These days it can be hard for physicians. Many in the physician workforce wonder whatever happened to the ideals and expectations that drew them to this noble profession.
Many physicians lament that some or most of these ideals and expectations have been lost in our profession, for many reasons inexplicable or beyond our control. It is not uncommon for some to state that most physicians enter the profession as passionate idealists though may end up as raging cynics. The only difference from one physician to another may be the length of time it takes for that transformation.
Chandrakanth Are, MBBS, MBA, FRCS, FACS
It is not surprising that all of this is taking a toll on the physician community. Physicians as a whole are known to have a higher rate of burnout and depressive symptoms.1 Physicians are also known to have a higher rate of suicide when compared to the general population.1 We lose nearly 300 to 400 physicians to suicide every year—almost the equivalent of the number of medical students in 1 medical school. The irony of this can only be exaggerated by the unawareness in the general population of this insufferable calamity befalling the physician community. This becomes apparent by the shocked expression on the faces of my non–health-care friends when they learn about this unhealthy fact about the profession. If we lost this many physicians to another disease, there probably would be more headlines about it.
Steps in the Right Direction
Thankfully, we as a profession are taking the right steps. The first step in that direction is to continue to highlight the privilege of becoming a physician. We need to reinvigorate passion and pride for those who want to become physicians, particularly the younger generations, who still are coming in droves into our profession. There is no other profession in the world that can provide so much joy and gratification despite all its trials and tribulations.
The next step is to recognize the problems burdening our profession and tackle the issues contributing to them. We should be fortunate that many efforts are underway at various levels to tackle these problems at the local, regional, and national levels. Although all these efforts are laudable and required, there is also another simple answer that is readily available and inexpensive.
The answer is our white coat.
Tailored With Joy and Sacrifice
Each part of our white coat represents something that can remind us daily of the joy, pride, and privilege of being a physician and the trials, tribulations, and sacrifices made to accomplish that designation.
The body of the coat represents the broad expanse and the magnitude of hard work and enduring stamina that goes into becoming a physician. Four years of medical school followed by 3 to 7 years of residency and another additional 1 to 4 years of fellowship translate to nearly 8 to 15 years of training after an undergraduate degree. Long days and nights of work during training stretch for 24 +4 hours (longer in the past) and may seem to never end. Days turn into weeks spent working, sometimes without many breaks. Further there is an incessant and never-ending stream of documents being added to or replaced by the same incessant and never-ending stream of HIPAA [Health Insurance Portability and Accountability Act]–compliant texts. The high intensity of uninterrupted work sometimes prevents one from eating properly or even finding time to get some palatable food and instead settling for cold pizza leftovers in the lounge.
The sleeves represent the dexterity, intellectual depth, innovative curiosity, and delicate skills needed to become a physician or surgeon. It takes years of training to understand the nature of diseases properly—and many years on top of that to possess the knowledge to prescribe the right medication, which can be difficult, even with the help of the most advanced technology. Or, more importantly, to know when not to prescribe or treat something. Gaining the foundational base of knowledge and confidence to know what we do not know is the mark of a good physician.
As for surgeons, the level of benefit and risk is at another level. The years of training it takes to master the use of surgical instruments and operative procedures is not for the faint-hearted. Although learning how to tie a knot may be easy, knowing when and when not to tie one and where to tie one is even more important.
The lapels represent all the achievements/accomplishments and academic honors received throughout the career starting from school. Most physicians were probably the recipients of various recognitions, scholarships, and merit awards through their school and college years.
There is no other profession in the world that can provide so much joy and gratification despite all of its trials and tribulations.— Chandrakanth Are, MBBS, MBA, FRCS, FACS
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The pockets represent what you want to hide from the rest of the world because pockets are meant just for that. They represent the numerous sacrifices made throughout your long training and career. The sacrifices such as missing children’s birthdays and other important major personal events. And the many other personal sacrifices made of youthful joys and pleasures because most trainees are in the prime of their youth. The pockets also represent what you want to hide such as crippling student loans as well as dealing with professional and personal issues. More important, they represent those dark secrets that you don’t want anyone to know about such as dealing with depression or other disorders.
The high collar represents all the high ideals of the Hippocratic oath, which we are sworn to stand by from the first day of medical school until we stop practicing. The collar also represents the privilege of being a physician. In a country of nearly 320 million, there are less than 1 million physicians. You, as a physician, belong to less than 0.03% of the country’s population. This is a high privilege that many strive for but only the rare few are able to accomplish.
Each thread in the fabric of our white coat represents something valuable about our profession—that goes along the lines of extreme sacrifice, undying commitment, sustained diligence, passionate intent to serve, and all those Hippocratic ideals.
So, the next time you are having a bad day—go ahead and wear that white coat—and wear it with pride. Because you are the only one who knows what it took to achieve that rarest of the rare privilege to be a physician and to have rightfully earned the distinction to adorn that symbolic white coat. ■
Dr. Are is Jerald L & Carolynn J. Varner Professor of Surgical Oncology & Global Health; Associate Dean for Graduate Medical Education (DIO); and Vice Chair of Education Department of Surgery, University of Nebraska Medical Center, Omaha.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
DISCLOSURE: Dr. Are has received an educational grant from Pfizer.
1. American Foundation for Suicide Prevention. Available at https://afsp.org/our-work/education/healthcare-professional-burnout-depression-suicide-prevention/. Accessed July 23, 2018.