Class of 2012 White Coat Ceremony
October 4, 2008
Welcoming Remarks by P. Pearl O'Rourke, DMS'73

On behalf of the DMS alumni, congratulations! We celebrate your achievements and your future. Congratulations to your families and friends who have paid your tuition…listened to you whine…cheered you on…and who, if you treat them well, likely promise to keep doing the same.

We did not have a white Coat Ceremony. Rather, a few weeks before starting physical diagnosis, we were simply told to buy a white coat at the bookstore. On the face of it, a simple purchase; in fact, the coat cost less than any of our books. But this was a special purchase – this was tangible evidence that we were about to enter the world of clinical medicine – the reason we had come to medical school. But, with the excitement came nervous giggles, if not trepidation. While we had saturated our brains with panoply of basic science – crossing the threshold into clinical medicine was a sobering and somewhat daunting next step.

The White Coat Ceremony is a formal acknowledgement of that next step – it emphasizes the fact that becoming a physician is not only about learning the formulas and facts – it is also about learning how to apply that knowledge in an ethical, professional and moral manner. A prodigious step.

DMS alumni congratulate you and would like to offer some sage advice that we have collectively accumulated through the years. First, four infrequently articulated rules for proper wearing of this garment.

1.  You will notice hidden away in some obscure seam – a tag that gives directions for the care of this garment. Cold water, tumble dry – this is here for a reason – there is no magic, no divine intervention that keeps these coats white. Buy detergent. Find a laundromat.

2.  You will notice that there is a surfeit of pockets – especially good news for the women in the class, whose clothes are not known for their number or quality of pockets. You will be tempted to fill these pockets with crib sheets, good luck totems and other “stuff” – but beware, this coat is not wearable Samsonite – do not overstuff. Studies have shown that a naked white coat weighed 0.6 kg – yet coats worn by the medical staff weighed as much as 3.5 kg (and note – cell phones were removed pre weigh-in). In addition, the weight of the coat was inversely related to the experience of the wearer.

So – do not overstuff – it may cause back strain; it is a neon sign that you are a rookie AND, it looks ridiculous.

3.  Accessorize responsibly. You all will personalize your white coat – future pediatricians will start adorning the lapels with those little stuffed huggy-bears, others will add a variety of advocacy ribbons. BUT – do not add anything that could be seen as potentially disrespectful to your patients. For example, I once had to ask a resident who was doing an ICU rotation to remove a rather prominent “Grateful Dead” button. Don’t let that be you.

4.  Only wear this coat in medical settings. This is a uniform for medical activities – not for every activity in your life. In fact, if you wear this coat while food shopping at the Hanover IGA, do not get upset if you are asked to rearrange the apples in the produce department.

These four simple rules for responsible white coat etiquette should serve you well.

Today, as you snake your arm through the sleeve of your white coat, I would like each of you to spend a few moments thinking about the people who are snaking their arm through the sleeve of this garment.
   •  A woman having a breast biopsy
   •  A young man awaiting HIV test results
   •  An elderly woman who just broke a hip and knows that going back home is no longer an option
   •  A child having a tonsillectomy
   •  A child having a craniotomy for a brain tumor
   •  A 61-year-old waiting for his routine annual exam
These patients are here today and they are waiting for you in the future. They will be sharing with you their most intimate physical, mental and emotional details, with the expectation that you will elicit and process the necessary facts, identify the problem and develop a plan. They want good news – they try to prepare themselves for the possibility of devastating news. They are nervous, vulnerable; they want to trust you. So, you in the white coats – how can you deserve their trust?

1.  Be a student today and for the rest of your career. The faculty here is superb – but to quote an elder statesman from Harvard, C. Sidney Burwell, “Half of what you are taught as medical students will in ten years have been shown to be wrong, and the trouble is, none of your teachers knows which half.” Look at me – while I was in medical school, AIDS did not exist, cigarette smoking was not so bad for your health and MRIs were not yet even in the realm of magical thinking. Medical school is just the beginning of a life-long curriculum.

2.  Never pretend that you know more than you do – medicine is a team sport – that’s why we wear uniforms. Never hesitate to ask your colleagues, get advice. There is simply too much for any one person to know.

3.  Do not panic and lose perspective. Borrow advice given by Dr. Lasagna at a Tufts medical school graduation – the best counsel can be found on the label of a mayonnaise jar: keep cool…do not freeze.

I also thought it would be important that you hear directly from patients. So, in preparation for this talk, I conducted a study to document what patients would say to you today, if they had the opportunity. Using a validated survey tool, I interviewed my mother, my secretary, five neighbors and some guy who was behind me in an unusually long line at Starbucks. I share with you the high points.

1.  Be compassionate – show compassion – I need to know that you care.

2.  Show respect – it is difficult to feel dignified while perched on an examining table wrapped in a paper gown. Respect can be as simple as knocking on the door and asking permission to come into the room, rather than the entitled barge in.

3.  Acknowledge my presence – do not talk over me as if I were deaf and blind.

4.  Communicate carefully – engage me in a conversation – do not simply proclaim or notify as you turn to exit the room. Your usual medical terms are not part of my daily vocabulary, AND I may be a bit distracted by the fact that you just told me that I have cancer. So please, go slowly; repeat and expect that I shall have questions. I am the one who must incorporate this information into the rest of my life.

5.  Know my name and shake my hand – I need you to see me as a person before you see me as a patient.

The message can be summarized – be honest, be humble, be human.

In closing, the investment in your future exacts a high cost:
      A white coat:   $25.98
      A package of laundry detergent:   $3.49
      A year at DMS:   $40,000
      Meeting your first patient in your clean, unstuffed, tastefully accessorized white coat…priceless.

Enjoy the day; enjoy the occasion. In the pocket of your new white coat, you will find a note from a DMS alum. This is a note of welcome, a note of congratulations and an invitation for you to call upon us at any time.