Tuesday, September 7, 2010

An Arm Inside and Outside the White Coat

The last few months have been filled with firsts. On the second day of school, we received our white coats, initiating us into the profession. A few weeks later, we wore those white coats to interview our first patients in the hospital. We have taken our first (and second and third) finals. We have attended clinics, listening to patients struggle with Huntington's disease, alcoholism, and androgen insensitivity syndrome. We have made our first incisions on our cadavers' backs... and our last ones to get to their eyes.
In other words, we are becoming acculturated.
Right now, there is not much that separates us from the patient that is in room 206 of Massachusetts General Hospital, other than the fact that we anticipate one day caring for a patient in a room 206 somewhere. With that anticipation comes a code of behavior that we are learning now, years before we enter that room.
It is not merely about respecting the patient, listening to our colleagues, empathizing, and so on. As members of a profession--a medical culture--we actively shape the image we present to the public, and that image reaches beyond the confines of the workplace.
Our professor gave an example of this new responsibility. "Let's say one day you're on the shuttle with your classmates and you're talking about what you observed in the ER. 'It was the coolest thing!' you might say. 'There was blood everywhere and this guy's leg almost came off and...' It's perfectly normal--and not bad at all--for you to feel that way; you're excited by what you're learning and experiencing. But think of the passengers on the shuttle who overhear your conversation. They are going to think that you--and that doctors--sound incredibly callous."
It is an interesting concept: that our professional identity follows us even during after hours, and that there are boundaries that have been drawn--fairly or unfairly--not directly by us. Is there ever a reprieve? Should we watch what we say at the gym? In the supermarket? To our non-medical friends at a dinner party? Did I really sign up for something so all-encompassing?
For me, the question became pertinent fairly quickly as I realized that blogging fell into one of those gray categories. Before my first post, I solicited advice from my professor about the levels of appropriateness. Certainly, explicit details about patients were off-limits (due to violating HIPAA), as well as specific names of professors or individuals. But what about opinions on medical education or patient care, drawn from my observations in classrooms or on the wards? What about recounting a good patient encounter? And--more difficult--what about a bad one?
My professor told me that being a medical student means that others are very interested in hearing about our experiences as "insiders." She told me that I have to remember that when I am writing for others, what I say reflects on the profession and even may shock some, and so I should be sensitive about what I share. When I asked my society advisor, she admitted it was a tricky question and suggested that I ask permission from those I mention fairly explicitly. "People aren't going to trust you enough to talk to you if they think you'll have no restraint in writing what they say," she said. (Oh, the irony that I now quote her!) "The classroom would no longer be a safe place."
But otherwise, there is little policy or precedent with regard to social media. It is new turf, and its boundaries are being tested by those of our generation.
Are we really writing from inside the white coat? It's a grandiose claim, and one I surely don't deserve nor want yet. But I am not taking it entirely off either, because what I write about is inextricably linked to knowledge accessible only because I am allowed inside this coated world. What exactly does my pen owe that world?
Many questions remain. With time (and with some faux pas, no doubt), I hope to strike a balance. Maybe I'm only partially dressed at times, with one arm inside the coat and acculturating and one arm outside, writing about it.
So we write and interact in this new medium, with what I hope is caution, thoughtfulness, and sensitivity. It is the best we can do for now.

4 comments:

  1. I don't think you can go too wrong with this attitude. Please keep writing. I love reading your thoughts and vicariously sharing your medical school experience.

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