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Taking off the white coat: Putting the soul first and the IV second

Posted By Elizabeth Bailey, Tuesday, May 22, 2012

Editor's Note: For this week's Growing MedFT post, we have invited Elizabeth Bailey to share personal reactions to the commencement address Donald Berwick gave at the 2010 commencement ceremony for the Yale School of Medicine.  The text from Berwick's address is available here.


Donald Berwick is a champion of putting the patient first, in all of his or her fragile, complex humanity, as the only way to improve, indeed save, our failing, fractured healthcare system. As he has said so often, it is only by asking "what will it do for the patient” that we can begin to move towards the care we need rather then the care we currently have.

The title of Berwick’s commencement address "Stepping into Power, Shedding Your White Coat” which he gave to his daughter’s graduating medical school class encapsulates the conflicting forces confronting young doctors as they begin their professional lives. They step into a culture of power and privilege by putting on that white coat of medical authority. The white coat, both in reality and symbolically, distinguishes them from their patients but must not, with its associated rules, language and culture, separate them from their shared humanity. He asks these eager, young graduates to consider that in every human encounter they are always faced with a choice – the choice to put the IV or the soul first in treatment. It is only by metaphorically taking off the white coat that they can truly heal their suffering patients.

Several years ago my Dad went crazy from what turned out to be a cascading series of medication errors and miscommunications. He was hospitalized for almost a month with full-blown steroid induced psychosis. The steroid medication wreaked havoc with not only his mind but also his body by drastically elevating his blood sugar levels. Dad’s previously mild diabetes was now a medical crisis. The first few weeks were focused on bringing his diabetes under control. After being was deemed "medically stable” he was transferred to the psychiatric unit, his psyche proving harder to heal.
Elizabeth Bailey
I wonder if that young resident had taken off her white coat, if only for a moment, she might have seen a frightened, ailing person not a difficult, non-compliant patient.

    -Elizabeth Bailey
An extremely young resident conducted his intake. We told the young doctor about our Dad before his illness because we wanted her to see him as the person he really was in life – an erudite, active, 81 year old former lawyer, not the broken, crazy stranger sitting in a wheelchair in front of her. Too often in the main hospital, Dad’s care seemed impersonal and distracted, his humanity forgotten. We wanted her to know him…at least a little. And we were frightened by his state of mind and unfamiliar with psychiatric units.

We told the young resident that the steroids had seemed to unleash flashbacks of his experience as a young soldier in the Pacific during WWII. As if on cue, he launched into a horrific tale of being trapped by sniper fire on Guam. It was obvious how much Dad was suffering – suffering from the steroids still in his system, suffering from painful memories, suffering because he was a human being who was ill. The young resident listened to him with a blank, stony face.

The next day, we went to visit Dad but he was not in his room. The resident appeared and ushered us into a little side office. She said there had been an "incident” with Dad in the morning, but that he was resting now in the "quiet room” – shackled to a metal gurney, shot full of enough antipsychotic medication to subdue a horse. We would not be allowed to see him then – it was against the rules.

Apparently, Dad had gotten up that morning and decided that he had had enough with hospitals in general; with doctors who looked past him; with too many medications he did not understand. He wanted to leave and go home and read the newspaper. The resident ordered him back to his room. When he refused, security was called.

When Dad saw the guards, he reminded them that he was a Marine and they would never take him alive. They wrestled my eighty-one year old father to the floor. A burly guard sat on his chest while the others put him in restraints. They then carried him to the "quiet room”. She never called us to alert us: that was against hospital rules. We asked her when we would ever have found out if we had not come to visit. She had no answer for us.

When we returned that night, Dad, still heavily drugged, was in his bed in his room, mumbling, "How could they treat me so badly?” The nurses later apologized to Dad about what had happened. The young resident never said anything.

I wonder if that young resident had taken off her white coat, if only for a moment, as Donald Berwick instructed the graduates to whom he spoke, she might have seen a frightened, ailing person not a difficult, non-compliant patient. Might she have found out how much my Dad loves to read, about his favorite hotel in Paris, about how much he misses his wife who died too soon or that he makes a martini that knocks ones’ socks off? By taking off her white coat, might she have seen, as Berwick says, "the dignity in each and every soul ” and in so doing, joined with instead of towering over her patient and become a healer in a world filled with suffering?


About Elizabeth Bailey:  As a producer, director, and vice president of video production for several record labels, Elizabeth Bailey used checklists to oversee hundreds of music videos. While helping family and friends navigate their hospitalizations, she realized how production checklists could be adapted to help patients better manage the complexities of hospital care. She embarked on a career change, working on her book "The Patient's Checklist" for several years and enrolling at Sarah Lawrence College where she is currently completing studies for a Master's in Health Advocacy. She is also working part-time as a Patient Representative at a major teaching hospital in New York City.

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Jackie Williams Reade says...
Posted Thursday, May 24, 2012
Both the blog post and original commencement address are so beautiful and apply to our role, too. We may not have a white coat, but we wield our own version of power as therapists and also allow our helpful thoughts to be silenced because of the power/white coats that surround us in the medical system. "But, now I will tell you a secret--a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity--of the dignity in each and every soul. When you take off that white coat in the sacred presence of those for whom you will care--in the sacred presence of people just like you--when you take off that white coat, and, tower not over them, but join those you serve, you become a healer in a world of fear and fragmentation, an "aching" world that has never needed healing more."
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