The White Coat and physician complicity
“Let not your conceptions of disease come from the words heard in the lecture room or read from the book. See and then reason and compare and control. But see first.”
See First, implored Olser. Do doctors see, or is their perception of reality blinded by the glare of the white coat? What does the white coat symbolize, and do white-clad doctors live up to the responsibly it represents?
In a wonderful ceremony at my daughter’s medical school, a sagacious and humanistic doctor explained why an entire ritual had been orchestrated to sanctify the students’ wearing of the white coat. I sat in the back row; wondering what he would say. Students were divided into 4 societies, and my daughter fortuitously had been assigned to the Osler society, named after a heroic doctor who fought hard for patient-centered care and against the numbers-based corporate-driven health care system that blossomed at the end of his life and that expunged all the scientific and humanistic gains he had fought to sanctify as the icon of American medicine and founder of Hopkins medical school. That his name is so frequently evoked, and his spirit so violently desecrated, by medical schools and medical institutions that teach their students to do exactly the opposite of what he preached is the very nidus of America’s health care tragedy. Doctors and medical faculty often speak in Oslerian terms—patient-centered care, humanism, practicing with both the heart and the head, intellectual curiosity, intelligence—while discrediting all of those concepts through their deeds and actions.
If COVID has demonstrated anything, it is how beholden our nation’s doctors are to the dictates of dogma and industry-financed “experts,” how facile they can turn their heads away from intellectual curiosity and the spirit of science and simply comply with what they are told, how weak their hearts really are as they led our nation and the world into the greatest avoidable humanistic crisis since the holocaust. The masked-base horror which our nation’s doctors prescribed and proselytized, the one that decried the very basis of science and humanism, the one that led them to shut down our democracy and medicalize society, the one that broke the Geneva convention by forcing people to take experimental medicines and to follow medical dictates contrary to their wishes and interests, the self-serving and fallacious fear doctors infused into people’s minds and the absolutism they insisted must be beheld lest heretics be defamed and punished, the willingness of them to destroy the lives of our children and elders and to censor anyone who dared question their gospel, that is the true face of our nation’s medical society. the true message of their white coats. Such behavior is not new to COVID; I have been living within its shadow and writing about it for a quarter century, watching doctors script industry-written fictions that convince vulnerable people to subscribe to their biopolitical fearmongering, stipulating that unless people subject their bodies to incessant probing, drugging, and invasive violations they will surly die.
Reality veers far from the fictive horror film in which our nation’s doctors have placed us. We spend far more money to achieve the doctor-instigated assault on our bodies than most nations spend combined, and our outcomes are far worse than some of the poorest nations in the world, but people somehow still believe in doctors, somehow think their lives are being saved by wearing masks and taking twelve pills and having stress tests and stents and going to an army of specialists. None of this thorough care has helped anyone other than the doctors who insist on it and the corporate entities that pull the doctors' strings.
So, if this is the medical ethos that is being extolled and propagated at schools such as my daughter’s, what does the white coat really mean? Why is there an Osler society when the spirt of Osler stands in opposition to everything to which today’s doctors and institutions now preach and to which today’s medical schools now hammer into their students’ naïve and compliant brains? My daughter’s school, like all medical schools, receives the bulk of its funding from pharmaceutical companies. Its doctors conduct studies for those companies even as they proclaim to be prophets of Osler’s legacies and heirs to a philosophy of patient-centered humanism buttressed by science and free of industry meddling. So, when they talk about the white coat, what is it that they are truly trying to represent?
The wise and caring doctor who stood on the podium to speak about this—likely a true heir of Osler—who sought to explicated the white coat’s meaning, would not even venture into those choppy waters. After all, he is a player in the very system that drills into students’ heads the Flexnerian doctrine of health care being predicated upon testing people intensively, labeling them with disease, and then fixing any “abnormalities” that testing uncovers, even at the expense of the very patient who is being treated.
I discuss Flexner’s Report (written in 1911 and still the template upon which medical education and medical practice are built) in my podcast and explore its anti-Oslerian philosophy constructed from the bricks of industry, dogmatism, and one-right-answer thinking to maintain its impenetrable edifice. The more people can be scared into thinking they are sick, the more they will submit to the medicalization of society, the more doctors will earn, the more industry will prosper, and the more powerful the medical establishment will become. That is the true mission of medical education, and based on the submissive and mindless actions of our nation’s doctors, they have succeeded brilliantly. Students receive a gluttony of useless information to memorize and regurgitate that has nothing to do with patient care and is more of a test of their ability to comply with what they are told to do. They are assessed through multiple choice tests in an endless deluge of disciplinary oversight, teaching them that (in a complete reversal of Osler’s prime directive) health care is based on singular answers to complex questions, it is absolute and unquestionable, it is not nuanced or patient-centric, and it is achieved by simply regurgitating what experts tell them is the singular truth.
The white coat clearly represents the Flexnerian coup of health care. While the good doctor flashed a picture of a polar bear to show that certain animals have white coats, he should have plastered a picture of sheep on the screen, the animal mirroring what his medical school is trying to create. While he stated that the coat stands for science and humanity and safety, there is absolutely no evidence of any of those being the case, and rather it is what he said the coat should not represent—arrogance, authoritarianism, quackery, and an emotional barrier to patients—that is best encapsulates. He stated that medicine is not a singular endeavor but rather one in which doctors are part of a team. What he did not state was that the team is governed by standards of dogmatic care crafted by drug companies and their willing medical peons that puts profit over patients while painting their white-coat garb with a faux sense of intellectual humanism that has fooled people brilliantly for decades.
That is the white coat, and while the good doctor talks of Osler, while the school extols Osler through its society and its words, and while the doctor put up pictures of doctors wearing white coats to demonstrate all the good these coats represent, he did not show a picture of Osler wearing one. Maybe Osler did wear a white coat from time to time, but I have never seen a picture of him wearing one.
He dressed like a human being, not like a pretend scientist. He was in individual who connected to his patients and listened to them, not a sheep who authoritatively told patients that unless they adhered to his one-right-answer prescription that some industry-paid expert told him was an absolute truth that they would die, not a person who clothed himself in a garb of arrogance that distanced him from his patients and infused in him some sanctified goodness that made his dictates god-like and scientifically derived. Osler was everything the white coat is not.
It was germane that this ceremony was held in a church, because, as I have said before, medicine is more a religion than a science, more an exercise in dogma than an intellectual exercise that—as the speaker suggested—should be patient-centric and based on scientific curiosity and a careful understanding of human beings and robust scientific knowledge. The very fact that this institution stands in the shadow of the CDC—a corrupt institution financed almost entirely by pharmaceutical funding and whose leaders are former pharmaceutical executives, one that during COVID led our nation down a road bereft of science and cluttered by meaningless rules and rituals and that created a forced medicalization of society by turning its back on reality and fueling the flames of fear—is more a reflection of the reality of modern health care than this doctor’s dreams of what the white coat should signify.
The white coat to me represents everything that is vile and base in our health care system. I wore one only once, during my residency, out of respect to a doctor-mentor I cared for in the ICU since I knew he believed—like the doctor who spoke at my daughter’s medical school—in an idealized version of medical education and medical practice that today’s doctors defile at every turn. To me, the white coat, just like the mask, is an acknowledgement by those doctors and students who wear them that they will comply with the duplicity and deprivations of those who pull their strings. For those who enter the profession with open eyes and big hearts, the coat is a passage from a belief in using science in the interest of humanity to becoming doctors who knowingly and unknowingly are the agents of industry and dogmatism. The doctors who wear the white coat have a great responsibility to live up to what the good doctor thinks they should be, and that’s what makes them and the coat so dangerous. It’s that people do respect doctors and believe that the coat they wear confers on them a humanistic Oslerian spirit of scientific beneficence that makes their actions and values so contrary to what the good ones among my profession seek to achieve. The coat is a symbol of health care’s failure.
COVID is reflection of the perfidy of the white coat, a willingness of doctors to stop caring about anything that transcends meaningless numbers, to turn their backs on common sense and critical thinking skills through which they could have truly explored and analyzed the dogmatic proclamations of their paid-off colleagues, to being blind to the horrific consequences of the biopolitical stench of fear and forced medicalization they have enabled and encouraged. Our medical system has killed more people in the past three years than most vicious dictators can accomplish in their lifetimes. It has desecrated science more in the past three years than any right-wing religious fundamentalist could even hope to accomplish. And the architects and executioners of that assault on humanity and science are those who wear white coats, those whose brains have been purged of intellectual curiosity and humanism and replaced by a one-right-answer sheep-like compliance. COVID is merely our medical system on steroids; its vile self-serving pull has been present for many decades which is why it was so easy for doctors to convince a nation to fall into a medicalized coma, shut down its democracy, slaughter its children and elders, muffle and punish any who looked for the truth, cling to myths and rituals as a panacea against manufactured fear, and increase the power and influence of those who seek to profit from a desecration of human life.
To me, that is the one and only meaning of the white coat.