WEARING THE WHITE COAT: REFLECTIONS Scott C. Williamson, Ph.D. Scott Williamson, PhD (Professor at Louisville Presbyterian Theological Seminary) referring to Dr. Tina Yuan: “The empathy, the care, the ability to connect with patients in a minute, I don’t know how Dr. Yuan does that,” said Scott Williamson, PhD. “Whatever the forces are that take Tina away from patients are evil!” I met Dr. Tina Yuan at her Prospect, KY office on October 28th, 2014. Wearing my pressed white coat, confidentiality agreement tucked away in a pocket, I arrived promptly at 9:30 a.m. to shadow Dr. Yuan. She welcomed me graciously. We briefly exchanged the customary biographical sketches, leading up to the purpose for the shadowing experience that brought us together on a rainy Tuesday morning. And then we experienced a problem. Tina had not done this shadowing thing before and wasn’t sure what she was supposed to teach me. I had not done this shadowing thing before either and had no clue what I was supposed to learn. We had no objectives, no learning goals, no questions to answer, and no expectations beyond sharing time and space as Dr. Yuan cared for her patients. Now fast-forward to the Wear the White Coat debriefing dinner on the evening of November 5th. After a sumptuous dinner, Dr. Bruce Scott, President of the Greater Louisville Medical Society, invited reflections from those of us who wore the white coat for a day. Not knowing exactly what I needed to say but needing to say it with some urgency, I raised my hand. I intended to say how very good Dr. Yuan was with her patients. I intended to say that she met with seven patients in a 2-hour time period, a 30 percent reduction in her usual pace, because she didn’t want to overwhelm me. I intended to say that I have no idea how she created such a warm rapport with patients, and monitored their health, and maintained her sanity, in ten-to-twelve minute appointments that proceeded relentlessly. I intended to say that she did not schedule any appointments that afternoon because she needed to catch up on paperwork. I don’t remember how many of these things I actually said because I needed 18 LOUISVILLE MEDICINE to say something else. And then the words came to me, “Whatever bureaucratic forces take Dr. Yuan away from her patients are evil!” (This is a serious charge from an ethics professor.) The story here is: what happened to me on October 24th that made it so important for me to say that? What did Dr. Yuan do that morning that held such significance for me? She didn’t do much in one sense. She did not perform neurological surgery, resuscitate anyone back from flat-line, or deliver a premature baby. But in a different sense, by doing what she does every day as an internal medicine specialist, Dr. Yuan upholds a standard of patient care that is the bedrock of her profession, a standard of care that is increasingly undermined by a complex health care system that is difficult to understand. But Dr. Yuan endures. And she sees new patients. And she wears the white coat, though she does so less often these days because she has to schedule any number of hour-long appointments to complete paperwork, and care for bureaucratic mandates ancillary to the health of her patients. It will come as no surprise that Dr. Yuan’s patients were not content to let me remain a shadow. Patient #6 in particular needed to tell me a story. The patient did not know who I was or what I was really doing at her appointment. But she consented to my presence in that private space, looked in my eyes, and told me that she would have died were it not for Dr. Yuan. Tina looked down. On my drive home, I found that I needed to say something. Note: Robert H. Walkup is a Professor of Theological Ethics at the Louisville Presbyterian Theological Seminary.