The White Coat Phenomenon, Doctor in Training

A few weeks ago, a teenager in Florida was busted for donning a white coat and stethoscope, entering a hospital, and fooling physicians and patients alike into believing that he was a doctor. He spent a month doing this before he got caught, and he is now on the receiving end of legal and psychiatric intervention.

Years before, Leonardo DiCaprio dazzled us with his performance as Frank Abagnale in “Catch Me If You Can”, a movie depicting Abagnale’s astounding life of forgery and imitation crime, in which he got away with an 11-month portrayal of a doctor at a Georgia hospital. Abagnale went on to insert himself into many other jobs for which he was grossly unqualified, and eventually earned himself a small amount of imprisonment and then a career teaching FBI agents how he pulled all it off.

But not just anyone can pull off trying to be a doctor.

There’s a funny video from Entertainment Tonight in which the cast of Grey’s Anatomy were asked to explain the medical terms they use constantly on their show. Not any one of the actors could accurately elucidate what a CBC (Cool Boys Club?) or a whip stitch (it’s a stitch you do fast!) was. In fact, the cast members admitted to having cheat sheets in the beginning of their scripts every week.

Now it is my turn.

I remember when I put my long white coat on for the very first time, at the beginning of my residency. I was standing next to the full-length mirror and a young woman stood behind me to evaluate the fit. At first I asked for the smallest size she had, but even the smallest style dwarfed me. The shoulders ballooned; I looked like a football player. The sleeves traveled just past my knuckles. The pockets were laughably too far south. I couldn’t help thinking that I looked like a little girl playing dress-up.

The young woman drew on a sheet of paper where the coat needed to be taken in. In a month, I could expect a custom-fit white coat, one that didn’t make me look like a little kid who snuck in to a hospital, stole a coat, and made everyone call her doctor. I never grew quite tall, topping out at about five feet since the age of 13. I had to navigate carefully through the world, developing my own system of pulling things off shelves without asking for help. But it was a sore spot for me to be called names, and it was even more embarrassing when I was targeted for my stature.

I recall a time in my biology class when I was prompted to stand up in front of everyone with a guy in my class who was on the football team and had a ridiculous amount of muscle bulk for his age. The teacher then made her point that drinking eight glasses of water a day was actually a myth, and that the amount necessary was really based on body size.

“For example”, she said, “If we gave Muscles the same amount of water that would sustain Liz, he would dehydrate and die. If we give Liz the same amount of water that would sustain Muscles, she would float away.”

Cue the laughter, cue the inferiority complex.

Since those days, I’ve grown up. Maybe not physically, but after a college education and a medical degree, to some extent I’ve proven to myself that you don’t have to be of average height to make a mark in the sand. Intelligence isn’t measured by shoe size – otherwise Shaquille O’Neal would be the next Austin Powers nemesis. But as I have found out throughout my journey in medicine, feeling small is associated with other disempowering feelings, such as powerlessness or inferiority.

Think of the worst day you’ve had a resident:

You woke up exhausted because a restful night sleep doesn’t exist anymore. You think of the relatives you haven’t called in a while or the terrible things that are being discussed on the news. Early in the morning, before rounds or signouts even start, you’ve already screwed up several important concepts that you should know already. Everyone else knows this stuff, why don’t you know it? Your supervisor looks at you like you’re the biggest mistake the program ever made. The weight of your mistakes crackles miserably on your back, and then gives way in a moment where you feel crushed beneath the mass of your own errors. All at once, you leave the situation. You go sit in a dark room and think about the day, maybe even shed a few tears. The pager goes off, something needs your attention. Notes, phone calls, consults, paperwork…and before you know it it’s been half a day since you’ve eaten, gone to the bathroom, or had just a second to yourself when you didn’t have to be a doctor. On days like this, you’ve wondered why you let this overwhelming job take everything from you, including the lifestyle you once enjoyed, full of happiness and creativity.

It’s no wonder that so many doctors burn out before their time. Medicine, for better or worse, is a job that requires you to digest and maintain enormous volumes of information. As a resident, it’s a daunting task to put all the pieces together, and when it cannot be accomplished in the preferable amount of time, as dictated by the colleagues who seemingly succeed flawlessly, you see yourself as a failure.

You feel like the ultimate imposter.

You feel like someone who luckily got past the security guards, put on the white coat, and pretends to be a doctor. But at the end of the day – or the month or year – it turns out you cannot just put on the white coat and go about your day. Someday, someone will figure out that you don’t belong there.

The good news about this universal feeling is that one day, everything will come together. Feeling “small” is a temporary condition. One day, things will click. Everyone learns at his or her own pace, on their own track, and what works for one person doesn’t mean it will work for you. And for the people around you who seem to do everything flawlessly, they are not perfect. They have the same insecurities and intimidations that you have.

You got yourself this far, what makes you think you’re an imposter now? And then someday, you’re going to fully understand the intricacies of your work. It might not be the breadth of information contained in your textbooks, or in the mind of Dr. House, but it will be enough to know how to do your day-to-day activities. You will graduate and be successful. And you will be a valued member of your healthcare team.

The anecdotal evidence has shown us that anyone can put on the long white coat and spend a day in the garb and the role of the doctor. There will come a time to start making the big decisions for your patients, and you have to stop pretending and assume the role you’ve spent years learning to play. That time is now.

Liz McKinnon, MD is a Pathology Resident at Duke University.


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