To Wear A White Coat

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There are many ubiquitous symbols that represent a doctor – the stethoscope, the snake and staff, the gloves. But none is more enduring, or more laden with meaning for both patients and doctors, than that of the white coat.

“The white coat symbolizes health and healing,” says Kayse M. Shrum, D.O., president-designate of the OSU Center for Health Sciences. Shrum also holds the George Kaiser Family Foundation Endowed Chair of Medical Excellence and Service and the Saint Francis Health System Endowed Chair of Pediatrics.

“The color white symbolizes virtue and integrity. It is an outward expression of your commitment to your patients, their families and your community to provide compassionate, quality care to those in need. The white coat serves to remind us of our obligation to society to use our education with utmost respect for the betterment of society, always acting with integrity and virtue.”  

The symbol of the white coat evolved during the early 20th-century emphasis on antisepsis and cleanliness, Shrum says. The coat became a sign of the purity associated with these concepts. Prior to those times, physicians wore black, as a doctor’s visit – often a last resort during that era – was usually a formal and solemn occasion.

Today, Shrum says, “Medicine begins as a career path. When you graduate from medical school you become a physician, but as you mature in your training you realize being a doctor is not what you do, it is who you are. When you take the oath, you are saying, ‘I will use my knowledge to help those in need anytime and any place, because life doesn’t conform to office hours.’”

Here are what a few of Oklahoma’s most dedicated physicians have to say about their profession, and what the white coat means to them.

Dr. Rebecca Goen Stough

Rebecca Goen Stough, M.D., director of imaging at Mercy Women’s Center at Mercy Hospital, has been a physician for 37 years. Her medical degree, internship and residency were all completed locally at the University of Oklahoma Health Sciences Center. But long before she completed her formal medical education, she discovered a passion for medicine when making the rounds with her father and working in his doctor’s office as she came of age.

Specializing in diagnostic radiology, Stough focuses on the early detection of breast cancer through such methods as digital mammograms, ultrasounds, MRIs and needle biopsies. She and her team take a multidisciplinary approach to patient care, guiding the patient from diagnosis to treatment and recovery and consulting with experts in the fields of surgery, oncology, radiation therapy, pathology and genetic counseling.

“It is such a victory to discover early-stage breast cancer in a patient,” Stough says. “The chance of a cure when breast cancer is discovered smaller than 10 millimeters (1/2 inch) is 96 percent with a lumpectomy and radiation therapy alone. When we added an Aurora breast dedicated MRI in 2003, we began to discover more extensive breast cancer than previously suspected as well as additional unsuspected cancers in the same breast or in the opposite breast. This meant the patient had the correct surgery the first time with many fewer returns to the operating room for positive margins and fewer delayed diagnoses of unsuspected cancers later.”

Like many of her peers, Stough says that sometimes the biggest difficulty she encounters is being faced with certain limitations. “The greatest challenge for me is that we can’t find all cancers early,” she says. “I feel so bad when a patient comes in with a large mass and hasn’t had a mammogram in several years. Even with yearly screening mammograms, if the patient has dense or complex breasts, a cancer may be fairly large before it can be discerned on a mammogram. Yet, it is the best low-cost screening tool we have. Having the availability of other tools, such as ultrasound and breast MRI to assist us with screening when appropriate, saves lives.”

But despite the occasional setback, Stough is sure of her calling. “It is so challenging and satisfying to work in a practice that combines imaging with direct patient care. I have met the most wonderful ladies who humble me with their toughness and resilience. I love to give someone the good news that a mass they were feeling is not cancer. I love to pray with some of my patients when they are bravely facing their crises and invite ‘someone’ greater and wiser than me to participate in their care. I love what I do.”

“The white coat is a symbol of trust and authority,” Stough says. “Patients will share the most intimate details of their lives with their health care provider. They trust that that information will be used only for their good and not for their harm. They permit physical examinations and procedures that investigate their most private parts. What an awesome privilege and responsibility.”

Dr. Kevin F. Tulipana

“As a child, I found science and the study of living things fascinating and honestly, quite easy,” says Kevin Tulipana, D.O. “From the time I was in upper elementary, I had a desire to become a physician.”

After studying biology during college, however, Tulipana says he realized that the study and treatment of human beings went far beyond simple science. “One must approach people with the understanding that we are not simply living organisms that need to be fixed when broken, but an intricate person who has physical, mental and spiritual needs that must be recognized and acknowledged,” he says. “Medicine allows for that combination of needs to be met, and this is why, historically, hospitals throughout the world have been established and run by religious organizations. The scientific knowledge of medicine can be learned by anyone who has the academic ability, but the practice of being a physician is something that one grows into.”  

Today, Tulipana is a practicing hospitalist for Saint Francis Hospital South in Tulsa. In his specialty, Tulipana focuses on treatment, care and management of hospitalized patients, filling the role of primary care physician during patients’ stays and coordinating with the patient’s regular doctor after their release.

“I am blessed with the opportunity to care for people at some of their most vulnerable times,” Tulipana says. “When one is ill, especially ill enough to be hospitalized, fear can often take hold. I take this responsibility seriously and strive to provide compassion, expertise and a confident presence to people who are in need. When my patients leave the hospital, I hope that my example of treating each and every patient with dignity and respect will be an example that is followed.”

While Tulipana appreciates the difference he can make in the lives of patients when treating them, he says that he sometimes also must be there for a patient for whom it’s too late.

“One of the greatest challenges of being a doctor is knowing our limitations and recognizing when regardless of all that we do medically, a patient may not survive an illness or traumatic injury,” Tulipana says. “These can be some of the most difficult times.

 “I wear a white coat every day in the hospital and I do believe it bears with it a distinct identity and symbolism,” he says. “When the white coat is seen, patients immediately know who the doctor is among the team of providers. The white coat says to patients that I take this responsibility seriously and identify myself as not only a provider of health care, but a scientist. I understand the biological process of the human body but also strive to understand what really makes us human – the spiritual, mental and emotional aspects. Additionally, to me, the white coat symbolizes a purity of motive in providing care. By donning the white coat, I am reminded that regardless of how a patient presents or what their means are, that I am to provide the same care to each and every human being.”

Dr. Christopher Lentz

As the oldest son of a nurse, Christopher Lentz, M.D., was groomed his entire life to become a doctor. However, for many years, he thought that being a math teacher would be his true vocation. It wasn’t until he entered medical school that he began to realize that each case was, in its own fashion, the most challenging of math problems.

“When I got into medical school, I realized that a lot of the thinking in medicine was close to the thinking in math,” Lentz says. “It’s algorithm thinking, going down thought trees… It suited my way of thinking. And as a fan of detective novels, Sherlock Holmes especially, I thought the type of thinking and deductive reasoning used to figure out what was wrong with patients was exciting. Being able to figure problems out and treat patients was much more rewarding than a career in mathematics would have been.”

After wholeheartedly embracing the medical profession and nursing a lifelong respect for it, Lentz says that he couldn’t wait to get his white coat. “Once I was in, I wanted that white coat like a badge of honor,” he says. “The white coat is a symbol of someone you can trust, that will care for you and make you better. I had tears in my eyes when I took my Hippocratic oath. It was as important as wedding vows: that I was going to take the best possible care of patients and put them before everything else in my life. I still believe that to this day … I want patients to feel trust, to know when they see me that I have their best interest at heart. I can’t give anything less than 110 percent. That’s what patients want, and that’s what the white coat means to me.”

Now a physician for 21 years, Lentz is the medical director at the Paul Silverstein Burn Center at Integris Baptist Medical Center in Oklahoma City, where he specializes in the treatment, surgical reconstruction and recovery of burn victims. He says that in addition to the challenging nature of the field, burn treatment offered what was at the time a unique opportunity to provide team care.

“When I was going through different medical specialties, I was attracted to figuring out complex diseases, diagnoses and treatment,” he says. “But what really struck me as interesting about burn care during medical school in the 1980s was the team approach to patient care I’d never been exposed to in a hospital. Nurses, therapists, dietary experts … all managed patients in 360-degree care. It was a better way of managing patients, by viewing treatment as a team approach to care instead of as individuals working independently of each other. Our team goal is getting patients to the highest level of function after injury.”

Lentz says that like the treatment, the very nature of burns themselves is a challenge.

“Burns are unlike a lot of other diseases,” he says. “If you know you’re not managing your weight, or you are smoking, etc., you know you’re going to get problems with heart disease or diabetes. You know in the back of your mind that if you live an unhealthy lifestyle, something will happen. No one ever plans on getting burned. All of a sudden you have an injury that affects you both inside and outside, and patients have so many questions. Am I going to be functional? Am I going to scar? How will I make ends meet with long hospital stays? I can make a difference showing them there’s life after getting hurt.”

In addition to the challenges of the conditions they treat, Lentz says that today’s doctors face perpetual frustrations connected to financial limitations. “We practice in a country where our health care is more expensive than any other on the face of the planet,” he says. “It’s difficult to practice in the manner I like without having the resources to give to patients. For example, many patients without insurance can’t get rehab or dressing supplies. It’s hard to give patients what they need with such a limited supply.”

For this doctor, however, the rewards outweigh the problems. “When our patients are able to walk out of our burn center feeling better and with more hope, that’s the reward,” he says. “But doctors aren’t the miracle workers; patients are where the miracles happen.”

Dr. Trudy Milner

For 10 years, Trudy Milner, D.O., dedicated herself to a career in nursing. During that time, she even taught nursing classes and was in the process of pursuing her master’s degree when her life changed course.

“I stared working for a physician and decided I liked the continuity of patient care and developing relationships with patients,” Milner says. “The doctor for whom I was working encouraged me to go to medical school, so I applied.”

Today, Milner practices in family medicine at St. John Medical Center in Tulsa, treating patients from birth to end-of-life care. In doing so, she draws upon both her history in the nursing field as well as her opportunity to work closely with her patients.

“When I went to medical school, one of the things they told us is, ‘If you truly listen to the patient, they’ll tell you what’s wrong,’” she says. “It really works. You get to learn about their social and psychological as well as their medical issues. I think having someone listen helps them. It really is important. I really care about my patients, and this is one of my passions.”

Milner agrees that there are definitely challenges to overcome in her career, such as keeping up with the rigorous routine of continuing education. But in the end, she says seeing those positive outcomes in her patients is more than enough encouragement.

While she did not have a formal white coat ceremony during her years in medical school, she has participated in numerous such events in her subsequent career, and the white coat is a powerful symbol for her all the same.

“It’s a source of pride to be able to wear that jacket and know that it distinguishes you and gives you a responsibility,” she says. “You are more cognizant of that while you wear that coat.”

Of the ceremony that now formally confers the white coat in many medical schools, she says, “It’s where we welcome our students into our profession. We tell them what their responsibilities are – ethical ways to behave, committing to lifelong learning and that there’s a human obligation to being a doctor, especially taking care of their patients. It’s the beginning of their professional life, and it has a big impact on students. They are proud of where they are and where they’re going. They learn to respect one another and be compassionate to peers and patients. They always strive to be worthy of the privilege of being a doctor.”

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