the room as well I will keep my remarks brief. Let this be your first lesson in how the different medical specialties can cooperate for the common good. Dr. Williams wants you awake, Dr. Peska wants this short — it’s all going to work out well.

Now, typically a White Coat Ceremony speech has a section about the history of the white coat and the white coat ceremony itself. President Williams has told me a little about your class and how intelligent and eager you are to get started. All of you were at the top of your college classes and Dr. Williams believes that all of you expect this to be true here as well — which as I say that aloud makes me think I know one of the first things that most of you are going to learn. But I digress.

As I was saying, because of your dedication, your eagerness to learn, and your desire to take it all in you no doubt have read extensively about the history of the white coat, the symbolism of the White Coat Ceremony, and what benefits and obligations that wearers of said white coat have that others do not. Because of this extensive preparation it therefore is unnecessary and even redundant for me to tell you that the White Coat Ceremony serves to welcome you to the medical school, that these kind of ceremonies originated in the 1970s to serve both as a marker for the transition from the basic sciences to patient care and as a declaration of the new responsibilities associated with doing so, that WCC are held at over 100 medical schools across the US, and that for most of us physicians it means welcome to the profession. That you already know these things is saving us some time here.

Now there are a select few among you — for the moment let’s just call you “overachievers” — that have gone a step further in your preparation. You didn’t just do some reading but instead committed many other useful facts to memory. If called upon you will be able to engage in a White Coat Ceremony discourse as to the proper timing of the ceremony, whether the ceremony and the oath taken during the ceremony places a moral or ethical burden on you as a student that you are yet equipped to handle at this stage of training and whether taking such a pledge has unintended ethical implications by possibly suggesting to the newly initiated a usurping of personal and societal morality. To make your points you will quote directly from speeches given at other white coat ceremonies and of course from the peer reviewed literature on the subject. As an aside I know that you select few are hoping beyond hope that President Williams or Dean Peska happen to bump into you in the hallway later on and in the course of exchanging greetings happen to ask you about the white coat ceremony. What an opportunity to shine that will be! This attention to detail I suspect will make for great reading when you start writing your first histories and physical exams. Did I mention that there are names for people like this?

Since I didn’t have to use any time telling you about the white coat ceremony it gives me the opportunity to give some advice. Now this is a particularly dangerous thing for physicians to do. Not because we aren’t trained in giving advice because we are. It is dangerous because many of us seem to think that our deep knowledge of the basic sciences and clinical medicine extends to nearly everything — other specialties, running hospitals, investment banking, the Dallas Cowboys, etc. In this case, however, I believe that I have some justification for the advice I am about to give.

I have thought from time to time about what advice I would give myself if I could go back in time to various points of my medical education and career. I did not come from a medical family and I really had no idea as to what to expect from medical school or anything that followed. I just knew somehow that physicians provided care based on science and seemed to have a deep desire to help other people. Very importantly for me, physicians also didn’t work in coal mines like my family did in West Virginia. So like you, I went off to college, in itself a novel concept in my family and neighborhood, and did well enough to get into one of the state’s medical schools, then into residency, and ultimately into practice. Somewhere along the way I even managed to earn degrees in both business administration and heath care management. It has all worked out and I unequivocally have a successful career but from time to time I have watched friends and colleagues struggle both professionally and personally. Most importantly, I have struggled as well. The white coat you see, if not worn well, can be a heavy burden for some of us.

What advice then would I offer to my past self or to you now? It consists of a few simple things:

coat-close-up.jpgFirst, always keep in mind that becoming and being a physician is a journey, not a destination. Like all good journeys the scenery is going to change from time to time and sometimes rapidly. This certainly applies to your medical education. You are going to have a heavy emphasis on didactic learning initially with a more limited clinical involvement but before you know it that will be completely flipped around. But more importantly, it applies to the practice of medicine as well. The way we do things, the tools we use, and where we use them is constantly evolving. For example, forty years ago the idea of performing surgery anywhere but in a hospital was considered malpractice if not outright crazy. Now my surgical and anesthesia colleagues have flipped the discussion around so that the debate is about what surgical cases still have to be performed in hospitals. The list gets smaller every year.

Similar statements can be made about how, where and by whom primary care is delivered or whether physicians working remotely can deliver most care via telemedicine. The benefit of seeing your career as a journey and not a destination is that you never get too comfortable with the way things are which is a good thing considering that change in health care and medical practice is accelerating, not slowing down.

As for your journey through training only a few of you will be at the top of the class. Don’t despair however, because it matters only a little where you are in the class ranking. Remember, this a journey and not a destination. You will be healthier — physically, mentally, emotionally — if you learn to play the long game. If it turns out that your best means you are the best in the class then great. However, only half of you are going to be in the top 50% of the class. Dr. Williams was kind enough to confirm that with several biostatisticians. That and other statistical facts make it difficult to be the smartest person in the room anymore. Strangely enough, that isn’t a bad thing because it is an introduction to the concept that medicine is a team sport. Sometimes the person with the right answer is not going to be you. It may be another physician but it might very well be a pharmacist, a nurse, a physical therapist, a patient’s family member or someone else involved in the life of the patient. Pace yourself, protect your relationships with your loved ones, and focus on the big items in your educational development. The journey is more fun when you do it with people you care about and care about you.

The good news, as you can certainly attest, is that the journey doesn’t really start here today. It took a lot to get here: good grades, test scores, references, and interviews obviously come to mind. Not so obvious are the opportunity costs that you incurred. The bad news if you will, and it really isn’t bad, is that more of the journey is in front of you than behind you. If you are a great physician you will never stop learning, never stop listening, and most importantly never stop caring about your patients, their families, and your profession. In fact, it is a journey that great physicians know never actually ends except maybe when we stop practicing and for many of us not even then.

The second piece of advice involves what you need to learn in the next few years. It is not what you think and possibly not even what some of the faculty think you need to learn. In my opinion the absolute best things for you to learn, develop and master are not the vast array of facts, disease processes, or curative therapies that are overtly taught here and in residency. Yes, you have to have a strong foundation in these things but these facts change as our understanding of the science changes. Besides, much of the minutiae can be readily accessed electronically. In my opinion our abilities to actively listen, appreciate context, employ critical thinking, make sense of complicated and complex clinical scenarios and engage patients in needed behavior modification are going to be the skills that keep us relevant and distinguishable as physicians and from other clinicians interested in providing care to patients. The first but maybe the most difficult of these skills involves listening. However, over my career I have learned that patients and their families will almost always tell you what you need to know to help them if just let them talk while you listen. Learn to listen.

The third concept for you involves enjoying where you are when you are there. In other words, live in the moment. Practice what psychologists and psychiatrists call mindfulness which means engaging in the moment at hand, in the present life that you are living, involving and being involved with your family and loved ones and taking things as they are. You will be happier, less stressed, and have better relationships. Of all of the things I wished I had known at the start I believe for me this would have been most valuable. I could have been a better husband, a better father, a better son and brother and a better friend to many if I hadn’t let medicine and career become too important.

My last piece of advice is both the simplest but also the most profound at least for me. Focus on the patient. Every aspect of what we do and who we are should flow from them. If you focus on the needs of your patients you will get it right nearly every time. Your patients will love you and your colleagues will respect you. Most importantly, everything else will take care of itself. As you get deeper into the profession you will no doubt hear grumblings about the direction of medical practice and hear physician colleagues disparage the state of things. To this I say, remember it’s a journey; the scenery is going to change. Don’t forget, however, that you have the opportunity to help set the course if you will only take it. I am confident that neither Dr. Williams or I anticipated when we met thirty years ago where our careers would lead so don’t let the world view of others and their anchors to the past determine your journey or your attitude about the practice of medicine. Chart your own course and be a leader in charting the course of future physicians as well.

Finally, thank you for allowing me to a part of this special day. Wear your white coat with both a little pride and a lot of humility. Let it be on occasion a gentle reminder for you of our calling as physicians. Welcome to medicine and best wishes on your journey as a physician. Thank you.


rnf3537-hicks-,-michael-ray-231485-resized-600.jpg Dr. Michael Hicks is the CEO of EmCare Anesthesia Services. Dr. Hicks practices medicine in the Dallas, Texas, area while holding the position of Regional Medical Director for a national health care company and performing his administrative duties for EmCare Anesthesia Services. He received his M.D. from West Virginia University School of Medicine, and did his residency at the University of Texas Southwestern and Parkland Hospital in Dallas, Texas, as well as the Texas Heart Institute in Houston. Dr. Hicks is a Fellow of the American College of Healthcare Executives. 

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