Joy Dorscher, MD, White Coat Speech (10/07/2006)

Good afternoon faculty and staff, friends and family, honored guests/students. 

It is truly an honor to be here today. In thinking about what I was going to say this afternoon I have to admit that I began to feel a little bit unsettled.   Because I thought about the fact that I would be addressing you as you begin your medical education and really your medical career.

Then as I further considered the meaning of the white coat ceremony, and how strongly I believe in what it represents-well that was even more intimidating.   And then finally to realize all of that while having to talk to you in front of my supervisors and colleagues.  Well that I really have to confess nearly put me right over the top. 

But even more than all of that, the most intimidating part of my being here today was the belief that if I had had the opportunity to participate in the white coat ceremony when I was in medical school I would have remembered the words of the speaker for a very very long time.  I would have remembered them not because it was a public ceremony to display my accomplishments, if that were true I would remember every detail of my college or medical school graduation and I barely remember either of them.  I would have remembered those words because although done in a public setting this is a very personal ritual.  I think of the white coat ceremony as the ceremony of “becoming”.  Becoming a physician. 

Each of you is becoming.  I would like to be able to stand here and honestly tell you that you will be exactly the same person at the end of your medical education that you are today.  You will not.  And although in some ways that is very sad in others it is cause for great joy. 

• How could you possibly be the same person that you were before you handed a mother her child for the first time,
• as you were before you talked to a man who has now healed from his heart attack and has a new view of life
• or as you were before you were present with a patient as they passed on to the other side. 

How can one have those experiences and remain unchanged?  Physicians have such a wonderful opportunity to touch the lives of the people around them.  As physicians we touch our patients both literally and figuratively.  I can’t think of any other occupation, career or calling that allows this kind of interface. 

The touch of a physician can be demonstrated in the touch of their hand, that is obvious or in the touch of their heart.  I used to tell my patients that it was “the power of the room”.  They would come into the clinic, get weighed, get their vitals checked then settle the examination room, reading an old magazine and then I would come in.  “What can I do for you today?”  And their eyes would begin to leak-almost imperceptibly at first but eventually it couldn’t be ignored and they would begin to cry, sometimes sobbing.  Before that moment they were completely unaware that they wanted or needed to cry and they would apologize-profusely.  “I don’t know what is the matter with me.  I don’t know why I am crying.” And I would tell them,” It was the power of the room. “ The safe place where they can come and honestly relay the concerns that had been swimming around the back of their minds and now have been given form, a very scary form that brought them to tears.

We touch our patients lives in other ways too: I was in Target the other day-for those of you who don’t know I became a grandmother in August and I felt that my new grand daughter needed yet another little outfit, so I was in the baby section-I ran into a young family there.   The father brought his son to me; he was about 4 years old and introduced this young boy to the doctor that delivered him.  I hadn’t seen them in at least 3 years but they remembered.  And the father was still grateful to the physician who helped expand his household from that of a couple to that of a family complete with child.  I run into “my families” all the time, they give me updates on their children and perhaps their parents if I cared for them too-sometimes they have hugs, often wondering when I am going to go back to practice but always happy that we can stop and chat.  They make me feel as if I am a part of their family. 

Each time a meet a family or patient in this way I cannot help but feel a great honor at being allowed into their lives in such a personal way.  We touch our patients both literally and figuratively.  It is an honor to do so-but with that honor, that opportunity comes a great deal of obligation and responsibility and we have to honor that too. 

I couldn’t give a talk like this with out talking about George (not his real name).  I met him shortly after his wife had passed on.  He had lived his life as an independent hard working man but now he was alone. The minute that I would enter his room he would begin to yell at me.  There was more than one day where I would stand outside of his room and have to take a few deep breaths and talk myself into going through the door.  I would enter, [HOLD UP HANDS] and say, “Now George you can’t yell at me but…” and then I would launch into the treatment plan for that day.  And of course he would yell.  It was awful. 

Then one day instead of trying to get out of his room as quickly as I could I decided to sit down and really talk to George.  And he began to tell me how 6 months before, his wife had become unexpectedly ill and died with symptoms similar to the ones he was experiencing now.  It was only at that point that I realized that he was scared and worse- in the way I was handling the situation I was making him more anxious which was relieved by his yelling.

Well George got better and went home.  But he came back to see me at the clinic.  When he went to a nursing home 45 miles away, he came back to see me at the clinic.  And most touching of all when I graduated from residency and moved to Duluth he came to see me there as well. 

The science is exciting and it provides you with an understanding of how the body works and what happens when it doesn’t work and even how to fix it.  I suspect that each person sitting in those seats has a fascination with the science of medicine.  And perhaps after your first couple of tests maybe even a bit of a frustration with the science of medicine. 

The art of medicine can be described in many ways-but is usually thought of as clinical judgment and observation, the interpersonal attributes that allows one to pull an accurate story from the patient, and that gut feeling that tells you when you are on the right diagnosis path.

But it is the heart of medicine that I would like to address today. And although there are several stories that illustrate this I would like to share the following:

When I was in residency there was a wonderful teacher-a pulmonologist.  Physically she was only about 5 foot 1 but she was a force- -personable, kind, empathetic, with an intelligence and ability to interpret data that was unmatched by any with whom I have come into contact.  She was (and I suspect still is) quite a phenomenal physician.  She came to the bedside armed with a full arsenal of knowledge, skills and compassion.   And she used each one at the appropriate time. 

One day we were walking on the ward and she turned to me and said, ”Isn’t is a glorious day?”  And of course I agreed, it was spring, the leaves were budding, the lilacs were beginning to bloom; it was in all ways a beautiful, and glorious day.  Then she said, “Mr. So and So is going home today.” [PAUSE]

When I was on her service several weeks earlier Mr. So and So came into the hospital and through a series of very complicated tests was found to have an incurable illness.  The primary care physician read about a new treatment that had just been approved by the FDA that could offer this patient a few additional months.  But it would also require that he stay in care facility where he would surely spend his last days.  The primary care physician provided the patient with this choice and being of that older generation the patient acquiesced to his recommendation-the primary care physician chose the science over the patient.

 This pulmonologist sat down with the patient and his family- and discovered that this was a man who had been born in the house where he currently resided.  He married and brought his bride to this house-where they raised their family and they had subsequently retired.  All he wanted to do was to go back there and comfortably spend his last days in the same house where he was born.  She fought for his right to do so. 

Without her I wonder what would have happened in this case.  She chose the patient over science-even more than that she was pleased that she was able to do what she did for him.  The patient will never know that she risked her relationship with that large primary care group, a member of her referral network, in order to provide him with that beautiful day. 

This is the heart of medicine.  And it like the science of medicine it must be tended and nurtured in order to develop to its fullest potential.  It is up to each individual to make sure that that occurs. Unlike the intellectual aspects of your education your heart is not evaluated except by you. 

Your heart is truly known only to you and that is why the white coat ceremony is so important and why it is such a personal ritual, the ritual of “becoming”.