The white coat ceremony represents the beginning of the journey to become a physician.  One of the greatest honors I’ve ever received was being asked to give the faculty address for the Baylor College of Medicine white coat ceremony.  The following is the text of the speech.

Today is an important day.

It’s the day you are going to put on a white coat for the first time as a member of the medical profession.  This is the symbolic beginning of your journey as a physician.

This journey starts with lots of late nights and seemingly endless pages of anatomy, cell biology and, yes, even embryology to memorize.

There will be hours and hours of studying and a lot of tests.

But in this maze of information and examinations….

You are going to learn how to heal.

You will even learn how to save lives.

And when you can’t heal or save a life, you will learn the important art of compassion – how to walk with someone though some of the most difficult, touching and intimate moments a human being can experience.

And it all starts here – with putting on the white coat.

Of course, you’ll have to learn how to actually wear the coat.  There are all kinds of subtle cultural rules that you’ll figure out.  White coats should always have your name on them.  There is room for a lapel pin or two, but some will be acceptable and some won’t.  And then there are the pockets….  When you first start out, your white coat will serve as a mobile and socially acceptable backpack in the clinics.  You will have reflex hammers, stethoscopes, otoscopes, clipboards, flashlights… all within a moment’s grasp in your pockets.  As time goes on, the number of items will decrease.  In fact, it’s generally true that the number of items in a white coat is inversely proportional to the seniority of the person wearing it.

You’ll also have to learn that wearing a white coat can help or hurt relationships with your patients. The image of authority a white coat conveys can be reassuring to some patients, but a white coat can be a barrier, too.   It’s a barrier literally in some ways – everyone on his or her pediatric rotation has experienced a baptism from an undiapered little boy and was saved from having to change his or her shirt because they were wearing a white coat.    In addition to being a physical barrier, a white coat can also be a psychological barrier because of the hierarchy it represents.  It’s not surprising, in this context, that psychiatrists virtually never wear white coats. Learning when not to wear your white coat will ultimately be as important as knowing when to wear it.

The coat you are putting on today is brand new.  It’s clean and perfectly white… but it won’t always look like it looks today.

One of our star students once confided in me that she had really struggled during her surgery rotation.  She also told me that for the first time, she had gone an entire rotation without washing her coat.   Her partner at home was really worried about her.  After long shifts in the Ben Taub emergency room, her exemplary compassion was taking a beating.   She was burnt out.  It took so much energy to cope with what she was seeing and doing that there wasn’t any energy left for kindness.

Her partner at home looked her in the eye and said, “This isn’t who you are.”

And so, together, they washed her white coat.

“The word candor is derived from the Latin candidus which means white.  The most common usage of the word candor is frankness, being forthright, being honest.  The dictionary also defines it as fairness, brilliance, freedom from prejudice or malice, and impartiality.   It also has an obsolete meaning that has particular relevance for us today.  Candor also means kindness.

You are starting a career that will demand devotion and extraordinary effort.  It will, in return, give you access to some of the greatest professional joys a human being can experience.

You will get tired.

You will have times you are so physically and emotionally spent that you have nothing left to give.

You will have times you lose your ability to be kind.

You have to be candid when this happens and realize that what you are experiencing is normal and expected.  It’s no different than the dirt and stains that accumulate on your white coat.   And so, you have to wash your coat.

Get the stains off your white coat with a good washing machine or by taking it to a professional laundry.

Washing your coat of candor requires just that – candor.   Recognize when you have accumulated the emotional and spiritual stains of learning to care for other people and consciously deal with them by taking care of yourself.  Take care of your physical self with good food, exercise and sleep.  Take care of your emotional self with relationships that allow you to tell the stories of your day.  Take care of your spiritual self with quiet time, with contemplation and by seeking out moments of awe.

Today you are putting on your white coat.  You are putting your a coat of candor, of sincerity, of openness, of kindness and of self-care.

Welcome to the healer’s art.  We are so proud of you and we are so glad you are here.

Mary L. Brandt, MD  – August 13, 2010