Iiiiiiiit’s SOAPBOX TIME PART TWO!

Let’s start with a throwback to my surgery rotation.

Allow me to describe, briefly, the scene before a minor surgery. Like a lipoma excision, or a skin graft. The room is sterilized about fifteen minutes before the patient is wheeled back; no one is allowed in without a mask. Once the patient comes in and is put under anesthesia, they’re sterilely draped. You can’t even touch the lights without a special sterile holder, and anyone near the sterile field has to wear a ridiculous-looking full-length gown and specially-sized gloves.

There is a person in the room, the Scrub Tech, aka Dominatrix And Ruiner of Medical Students, who exists first and foremost to protect the sterile field around the patient. If you (especially if you are a medical student) contaminate the sterile field by bumping something you shouldn’t have, or moving, or breathing, or just generally existing as a medical student, the Scrub Tech may announce “YOU HAVE CONTAMINATED THE STERILE FIELD” with the same vigor that Gandalf uses when facing down Balrog and screaming, “YOU! SHALL NOT! PASS!:”

Cackling, the Scrub Tech can then kick you out of the room, forcing you through the entire sterilization song and dance again.

And yes, I had to look up the name for that demon-thingy.

This fanatical attention to being clean, hilarious though it may be, is a major reason why few surgeries end with the patient dead from overwhelming infection. Thank the Scrub Tech.

Now let me take you elsewhere in the hospital. A medical student joins his team for morning rounds, all properly attired in their white coats. The white coats are different lengths, which is of course patently ridiculous by itself: long white coats for the attendings, medium for the residents, and short for the medical students.

Seriously! Our white coats are sized to mimic the scope of our medical knowledge. You can’t make this stuff up. Anyway.

First the team visits the room of a man with congestive heart failure. He’s here because his heart can’t pump well, so his lungs have begun to fill with fluid as the system backs up. That fluid then got infected, and the man picked up a pneumonia. As the medical student performs the exam in front of the team (an exam he already did earlier that morning: this is just for show and tell, which is essentially the purpose of rounds – please don’t get me started) while the poor patient hacks up a lung all over the white coat-clad idiot.

(Again, all med students are idiots. Don’t take offense, you know it’s true.)

As the student listens to the patient’s chest, the patient’s hand brushes his sleeve.

The team confers about the patient’s treatment plan, smiles warmly at the coughing guy, and leaves.

In the next room is a man with cancer who has a roughed-up heart as a side effect from one of his chemotherapy drugs. Cancer-fighting drugs are generally designed to kill cells that divide quickly, like cancer cells – but unfortunately, immune cells multiply fast as well. So this man is immunocompromised, unable to effectively fight off infections.

The Bacteria Transmission Unit, aka the student, moves to the bedside and performs a physical exam again.

It is not difficult to see how hospital acquired infections happen, is it?

How does this make any sense? How can we be so crazy about infection prevention in one half of medicine and in the other, wear portable germ blankets from room to room in the name of antiquated tradition? What good is hand hygiene when you’re wearing a coat sleeve impregnated with the exact same crap you just washed off your hands?

The doctor’s white coat was borrowed from lab scientists at the turn of the 20th century, ironically to lend an air of science-y truthiness to what was mostly quack medicine. The thought was that by wearing white coats, doctors would look more credible. And in fact, surveys show that patients believe their doctors to be most trustworthy, competent, and knowledgeable when wearing white coats as compared to other forms of professional dress. Thanks, 19^th century!

The imbuement of trustworthiness/competence/knowledge associated with the white coat is often cited as a primary reason for wearing white coats in the first place.

This is also a dumb reason. I’d argue that what patients are attaching to is the uniform. If you think it’s important to differentiate physicians from other healthcare workers (I don’t), then give them different colored scrubs. Turn the hospital into a real-world version of Divergent: nurses can be light blue, doctors can be dark blue, techs can be orange. Pick your color, it doesn’t matter – although medical students should be required to be fire engine red so that patients are aware that an idiot with a stethoscope is on the loose.

Yes, I know Divergent was a terrible movie, but that doesn’t ruin the metaphor. Shut up.

Did you see Divergent? The world is divided into 5 “factions” of people, all with different traits. They are color coded. Here, this will kind of help: 

 

WAIT I CAN DO BETTER!!!

Sigh. I love procrastinating.

Anyway. Other reasons people give for using white coats are summarized below in the table I created, beautifully, in Word.

Back to my idea. A color-coded system would also slyly sidestep the remarkably pretentious attachment we have to our white coats (we being, among other things, idiot medical students with large egos). At most medical schools, students are formally inducted into the study of medicine during the White Coat Ceremony, where Important Older People use big words to talk to Excited Young And Hopefully Diverse People about how special and brilliant they are.

Of course, in med school “special and brilliant” really means “uncommonly gifted at taking standardized tests,” but that’s something we don’t talk about at parties.

At the end of these ceremonies, the Dean or equivalent-level Important Older Person robes students, one by one, in their white coats – an officialized Welcome To The Club. Ours even came with a fancy pin and our names emblazoned on the front. You get to feel quite important, and your mom gets to take lots of pictures of you. It’s all very exciting and it’s wonderful for your self-esteem. You stand a little taller and walk a little more confidently in your germ blanket.

Which, honestly, should terrify the entire population in a five-state area, because society has just applied a professional coat* of total BS to a person who really won’t know how to take care of you for about five years.  But if they walk into your room, and professionally and confidently pronounce that tomorrow they – actually, sorry, it’s “the TEAM” – are going to professionally and confidently take out your spleen, you’re more likely to believe them because they have a white coat.

Assuming you have a spleen. And that you’re in the hospital for something semi-related to your abdomen.

*(WAS THAT PUN NOT AMAZING)

Okay, I think this is the end of soapbox time. Once funny things start happening on neurology (may possibly be never), we’ll return to your regularly scheduled programming.