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The Weight of the White Coat

Published Online:https://doi.org/10.1176/appi.pn.2020.9b18

Abstract

Photo: Frank Clark, M.D.

“It’s cold outside. You might want to wear a coat.” This is a familiar parental exhortation that remains embedded in our memory centers. Experience teaches us that coats function as armor to help shield the body from the deleterious effects of inclement weather. We develop an affinity for certain brands because of their durability to help repel the storms that have a proclivity to drench us even on the sunniest days. We marvel at their comfort and welcome effusive praise from spectators. However, even the most luxurious, embroidered, immaculate coat comes with a burden that is opaque even to the individual with 20/20 vision. It is the weight of the white coat worn by generations of physicians that warrants unequivocal attention if the health care system is to flourish.

The herd of white coats continues to lay footprints of discovery, compassion, mentorship, and sponsorship. They are the brotherhood and sisterhood who value integrity rather than hypocrisy. They serve as a moral compass to shepherd the young who have a voracious appetite for serving their communities. These are positive lightweight attributes that my colleagues and I welcome without trepidation. However, all white coats are susceptible to the infectious heavyweights that can dismantle the herd, resulting in a chronic pandemic: physician burnout. These heavyweights may masquerade themselves as imposter syndrome; depression; financial debt; and discrimination based on race, ethnicity, age, gender, sexual orientation, gender identity, and religion.

I have always considered it a privilege to be a member of the society of white coats. The journey to gain membership into this esteemed group has been arduous yet rewarding. I feel blessed each day to serve my community and to embolden the future leaders of tomorrow. My faith, family, and friends help restore my equilibrium when I am feeling weighed down by some of my acute and chronic heavyweights: imposter syndrome and depression. The ability to care for patients and teach learners of various disciplines rejuvenates my soul. It allows me to reenter the ring for another round with my nemesis. My therapist serves as the Jiminy Cricket who encourages me to find the silver linings, especially during these unprecedented times in our world. My feet hitting the pavement like a swift deer reminds me of the freedom that comes when I take off the cape weighed down with unrealistic expectations from others. It is during these enlightening moments that I feel like a weightless feather who can breathe comfortably.

The white coat saints who paved the way for our entry into medicine were resilient pioneers. We may never comprehend the heavyweights they endured while wearing the coat that pledges to do no harm. However, it would behoove us to learn how they continued marching on during times of trial and tribulation. We as physicians have the opportunity to be transparent and illuminate the weights that burden us throughout our career. We must remember that underneath the white coat is an individual who is the epitome of imperfection. The herd is only as strong as the individuals who form it. Let us bear one another’s weights and love each other until our final day of rest. ■

Frank Clark, M.D., is medical director and division chief for adult inpatient and consultation-liaison services at Prisma Health-Upstate and a clinical assistant professor at the University of South Carolina School of Medicine-Greenville. He is also a member of the APA Presidential Task Force to Address Structural Racism Throughout Psychiatry and an APA delegate to the AMA’s Section Council on Psychiatry.