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Books about the education of physicians are so plentiful they practically constitute their own subgenre. For starters, there's Melvin Konner's Becoming a Doctor, A Not Entirely Benign Procedure by Perri Klass, and several books by Robert Marion (including Learning to Play God, Rotations, and The Intern Blues). Joining the field is Ellen Lerner Rothman with a memoir of her years at Harvard Medical School. It's a workman-like account of learning the art and science of medicine in the era of HMOs, in which paperwork seems to have replaced healing as the main product of hospital bureaucracy. Rothman wrestles with the dilemmas of compassion and objectivity as she encounters patients, learns procedures, and prepares to don the white coat that symbolizes physician competence in a world of backless patient gowns.
Of particular interest are Rothman's accounts of the rabid fan base among medical students for a certain top-rated medical TV drama; they study its jargon almost as exhaustively as they review the physiology of the heart. "It was just like on ER," she notes following an encounter with a traumatic cardiac arrest that ended with the patient's death. The lines between pop culture and science are ever blurred. --Patrizia DiLucchio
From Publishers Weekly
When Rothman donned her fresh white coat on her first day of orientation at Harvard Medical School, she assumed a complex new identity. To patients, the white coat meant medical authority, whereas to Rothman it represented "a power that I was not ready to accept." Written with admirable candor and insight, her account of how she grew into her white coat during the four-year program will interest the mix of general and professional readers who enjoyed Perri Klass's similar memoir, Not an Entirely Benign Procedure. Rothman, who is now a resident in the combined pediatrics program at Boston Children's Hospital and Boston City Hospital, begins with first-year anxieties associated with classes and working on cadavers. She honestly confronts the competitiveness among her classmates and the difficulty of balancing a demanding schedule with personal relationships. She explores the excitement and glamour of being a doctor while acknowledging the awesome responsibility it entails: "I must be above human fallacy.... My mistakes and failures could have catastrophic consequences." She also writes with great sensitivity about the first patient she touches, the obnoxious patient she feels guilty for disliking, the pain of having to tell a man he has cancer and the stress and humiliation of being grilled by senior doctors. Anecdotes about herself and her classmates (they are addicted to the TV series E.R.) also add flavor to her account. Rothman ends her book admitting that, although she is now comfortable in her white coat, "I will never finish growing into my role as doctor and caregiver." Agent, Kip Kotzen. Copyright 1999 Reed Business Information, Inc.
From The New England Journal of Medicine, April 6, 2000
This slim book contains the reflections on medical education and training of a well-known presence in American medicine and medical education, J. Willis Hurst. The major topics he discusses are clinical teaching, the organization of curriculums, and the problem-oriented record. The book does not pretend to be a review of the literature on these themes, since nearly all the references at the end of each chapter are to Hurst's earlier writings. Yet given his substantial contributions to clinical medicine and medical education (154 Medline citations from 1966 to the present, several books, numerous chapters, and an unknown number of trainees and physicians influenced by reading his work or by seeing him examine a patient or teach), his views are worthy of our attention. Hurst was trained at Harvard Medical School and Massachusetts General Hospital under Paul Dudley White. He joined the faculty of medicine at Emory University in 1950 and served as professor and department chair from 1957 to 1986. That tenure as department head is astonishing (to me, at least) by current standards and testifies not only to Hurst's energy and character but also to how much the world of medicine has changed since he retired. Hurst reviews some of the changes and, for the most part, feels that things were better in the past. He laments the declines in a number of areas. The first is that ward rounds are no longer teaching rounds in some hospitals. Attending physicians blame managed care for eating up the time they would like to spend teaching. What can be done about this? Hurst is silent. The second area of decline is medical grand rounds, which used to be formal case presentations. This was the desirable format, because doctors remember facts and principles that are linked to patients, especially their own patients, more easily than facts disconnected from their own experience. Now, increasingly, medical grand rounds have become lectures that are nearly always ineffective and are soon forgotten. Why has this happened? And what can be done to restore the classic format? Hurst does not say. The third decline concerns visiting professors. Visiting professors used to be chosen by the department chair or division head, and they would visit a school for three or four days. During this time, there were ample opportunities for trainees to meet and talk with the distinguished visitors, who also conducted separate teaching sessions with medical students, house staff, and fellows. "The impact of the visit on the local group was enormous." Now, visiting professors are sponsored by pharmaceutical companies; the visitors meet rarely with students, house officers, and fellows. Instead, they give a lecture on a subject of their interest, which "`coincidentally' matches the interest of the pharmaceutical house" sponsoring the visit. The agenda of the visitors is increasingly not about teaching, and this trend should be halted "as quickly as possible." But how? Hurst offers no suggestions. The fourth decline is in the area of consultations. Because hospital stays have been shortened so drastically, surgeons no longer have the time to ask a consulting internist whether it is wise to perform a particular operation. The consultant instead is asked to deal with postoperative complications. It is more difficult for patients to obtain a second opinion than it was in the past. The fifth area of decline is board examinations. Formerly, a written examination tested a candidate's knowledge, and an oral examination tested his or her clinical skill. Now, clinical skills are no longer examined. The examination sends the wrong signal: it tests short-term factual recall and not clinical skills, including skill in thinking. Finally, Hurst laments that the clinical skills of house officers have declined. "The dismal state of affairs is not the trainee's fault." As before, trainees continue to be highly intelligent and motivated people. So what has happened? Once again, the blame lies with managed care: it restricts the time a physician can spend with both patients and students, and teaching and caring for patients both take time. The chief solution proposed by Hurst to all these problems is better teaching. Above all, medical education needs more "true teachers," a term Hurst uses to refer to teachers dedicated to becoming intellectually engaged with their students, not telling them the answers but asking questions that cause them to think about the causes of disease manifestations, and seriously fostering the development of their clinical skills. The need for this type of teaching has long been recognized. It has been part of the Western educational canon since Plato wrote about Socrates in Athens. Hurst recognizes that acquiring clinical skills takes time, practice, and skilled, timely feedback. But the larger problem is, what is happening in the health care system that aggravates these problems? Hurst points to managed care, shortened hospital stays, and similar constraints on daily sustained contact between mentor and learner, but regrettably, he does not propose solutions to these problems. Like many physicians of his generation, Hurst recognizes that something has been lost in American medical education in the past 10 to 15 years, and he does not know how to recapture it. To some extent, admittedly, these feelings are typical of senior citizens -- things were better in the past. But Hurst is not alone in feeling that despite the technological wizardry now in abundance in American hospitals, thinking and caring physicians either are in short supply or must practice their art under constraints that lower the level of care. On this melancholy note, he leaves us with a great deal to think about. Reviewed by Arthur S. Elstein, Ph.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
From Kirkus Reviews
A medical student's thoughtful and revealing chronicle of growing into the white coat of a doctor under Harvard Medical School's New Pathway system, beginning with day one of orientation and ending with graduation four years later. In the new tutorial system, which emphasizes a three-year course in patient-doctor relations, students are introduced immediately to patients, learning to take medical histories in their first year and how to perform physical exams in their second. Rothman, whose interest in medical ethics led her to medical school, flourished under this humanistic approach. Expecting that tough course work and long hours would be the toughest hurdles, she found instead that accepting the responsibility that comes with the white coat was a greater challenge. She is a careful observer and meticulous reporter, providing the kind of detail that prospective medical students will find invaluable. She gives a clear overall picture of how the program is organized and what students are expected to know and do at each stage of their education and then fills this in with chapters describing her own experiences with patients, doctors, and fellow students. While she has changed names and details, her description of these encounters and her reactions to them, especially the stories about patients, have the clear ring of truth. Theyre not pretty and often have no neat ending, but through them, the conscience of a compassionate doctor can be seen developing. What is refreshing about Rothman's account is its matter-of-fact style, notably lacking in whining, sensationalism, and disguised boasting. We also follow her romance with a fellow student that ends in marriage just before graduation and the promise of parallel careers to follow. This medical coming-of-age story is told with clarity, candor, and grace and would make a fine graduation present for any pre-med student. (Author tour) -- Copyright ©1998, Kirkus Associates, LP. All rights reserved.
Chicago Tribune
"Rothman, whose interest in medical ethics led her to medical school, possesses a journalist's eye for detail and makes engrossing reading of even the most mundane tasks associated with medical training. She also lets us follow her romance with a fellow student, adding another dimension to this unflinching look at the healing profession."
Book Description
White Coat is Dr. Ellen Lerner Rothman's vivid account of her four years at Harvard Medical School.Describing the grueling hours and emotional hurdles she underwent to earn the degree of M.D., Dr. Rothman tells the story of one woman's transformation from a terrified first-year medical studen into a confident, competent doctor.
Touching on the most relevant issues in medicine today--such as HMOs, aIDS, and assisted suicide--Dr. Rothman recounts her despair and exhilaration as a medical student, from the stress of exams to th hard-won rewards that came from treating patients.
The anecdotes in White Coat are funny, heartbreaking, and at times horrifying. Each chapter taes us deeper into Dr. Rothman's medical school experience, illuminating her struggle to walk the line between too much and not enough intimacy with her patients. For readers of Perri Klass and Richard Selzer, Dr. Rothman looks candidly at medicine and presents an unvarnished perspective on a subject that matters to us all. White Coat opens the infamously closed door between patient and doctor in a book that will change the way we look at our medical establishment.In White Coat, Ellen Rothman offers a vivid account of her four years at one of the best medical schools in the country, and opens the infamously closed door between patient and doctor. Touching on today's most important medical issues -- such as HMOs, AIDS, and assisted suicide -- the author navigates her way through despair, exhilaration, and a lot of exhaustion in Harvard's classrooms and Boston's hospitals to earn the indisputable title to which we entrust our lives.With a thoughtful, candid voice, Rothman writes about a wide range of experiences -- from a dream about holding the hand of a cadaver she had dissected to the acute embarrassment she felt when asking patients about their sexual histories. She shares her horror at treating a patient with a flesh-eating skin infection, the anxiety of being "pimped" by doctors for information (when doctors quiz students on anatomy and medicine), as well as the ultimate reward of making the transformation and of earning a doctor's white coat.For readers of Perri Klass, Richard Selzer, and the millions of fans of ER, White Coat is a fascinating account of one woman's journey through school and into the high-stakes drama of the medical world.In White Coat, Ellen Rothman offers a vivid account of her four years at one of the best medical schools in the country, and opens the infamously closed door between patient and doctor. Touching on today's most important medical issues -- such as HMOs, AIDS, and assisted suicide -- the author navigates her way through despair, exhilaration, and a lot of exhaustion in Harvard's classrooms and Boston's hospitals to earn the indisputable title to which we entrust our lives.With a thoughtful, candid voice, Rothman writes about a wide range of experiences -- from a dream about holding the hand of a cadaver she had dissected to the acute embarrassment she felt when asking patients about their sexual histories. She shares her horror at treating a patient with a flesh-eating skin infection, the anxiety of being "pimped" by doctors for information (when doctors quiz students on anatomy and medicine), as well as the ultimate reward of making the transformation and of earning a doctor's white coat.For readers of Perri Klass, Richard Selzer, and the millions of fans of ER, White Coat is a fascinating account of one woman's journey through school and into the high-stakes drama of the medical world.
About the Author
Ellen Lerner Rothman, M.D., lives with her husband, Carlos Lerner, in Brookline, Massachusetts.She is currently doing her residency in the Boston Combined Pediatrics Program at Boston Children's Hospital and Boston City Hospital.This is her first book.
Excerpted from White Coat : Becoming a Doctor at Harvard Medical School by Ellen Lerner Rothmen, Ellen Lerner Rothman. Copyright © 2000. Reprinted by permission. All rights reserved
White Coat "You'll never ever guess what I did," Roy said over the phone. He had just returned from a clinic where he followed a physician as he saw his patients. Roy was the first member of our class to perform a rectal exam. In fact, besides taking blood pressure, it was the first procedure any of us had performed. The gentleman Roy practiced on was subjected to three prostate exams on that particular visit -- one from the physician and two from the medical students. But as uncomfortable as the experience must have been for the patient, it was equally awkward for Roy. When I told my mother about Roy's experience, she was incredulous that the patient permitted such inexperienced hands to probe his prostate. "The patient actually allowed that?" The only way to explain the patient's willingness was Roy's white coat. After several months of wearing mine, I was already accustomed to patient trust way out of proportion to my abilities. Another classmate questioned a patient about his diagnosis. Unfamiliar with the disease, he could only ask, "Um, do you think you could tell me more about what that is?" The patient replied, "I was hoping you could." My classmates and I received our white coats with "Harvard Medical School" embroidered on the breast in crimson cursive on the first day of orientation to medical school in our white coat ceremony. Our event in the Holmes Society was anything but ceremonious. Our class was divided randomly into four different societies, mainly for administrative purposes. Each of the four societies hosted its own ceremony, and we all met afterward for lunch, self-consciously checking one another out in the new and unfamiliar white lab coats. I stood near the end of a long, disorganized line in the Holmes Society office, waiting to receive my coat. By the time I reached the front, all the small coats had been given out, and I received one several sizes too large. "You can trade with someone," the administrative assistant said. A day later, wearing our coats still creased from the packaging, we attended our first patient clinic as formal members of the medical world. The white coat ceremony, a new idea from the administration, was intended to herald our induction into the medical community on our first day of medical school. While not the long coat of a physician or resident, the white coat signaled our medical affiliation and differentiated us from the civilian visitors and volunteers. This was not an affiliation I was ready to claim as a first-year medical student. Over the course of the year, after taking courses in anatomy, pharmacology, biochemistry, physiology, genetics, and embryology, I was more deeply impressed by how little I knew than by how much I had learned. Yet every Monday in our Patient-Doctor course I found myself in my white coat interviewing still another patient. Despite the uncertainty of my place in the medical world, my white coat ushered me into the foreign world of the patient-doctor dynamic. To my patients, the white coat denoted the authority and trust ascribed to physicians by the general public. Most patients were not attuned to the medical hierarchy designated by coat length. A white coat is a white coat is a white coat. Never mind that my coat loudly proclaimed "medical student." I felt as if I wore the scarlet letter, but no one knew what it stood for. These weekly interviews as part of our Patient-Doctor course were about learning the important questions, the right mannerisms, and the appropriate responses to our patients. Our instructors taught us to take a careful, methodical history, which I more or less skillfully replicated every week with a different patient. Although the goal of these weekly patient interactions was to discover a person's experience of illness, these interviews were more about my learning process than about the patient's story. As I walked with my classmate back to the medical school from the hospital after a Patient-Doctor session, Andrea remarked, "I hate this. I'm so caught up in figuring out the next question that I can't really focus on the patient's story at all. Do you think this will ever change?" When I interviewed patients, they saw my white coat. Many of my patients were well into their seventies, and at twenty-two I must have seemed a child to them. The white coat masked my youth. It masked my inexperience. It masked my nervousness. Yet in the medical world my white coat did not offer the solace of anonymity but forced me to take on power that I was not ready to accept. As a white coat I could ask any question, and patients felt obligated to answer. They trusted me to hear their story without judgment, to understand their symptoms and their suffering, to listen with compassion. I collected information about their most personal problems and asked them about some of the most deeply private parts of their physical and psychological lives. In return they learned nothing about me. Furthermore, these weekly interactions imposed power without responsibility. Every week I left the patients' rooms with a few pages of frantically scribbled notes, never to return. Their lives and our interaction were reduced to my chicken scratch. I had no relationship to the patients' care. My continuing obligation to the person was restricted to the requirements of confidentiality. Before entering medical school, I would not have thought twice about allowing a medical student to perform a rectal exam on me. The white coat would have fooled me too. While I fully appreciated the opportunity afforded me by these patients to learn how to interview and perform simple procedures, I looked forward to a time when I would be able to offer my patients concrete skills. I looked forward to growing into my white coat. Copyright 1999 by Ellen Lerner Rothman, M.D.
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