October 4, 2018
Last week, I had the honour and privilege of giving the keynote address at the White Coat Ceremony for the University of Saskatchewan College of Medicine’s incoming Class of 2022. I was able to welcome them to what has, for me, been an amazing, challenging, rewarding and uplifting path. And it got me thinking about our white coats, and why we wear them.
I started my medical career much like them, as a first-year student at our College of Medicine in 1991. Right from my very first day I knew I was in for something special. What I didn’t know was how much was ahead of me, how I would grow during medical school, and how much I continue to grow as a person all because I was given the privilege of donning a white coat, one of the symbols of our shared profession.
We didn’t always wear white coats. For centuries, doctors wore somber clothes, black robes, as did all professionals at the time: doctors, lawyers, priests, academics and more. Keep in mind that the reality of medical care at that point in our history was such that seeking a doctors’ advice was usually a last resort, and often a precursor of death. Our predecessors wore black out of respect.
As our shared understanding of science developed, doctors moved to a more scientific uniform. We started donning white lab coats to connect ourselves to the scientific foundations on which we aimed to develop our knowledge. We also were gaining a better understanding of the importance of hygiene and cleanliness as part of good health.
In the late 1800s, Dr. Lister learned about germ theory and developed Listerine as part of antiseptic surgery. His application of science transformed care and we continue to refine what he discovered. You will be familiar with Listerine as a mouthwash that you buy at the grocery store. You probably don’t want to be familiar with the original formula, which was also sold as floor cleaner and a cure for gonorrhea.
Wearing white made sense at the time. Physicians had more to offer than a few kind words and some opium drops as death approached. A white lab coat connected the doctors of the day who were attending the new medical schools with scientists. As medicine became more organized with institutions, academies and colleges, the white coat was a symbol that identified those who were members of organized medicine from those who weren’t.
The white coat started as a symbol of science, cleanliness and being part of a profession, and at their White Coat Ceremony, I asked this class of young doctors to think about their white coats and the connection between their future profession and their humanity on a daily basis.
As we moved from black robes to white coats, Dr. William Osler redefined the practice of our profession. Dr. Osler was a Canadian physician who is widely recognized as one of, if not the true, father of medicine as we practice it today. Some of his enduring contributions include:
These are still core elements of how we learn and practice medicine. Osler also wrote extensively, passing on his observations and lessons not only to his students but also to the generations who followed him.
While pretty much being the architect of the learning path the Class of 2022 is starting on this fall, Dr. Osler’s biggest contribution is the underpinning of his teaching: “Medicine is learned at the bedside.”
Osler also said: “Listen to your patient. He is telling you the diagnosis.”
Our patients do that and so much more.
Patients are our teachers and guides. Part of the work ahead of young doctors is to learn how to learn from them. Young physicians in their white coats will be taught some of the principles of how to do this in simulation labs and small learning groups. But where they will really learn this is from practicing with patients and reflecting on their experiences.
I shared with the class of 2022 three of the key lessons I’ve learned since starting my career in 1991.
The first one is, learn how to be present at the bedside:
In return, patients, if we listen to them, will teach us more about medicine and about life than we could ever imagine.
The second lesson is to be aware of how much we do not know.
My clinical work is as an intensive care doctor. My job is to lead a team who provides life support to people at high risk of dying. I spend a lot of time in that space between life and death.
After about 12 years of training and five years of practice, I met with the family of a First Nations man who was dying in my ICU from an overwhelming infection. I spoke carefully and clearly as I described the impact of his illness, the supports he was receiving and the sad news that our medical care, my medical care, was not going to be able to save him.
After sitting in silence for a while, one of the Elders in the room spoke up. Kindly and clearly, he asked, “Yes, Doctor, but how is his soul?”
Medical school, residency, fellowship and five years of practice did not prepare me for that question. That is still the best question I have ever been asked by anyone.
How is his soul? More than 10 years later, I still don’t have an answer for that man and his family. There is so much we do not know. Our understanding of how our bodies work and don’t work is incomplete. And our western model of health and health care is only just starting to recognize the connection between physical, mental, emotional and spiritual wellbeing. We have so much to learn and to discover together.
So lesson two: It’s good to be connected to what you don’t know. Practice humility.
My third lesson is one that physicians need to continuously work on: try really hard to stay human. Whether you’ve been a doctor for years or a medical student for but a few weeks, we are all human. We have much in common, and I think we have much at risk.
Earlier I wrote about Dr. William Osler, who I learned about in my first few months of medicine. Today I want to introduce you to a 21st century version of Dr. Osler. You can find Dr. Mark Reid on Twitter at
Dr. Reid initially started his Twitter feed to collect the teachings of famous, old, dead doctors: Osler, Mayo, Lister, Pasteur and more. He then moved on to documenting his own learnings. He tweets often about the need to take care of yourself and remember why you chose this path in the first place. One of my favourites is: “If you don’t bring your humanity with you to work, you might have trouble finding it on your way home.”
Class of 2022, I say this directly to you: Work hard to stay whole as a person. I can’t tell you how to do this. It will be your own path to discover. But I can tell you that you need to pay attention to who you are, what you are learning about yourself and how you are staying connected to what matters most to you. Medical school, and medicine, can be overwhelming and isolating. It is by working hard to stay connected to your values, your supports, your friends and your family that you will have the best chance of thriving and growing.
I told those young doctors to wear their white coats with pride for what they have accomplished so far, with gratitude for the privilege of what is to come, and with a strong sense of humility and openness to what they do not yet know, and what they are going to discover.
What is underneath the white coat is the most important part of who we are, and what carries us, as physicians, into the lives of the patients, families and communities that we serve.
To the Class of 2022, I wish you joy and support, and I look forward to working, learning and growing alongside you.
And to the rest of my colleagues out there, I’d love to hear what lessons you have to pass on to our learners and future colleagues. Let me know at email@example.com.
Dr. Susan ShawChief Medical Officer