White Coats and Cardigans

I recently read the book, “Breaking and Mending” by Dr. Joanna Cannon, a memoir of a doctor’s training experience in the UK.  In it, she writes, “In our first lecture on day one of medical school, as we were welcomed into our medical career, we were told something else—that there are two kinds of doctors, white coats and cardigans. Those who love the science, and those who love the people. Those that will order more tests for the patient, and those that will talk to them.”  

I had never heard this before; I thought perhaps it was more of a British construct.  In fact, throughout the book, I constantly had to adjust to their terminology such as junior doctor (resident), registrar (fellow), consultant (attending) and so on.  Still, the observation gave me pause. I began to ponder it more, thinking about several mentors, colleagues, and yes even myself, trying to determine validity.  

At times I would say I am more cardigan, which is probably why I went into Primary Care.  Following patients over time, establishing relationships, continuity of care, and talking with them, a lot–and not just about their health, but family, friends, recent travel, daily lives, this I truly enjoy.  On the other hand, I am still practicing at the University of Minnesota because I love the academic aspects of medicine. This includes teaching but also, learning about breakthroughs in medicine through Grand Rounds, Research Conference and the like.  This is definitely appealing to the white coat in me.  Most of us in medicine have some background in science; I was a Biology major, worked in a lab at 3M for four years, and completed a research fellowship at the University of Iowa prior to med school.  It was the idea that one could apply science to helping people that steered me towards medicine, as opposed to pursuing a PhD.

Then I began to think about colleagues and mentors I have admired most over the years; I would say, they were the ideal mix of both.  Such as Dr. Wes Miller, who sadly passed away from cancer just a few years ago.  He had a strong commitment to basic science research in Hematology/Oncology, but I am sure if asked, he would have said he was a cardigan and not a white coat.  Because his approach to medicine and interactions with patients and students was very relational, down to earth, not pretentious at all.  He also enjoyed talking and connecting and sharing stories, whether it was about fishing or woodworking or his tennis game.  Or I think of Dr. Todd Tuttle, a surgical oncologist who has published over 150 articles on outcomes related to cancer surgery.  He embodies the evidence based approach; always “show me the data” but on the other hand, his warm bedside manner and his sense of humor has the ability to put the most anxious patient at ease.  I also think of Dr. Kathleen Watson, who recently retired, one of the few female full professors in our department.  She was fellowship trained, well published, held many leadership positions and yet, inspired me to consider primary care when I was a resident.  I overheard her calling her continuity clinic “my day spa, my retreat” and that really stuck with me. Clearly it was the interactions and connections with her patients that served as inspiration for all the other roles. 

So it seems as though the ideal physician would be equal parts cardigan and white coat.  Or, they would be able to channel one or the other when the need arises.  Later in the book, Dr. Cannon writes, “I agree with many things we were told in that inaugural lecture, but I disagree that there are only two kinds of doctors.  I think there are as many doctors as there are people, and as many different landscapes as there are ways of healing.”  I enjoyed reading that; as health professionals and human beings, one physician may approach things much differently than a colleague, or even the same physician may respond in different ways given the type of situation or the patient sitting in front of us.  

Interestingly, after I finished this book, I noticed that on the back of my office door hangs my three clean white coats but also, a black cardigan to ward off the cold in the winter months when I am sitting in my office or in meetings.  I just had to laugh; I guess that is a good indication that I am truly both.  

And as the author Joanna Cannon points out, probably most physicians should be.