Beyond the White Coat

Sharpening the Saw


In 1863, Abraham Lincoln established a Thursday in November as a national day for Thanksgiving. Previous U.S. presidents and Congresses had intermittently appointed days for thanksgiving. After 1863, November became an annual tradition.

A day of thanksgiving can become a day for reflection and self-renewal. It is a time to go beyond thankfulness for mind (knowledge) and body (technical skills). It is also a day to renew the spirit (psyche).

Stephen Covey’s book "The 7 Habits of Highly Effective People" lists habit No. 7 as "Sharpen the Saw." He points out that a sharp saw cuts wood faster, but many people behave as if they are too busy cutting wood to stop and sharpen the saw. This actually makes them even slower and less productive. Tools accomplish more when they are properly taken care of. The same is true for people.

Many other self-help books offer similar advice. Self-renewal is partly letting go of baggage that is weighing you down. It is partly adjusting attitude, as the motivational cliché proclaims: "You can’t change the wind, but you can adjust your sails." It is partly developing strategies for the upcoming week, month, or year.

Medical conferences offer opportunities to update one’s knowledge through continuing medical education. Occasionally these opportunities are training sessions to learn new skills, which might be surgical procedures or even tasks on a computer. However, the most critical item to be updated is the aspiration of the physician himself or herself. Medicine is a calling. In the long run, instilling and maintaining the attitudes and vision of a vocation, in one’s self and one’s colleagues, is the most important activity of a professional.

Instilling Values Through Initiation

The Hippocratic Oath has been around for millennia. One of the recent additions to the rituals of health care has been the White Coat Ceremony. In just 20 years, the annual ritual has become prevalent at the majority of medical schools, as well as colleges of pharmacy and advanced nursing programs. The ritual has even spread internationally. Detractors say there isn’t empirical data about the long term benefits of a White Coat Ceremony, but I find support for it in analogous examples that have a longer history.

Whether it is a church, a fraternity or sorority, or a secular organization, initiation ceremonies are ubiquitous. It is hard to believe that these rites would continue if the senior leadership didn’t reflect back on their careers and assess the rites as valuable. Recently, I had the opportunity to visit the Harry S. Truman Library and Museum in Independence, Mo. A small part of the exhibit was dedicated to his joining the Masons.

The exhibit noted that: "The Masonic Order offered ethical guidance, companionship, and acceptance among other Masons, wherever he might travel." And more specifically, it had a quote from Truman:

"The Scottish Rite has done its best to make a man of me, but they had such a grade of material to start with that they did a poor job I fear. It is the most impressive ceremony I ever saw or read. If a man doesn’t try better after seeing it, he has a screw loose somewhere."

Truman was initially known in Washington D.C. as "the Senator from Pendergast." T.J. Pendergast was a political boss in Kansas City very similar to the more famous Al Capone who ran Chicago. Pendergast was instrumental in getting Truman elected, which led many senators to shun Harry. But within a few years, he was the senator spearheading investigations into corruption and quality problems in the manufacture of military equipment during World War II.

Maintaining the Vision

Aspirational rituals alone do not guarantee ethical behavior. But history demonstrates that professional behavior is better with rituals than without them. Since an oath alone isn’t adequate, it seems prudent for a profession to add another layer of social regulation, such as empowering patients with lists of rights and responsibilities. But initiation ceremonies and regulation aren’t enough. To be a great profession, worthy of the public’s trust and status, individual physicians must periodically refine and reaffirm the values, ideals, and goals that called them to care for others. There are many ways this can be done.

The highly effective physician realizes that keeping up to date reading the medical literature is important, but she can help her patients even more by reading one less journal article a month and using that time to make a habit of renewing her commitment to her core values. On Nov. 19, 1863, 1 week before that national day of Thanksgiving, President Lincoln took a train ride to a small town in Pennsylvania. He went to dedicate a cemetery. He talked eloquently about dedication and devotion to a cause. It takes but 2 minutes each Nov. 19 for me to recite his Gettysburg Address. I am not devoted to exactly the same cause, but I still find it inspirational.


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