My column in the September issue of Emergency Medicine News.  Enjoy!

https://journals.lww.com/em-news/Fulltext/2015/09000/Life_in_Emergistan__Lab_Coats_Don_t_Make_the.7.aspx

September 2015 – Volume 37 – Issue 9 – p 5

doi: 10.1097/01.EEM.0000471521.16507.34
Life in Emergistan

Life in Emergistan: Lab Coats Don’t Make the Physician

Leap, Edwin MD

 Dr. Leap is president of LeapMedicine, PC and practices locums emergency medicine., and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don’t Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, www.edwinleap.com/blog. Follow him @edwinleap, and read his past columns at https://bit.ly/LeapCollection.

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

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I currently sport what a family medicine resident told me was the ER Mullet: khakis and polo shirt. (Who knew?) I find it much more comfortable. While I respect those who choose the lab coat and I envy the voluminous pockets, I just can’t do it. I usually wear a scrub shirt, if only because it has my name above the pocket, where my now-indispensable reading glasses rest, along with my blue gel-ink pen.

I suppose the lab coat carve-out for administrators was a kind of homage to the perceived influence and power of physicians. (Can’t keep a straight face on that one!) It’s part of the belief that somehow, appearance equals importance, or sameness. Part of influencing physicians is for administrators to adorn themselves in the classic accoutrement of physicianhood, the lab coat. (A more realistic option simply might be to carry around a loan repayment book and a half-eaten turkey sandwich.)

Of course, it isn’t just the lab coat. It’s scrubs. Everyone and his brother wears scrubs. From housekeeping all the way to THE heart surgeon, scrubs are believed to confer some kind of weird authority. Our EDs are often populated by patients who themselves are in scrubs, sometimes because they came straight from work in a medical setting, and sometimes because they sleep in them. Often it is from a sense that wearing the uniform will get them taken to a room and treated more expeditiously as one of us. Silly rabbit.

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My Sister, the LPN

You’ve met them, I’m sure. “I know you say the fever doesn’t matter, but I’m a nursing assistant, and I think he needs some Zithromax.” Or this: “My sister is an LPN,” “My cousin is a pre-med student,” “My aunt is a chiropractor,” “My mom is in nursing school.” All are meant to suggest that our authority as physicians is somehow not a whit better than another person, another health care professional whose scrubs, clogs, or lab coat are tangible evidence of their own professional status.

I think not. I know because I’ve invested a lot of time in being a professional. And it’s more than scrubs or lab coats or even certificates. Professionalism is an honor and burden, a privilege and duty.

This is not, of course, to minimize the importance, utility, or compassion of those who work in other health care roles. I’m happy that we can work together, and I certainly need their skills and insights. But in the end, physicians have a different role. Maybe it comes down to accountability, which always seems to rest squarely on our shoulders. That’s part of professionalism. But the other part is the necessity that we do the right thing, over and over, day and night, whether or not it’s fun or pleasant. And that we have the confidence and authority to do so.

As physicians become commodities at a startling pace, I find myself torn between enormous resentment at how hospitals and government agents treat my colleagues and friends juxtaposed against a vast pride in the same friends and colleagues. I feel pride in what we do despite that the dismissive treatment reduces us to one more set of scrub-wearing employees.

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The Stone of the Soul

The older I am, the more joy I find in making the diagnosis, doing the procedure, knowing the answer in a way that was modeled for me by my physician mentors of days past. The more fierce I become in doing what is right, in making things happen in a timely manner, in comforting those in pain, in treating those in danger, the straighter I stand when I take charge of the confusing or terrifying situation.

And oddly enough, at 51, I find that I do these things while fatigued or under duress even better than when I was younger. Knowledge, skill, experience, propriety — professionalism — all of these are now worn deeply into the stone of my soul, indelible petroglyphs.

That, brothers and sisters, is nothing new to you. It is the fruit of an enduring professionalism, a kind of warrior spirit that seeks to help and heal, born of practice, dedication, trial, and compassion.

Uniforms don’t make the soldier, and lab coats or scrubs don’t make the physician. No matter how much the world prattles on about health care professionals and views us as pawns in the games of others — insurance, corporations, federal regulations, and data collection — we are so much more.

To my brethren, I say this: Your profession is your uniform. You earned it the hard way, and it can’t be counterfeited. Wear it with pride because there’s no shortcut. Anyone who thinks he can copy it is a fraud, no matter who they are, no matter what they wear. If they try, the world will learn soon enough, to its grief.

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