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The Curse of the Long White Coat

Benferguson72x721Ben Ferguson -- “What are you doing? You just contaminated everything!!” I was doing some shadowing in the ER during my first few months of medical school, and I’d been instructed by the nurse to put on sterile gloves and insert a Foley catheter into a gentleman who was barely conscious and speaking gibberish.

“I -- um, I’m sorry, I thought you just told me to put these gloves on,” I replied. I could feel the sweat inching its way out onto my forehead.

“No! These are sterile gloves! What the heck do you think you’re doing trying to put a Foley in like that?” she snapped. She clearly had a lot on her plate, making sure his monitor leads were all connected properly, his O2 was hooked up and flowing, and his ABG was striking artery.

“I apologize, but I think I need some help with this then. I’ve never done this before.”

“You haven’t?!?”

“No, I’m a first year.”

“You’re an intern and you don’t know how to put on sterile gloves.”

“No, no … medical student. I’m a first year medical student.”

She loosened up. “Ohhhh,” she said. “I apologize. I thought you were older.” Clearly everything started to make more sense in her head, though she had looked utterly incredulous moments before. She told me to hold on a second while she finished the ABG, and then she’d come show me what to do -- how to put sterile gloves on, how to remove the catheter from its kit, how to lubricate the catheter and sterilize the field. This was by far the most complicated procedure I’d ever witnessed in my young medical career.

I can’t blame her, though. What with my white coat, my fancy get-up underneath, and my unshaven face left over from the all-nighter I pulled for that morning’s physiology exam, I might as well have been an attending physician to her. At the University of Chicago, everyone wears long white coats -- attendings, residents, and medical students. Although the medical students have the school’s name and seal embroidered on them in the same spot where the residents and attendings typically have Their Names, M.D. on theirs, it is often hard to tell on first glance who is who, and the name badges do little to identify one’s place in the hospital totem. This, I’ve found, is both good and bad.

The good: Attendings, in theory, treat you as equals. You are not some runt running around the hospital in a short white coat. Patients, too, see you as competent members of their care team, and unless they are vehemently opposed to having medical students care for them, they do not mind sharing the patient love. Nobody truly knows how low on the totem you currently reside (below ground) or how little you know (very, very little) unless they actually talk to you. If you sit on some ketchup in the cafeteria or spill some morning coffee on yourself because you fell asleep in your chair, the long coat comes to your social rescue.

The bad: The above example pretty much falls squarely in this category, and some of the aforementioned goods are also bads. Attendings treat you as equals, and as such, they don’t feel as bad being jerks to you in some situations. Patients and nurses see you as competent members of their care team and, accordingly, ask you questions that you have no business answering and request that things be done that you have no business doing. People expect things merely because you wear a long white coat and resemble a doctor. Your coat drags on the floor when you hang it on the back of a chair, and you run over it with your chair wheels.

All in all, I like the long white coat. It allows you to blend in more. It allows you to avoid broadcasting the fact that you’re the hospital peasant. It’s strangely empowering. As with any power, you just have to remember to use it wisely and remember who you truly are and how limited your skill set truly is.

November 4, 2007 in Ben Ferguson | Permalink

Comments

In my experience of 1 year of clinicals, nurses, patients, and other hospital people usually don't know the difference between the short coats of students and longer coats of resients/attendings, anyhow!!!!!

And of course, it's nearly impossible to try to tell the difference between residents and attendings, since how long their coats are depend on how tall they are!

But all in all I don't think I would want long coats, as a student!

Posted by: D | Nov 6, 2007 4:07:28 PM

I'm a first year, and we have to wear the short coats, even though for the last six years I have worked in a hospital pharmacy and wore the long coats. I would rather wear the long coat. The short coats are actually nursing coats, and as such is confusing for non nursing staff to wear them, just like it is confusing, on occasion, when you see a nurse wearing a long coat.

Posted by: Justin | Nov 6, 2007 5:20:17 PM

All I can say is, man, do I hate my short coat! I'm a third year student and let's just say that I will be properly discarding my coat upon graduation.

I really don't agree with being singled out on our respective teams. The house staff, the nurses, the techs ... heck, a good portion of the patients themselves ... have all seemed to figure out where the "short coats" rank in the grand scheme of things.

And I really hate that term, btw.

Posted by: Jon | Nov 6, 2007 7:06:55 PM

Too funny Ben, thank you. But to get truly "below ground" you have to be a student midwife. :-)

Posted by: Lorri | Nov 6, 2007 8:07:42 PM

I loved the short coats we wore as pharmacy students. They were easier to keep clean and look sharp. The long coat I wear now snags on doorknobs and armrests. I can't keep the pockets clean, and it makes me look fat! But, culture being what it is, I still wear the long coat.

Posted by: Miami Pharm.D. | Nov 7, 2007 6:30:39 AM

As a nursing instructor, I often have to deal with students who complain about "having to wear a student uniform", but I have pointed out to them that it clearly identifies them as a student. That can save you everything from embarrassment to actually causing harm when someone expects you to know more than you actually do.
I have to ask why whomever placed you in that clinical situation wasn't clear with the nursing staff about who you were and what you knew. I try to always let the nursing staff know what is reasonable to expect out of a student, and in that situation the nurse might have been able to teach you even more..... if she had known.

Posted by: Marianne | Nov 7, 2007 9:41:24 AM

Another vote in support of short white coats: You don't look like an complete idiot when you're wearing a jacket over it. I had forgotten about this one when I initially wrote the post — it was in the high 60s in Chicago last week, after all — but this week we've had threats of snow (so it goes in Chicago), and the long white coats under short heavy jackets have once again emerged, right on cue, and it looks absolutely ridiculous.

Posted by: Ben | Nov 7, 2007 10:40:43 AM

I love reading these blogs on the white coat phenomenon! I'm a third year med student in Australia, and no-one wears white coats... students, interns, registrars and consultants all look the same, except for the armful of books and constantly befuddled look upon the students' faces. I have been mistaken for an actual doctor a few times, but you get used to saying 'I'm a medical student' with an apologetic look, although it does say 'medical student' in tiny little letters on our ID badges - you'd think they'd be able to read that! I personally think it's nice that you don't have to wear anything identifying like that, and doctors don't seem so segregated and intimidating to other staff or to the patients.

Posted by: Ally | Nov 7, 2007 8:57:55 PM

I so agree with your post, the good and bad and everything in between. I am a 5th year medical student in russia. When I was doing my summer attachment in a hospital back home, I was wearing the long white coat, and I faced the same problem as you did, especially with the patients. I felt kinda helpless, being unable to help them and having to explain that I am a medical student and am in no way able to help. But all in all, I love my white coat =)

Posted by: Vivien | Nov 7, 2007 10:43:09 PM

You guys all have my greatest sympathy.

Here in the wonderful land of Australia, white coats are essentially banned completely no matter what rank you are! Standard attire from attending all the way down to student is the same: dress pants and shirt, tie optional but not recommended due to infection risk. Theres a few attendings around who love their bow-ties but thats about it. Staff working in Emergency are free to wear jeans and a respectable top if they want, otherwise same as physicians: pants and long sleeve shirt.

And so from my very comfortable post here in Oz (although at the moment i have no choice in clothes because its surgical scrubs for theatre all day) i offer my sympathy and condolences for our short and long white coated friends overseas.

Posted by: Jeram | Nov 8, 2007 3:50:49 AM

Hello, I'm a 4th year medical student from Malaysia. Have been a loyal reader of the Differential. Being in and around the hospital most days of my current life, i totally get what u mean! In fact my colleagues and I are planning to do a research on the Hospital staff (doctors, nurses etc) opinion on having medical students around..whether they find us constantly in the way? Please mail me if anyone has literature on this, of previous similar researches etc...thanks and all the best.

Posted by: Michelle | Nov 10, 2007 6:26:51 AM

here in india everyone wears the same length of coat but the student coat has short sleeves, which makes us very easy to identify. since we have no A/C half the time, short sleeves are actually quite nice.

Posted by: nivedita | Nov 21, 2007 12:37:11 AM

hi all,
nice to remember white coat since i am out of hospital working for a software firm.missing white coat a lot

Posted by: seema | Nov 22, 2007 5:13:35 AM

I prefer the long coats. It helps protect me from what the patient may throw, toss, or lose control of when you are with them. In physical therapy, we are often the first to get the patient from bed and therefore more apt to receive what they have to offer.

Posted by: Tony | Nov 29, 2007 12:44:36 PM

with the white coat comes expectations! I don't think coat length is a good differentiation. I'm short so all my coats look long on me... Usually people look at the name tag which identifies who you are.

Posted by: yen | Dec 5, 2007 7:01:11 AM

my ignorant self didnt know there was a difference in coat length, and now on my 3rd week of rotations, a resident pointed it out to me. i was wondering why everyone kept calling me doctor..i'm a 3rd student year and damn, did i feel stupid when i found out

Posted by: rsd | Oct 13, 2008 5:08:55 PM

This is an excellent article and humorous thoughts on the white coat.

Posted by: nitrile gloves | Dec 5, 2009 10:14:18 PM

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