I thought the white coat was supposed to indicate respect and seriousness-- that the writer wanted to show the mother that she took this awful responsibility seriously. The whole essay was about the writer giving this event the serious treatment it deserves. She desperately wanted to get it right.
A long time ago, I was on a mailing list for young mothers. We’d all post about our pregnancies, and then post our birth stories. Most of them were joyous, of course, but I remember two that were not, and those two terribly sad stories illustrated that it matters how parents are told bad news.
One mother lost her newborn to a heart defect. Despite her fathomless grief, she was able to recall and be grateful for the sensitivity and kindness with which the doctor delivered the news that her son would not survive.
A second mother had given birth to a baby with many serious problems. She and her husband were trying to look on the bright side-- perhaps their baby would have problems but would nevertheless mature to a lovable, if imperfect, person. She could not forgive the doctor for coldly, bluntly, without warning or interest, telling them that their little girl would never meet any developmental milestones. There may be no good way to deliver that news, but there are bad ways, and this doctor found one of them.
I don’t know for a fact, but from all the anecdotes that I’ve heard I would imagine that as a female doctor the coat signifies the profession and is needed in a way that it is not for a man in the same circumstance. She needs it to signify that she is the one who is the official party with the news and not an aide of some kind. In a case like this it would eliminate potential confusion.
I understand, but 2 people (I think it was 2) said that their husbands who are MDs balked at the coat line. It is not out of the question that the coat is more important for a female MD trying to be sure that she looks the part and that the family understands that intuitively when she walks out.
My H, an MD who has had to deliver bad news, reacted exactly the same way as indicated in gouf’s post. He personally rarely wears a white coat because his personal belief is that he gets more respect from wearing scrubs - that he “gets his hands dirty” so to speak. But no matter, and certainly no need to be literal about it. He saw the white coat exactly as some of you said - almost a ritualistic way to assume/convey the mantle of authority and a mental transition to steel oneself and put on a professional face before going in to deliver heart-wrenching news. He saw it as having nothing to do with the whether the doctor was male or female or that it was more important for a female to do so. His approach is to sit down and think about what he has to say and the words he’s going to use, but it’s the same concept - when you’re going home to dinner that night, someone’s world is shattered.
Thank you for sharing. An incredible piece of writing.
Btw garland - I had my H read it, not have it read aloud to him. I think it’s more powerful that way, and gets you past the literalness of “well, *I don’t wear a white coat, so how can I relate.” The white coat is a symbol of authority, a symbol of the quiet dignity this moment deserves, and the act of putting it on symbolizes the transition from doing the doctor-part to being the bad-news-bearer.
Sigh. Way to derail from a discussion of a really emotional, compelling piece of work. Now we should talk about the color of the scrubs.
It’s abundantly clear that it wasn’t “first you get the coat because you’re a woman and it’s important they not think you are the nurse.” She was talking to everybody, not female doctors, about her ritual in this situation. Not everything needs to be a “feminist manifesto” when it’s intended to be universal.
No, rather it was called into question as being some stylistic flourish rather than a real detail that has been borne out of her experience. What is abundantly clear to me is that she knows that she has one chance to get this “right” for this family and she is leaving nothing to chance.
“Following an adverse event that may or may not involve negligence, patients report greater satisfaction and are less apt to sue when they perceive the physician as communicative, caring, honest, personal, and apologetic, when appropriate.”
I think you’re missing the point. The writer is saying this isn’t about her. She’s shattering someone’s world. It doesn’t matter if the doctor is a man or a woman, and she’s not worried about whether or not the family is going to mistake her for a nurse instead of a doctor. The entire piece is how one doctor handles this part of her job. It’s about showing repect to the family, delivering devastating news, then having the good fortune to be able to return to her own family and mundane home matters while the deceased’s family is left to pick up the pieces. It was well written and insightful.
What a beautiful and heartbreaking piece of writing.
That calm demeanor, formulaic script and physical positioning are also to help the hearer absorb the information, information the person’s brain is in many cases doing its best to block out.
I once drove a friend to the hospital following the ambulance after her husband had a massive heart attack out of the blue while on vacation. When they told her he had died they were very direct but it still took a while for it to sink in. She was in shock and asking when he could come home.
In my experience I can usually tell who the doctor or at least the head LP is by their manner. They don’t have to be brisk and steely, but need to clearly assert their authority. For one thing it reassures the patient they know what they’re doing. I’ve seen my own doctors in scrubs, business dress, and white coat, and it was always the way they approached me that told me they were the MD’s.
I would argue that because it isn’t about her she makes that point. If it were about her she would feel ok about going out in scrubs. If it were a “feminist manifesto” she would leave off the coat because it’s hot or inconvenient or unnecessary or old school. Because she is putting their feelings first in that horrible time of trauma and wants to leave nothing to chance she stresses that no matter what, without fail, she must have the coat. The family needs to know that the highest authority available has told them that their child is dead. They need to hear it as final in a compassionate way, but a way that leaves no doubt. They need to feel like the most important person took the time to tell them and that their pain and loss isn’t an afterthought.
No, it doesn’t matter if the doctor is s man or a woman but it does matter that in this time of great stress and trauma they instantly understand her to be the doctor and the final word.
the white coat is a symbol of the roots of becoming a doctor. And what being a doctor means.
the Hippocratic Oath often takes place at “white coat” ceremonies. “an oath stating the obligations and proper conduct of doctors” - grabbing the white coat is a respect for profession and for the family.
in a crisis, the first time a family may actually meet the doctor is when they come to deliver this terrible news. They may have met a nurse, social worker, chaplain - but unfortunately, they may not meet the doctor until this moment. The white coat is a visual that this person is of authority.
Totally choked up upon reading this poignant piece of writing.
The white coat ceremonies are a very new invention, though - last 10-15 years or so. They aren’t really part of any established medical tradition, which is not to say that they won’t be someday. But they aren’t dating from the time of Hippocrates!
thanks @arabrab i would not have seen this essay without your posting it. What a fantastic piece of writing! And on top of the really important subject matter, what a unique style…like a protocol, with directives. I don’t know if i have ever read anything like it! I usually don’t like short sentences. Here they work and work amazingly.somehow the sentence about getting new chairs each summer made me the saddest of all…
Wasn’t inferring that white coats were around with Hippocrates! But that the white coats are a recent (I believe since late 80’s, early 90’s) “ceremony” - hand in hand with the oath. Those words really come to meaning something in times like the article demonstrates.
Another MD’s wife here. Funny I missed the last line about her “husband’s socks” when I first read the piece. And I didn’t catch that the name she used as an example of breaking the news to her own mother was her own name (Naomi). I assumed the entire time that the writer was male!
My twin sister is also an MD and has often been (especially when she was young) mistaken for a nurse. My H always wears a white coat ( he gets his hands–and coat–dirty, too.) It is part of the dress code for the last two places he has worked-- for whatever reason. I think it symbolizes authority/knowledge/experience and increases trust–patients look to “the doctor” for information and trust him(her). In this case, I think it is important for the family to be able to identify who the doctor is here–especially in an ER where everyone is in scrubs. Everyone wears scrubs these days-- dental receptionists, repiratory therapists, PT assistants–you name it. But it is understood that the one wearing a white coat is the doctor.
I liked the piece because bad news is rarely considered from the perspective of the person who delivers it. And to have to deliver it routinely is a difficult job. I have sometimes felt sorry for doctors who must, unwillingly, play this sad and forever-remembered role in the most dramatic moments of other people’s lives. But I didn’t find the piece all that moving. Maybe because it is written as a “how to. . .” which makes it purposefully factual/procedural (because, otherwise, how could the doctor get through it?) Or maybe it is because I have been on the receiving end of bad news/unexpected deaths of family members several times. And my H has, as a geriatrician, attended quite a few deaths/prayed with families as their loved ones died/informed families of their loved ones’ deaths many times. I didn’t like the part about the broken chairs, punched walls. Not sure how the person who breaks/punches things will be “better/easier” than the ones looking at the floor or ceiling/ having their eyes fill with tears.
This essay had a lot of messages in it.
t’s not about telling patients about death.
Delivering the message of death is hard on the giver of news (white coat), harder on the family (explode their world) and then the third and most important part is the senselessness of the deaths in this particular ER.
It is really an essay about gangs and senseless shootings Learning to tell moms about death of their children in an ER setting under these circumstances should not be routine but it has become so. Which is saddest of all.
“But do not say he was murdered or he was killed. Yes, I know that he was, but that is not what you say.”
Why not say it? Because everyone already knows it. It happens all the time. At this point the murder/shooting doesn’t matter. The victim still belonged to a family who cared. The doc can’t take care of society–they can only help family in this very small way after the fallout.
But the fact that this is ROUTINE is mind-boggling to most. It’s really a call to arms–stop the madness.
Breaking chairs is a release of anger which is safer than pent up emotions. And the simple sentence that there is a budget for chairs broken is very powerful. It’s expected (during summer especially) which shows how often it happens. Now it’s just a seasonal occurrence. More routine. “Just put it in the budget.”
That image contrasted to “yell at your kids” (versus punching walls and breaking chairs) or a husband didn’t “pick up the socks” (versus getting shot or committing murder) shows how insulated (and ultimately “safe”) your life is from other’s reality.
Just for clarification, not to re-litigate … I shared a link that it turns out was against TOS because it was another forum so it needed to be deleted. But just for background it was a forum of female doctors discussing the coat issue and their own stories of being mistaken for other healthcare staff sometimes even with the coat. There were more than just stories of inconvenience or noses out of joint. There were actual stories of patient and family complaints which were escalated through the system based on not having seen a doctor or feeling ignored and neglected. They HAD seen a doctor but just didn’t recognize that even when the doctor had a clear badge and introduced herself as Dr. Blank.