Enclothed Cognition

In my life family will always be my greatest priority. I love my patients like I love life itself, but I love my family even more than life itself.Years ago I dreampt of being an MD. Since I was a small child in fact. To me this would be the pinnacle of life. Stethoscope around my neck, working in the trenches. Saving lives! This was my childhood dream, as well as my young adult dream, all the way through college. Not even Organic Chemistry could stop me. I just pushed through it, head to the grindstone, determined to reach my goal.Then one year away from finishing all my pre-med training something happened: I met a Physician Assistant! To me life has always been more than my job. The reason I created this my website, www.thepalife.com, is because I love art, photography and technology.I love kids, the outdoors and my family. I love to surf, to bike and to take my son and daughter for long walks. I love to make shapes out of the clouds, go on long weekend getaways, take my wife out dancing.

More than a PA; I love life!

If you don't know already being a doctor requires a TON of sacrifices. If you are considering becoming a physician and you are not prepared to give your life over to medicine, then I want you to take a long deep inward look at yourself and decide if what you want is really MD. Prior to many hours working in the University of Washington Medical Center I thought being a Dr. was fun, like Michael J. Fox in the movie "Doc Hollywood," or rugged like the doctors on Mash. I wanted to be like George Clooney in the TV show ER. This is an illusion. Being a Dr. means long hours, late nights on call, missed birthdays, missed anniversary's often second marriages. That last one is the part that is like the movies.

Want vs. Need

I realized that what I wanted most out of life was to help people be healthy. I love the human body, I love anatomy and I love science. I loved the thought of propping a young child up on the exam room table making a funny face and treating their ear infection. I loved the idea of sewing up a wound, setting a fracture, being there when another human being needed someone to hold onto. Helping someone come to terms with death while helping another come to terms with life. I didn't want MD, I wanted all of the above; to me there was no other way.

Balance

I have met more doctors who want to be PA's than PA's who want to be doctors. Why? Because there is more to life than medicine. PA's have the unique opportunity to live this. It is not about being lazy, it is not about lack of dedication. PA's tend to be some of the most dedicated and hard working people I know.

PA is the sweet spot!

PA is where life and medicine meet in the middle. I truly believe you can be better at compassion when you are more grounded. Having a life outside of work justifies life; it makes for a happy person which translates to better patient care. I realized after quite a bit of soul searching that I never really needed to be a Doctor, but I wanted to feel like one. If you are on this journey to being a health care provider, just know that a life exists beyond MD. It is a wonderful life, it has fulfilled every single one of my dreams of being a wonderful health care provider. And every time I prop a small child up on the exam room table and write the script to make their ear feel better, I smile. Then I go home in the evening and give my kids, and my wife, a big hug and a kiss. In my life family will always be my greatest priority. I love my patients like I love life itself, but I love my family even more than life itself. Click to Tweet I don't think I could have found this balance as an MD and I thank my lucky stars that life, or God or whatever directed me to UMDNJ, to PA School, to the job of my dreams. Being a PA is truly where life and medicine have found the perfect balance. I hope you too will give the Physician Assistant profession consideration as you go about life and pursue a rewarding career in the field of medicine. This post ran originally on author Stephan Pasquini's www.thepalife.com blog. Stephan Pasquini is a rural family practice Physician Assistant since 2004 and creator of thepalife.com. A National Health Service Corps Scholar and graduate from The University of Medicine and Dentistry of NJ (Rutgers) PA program and the University of Washington in Seattle, WA. Stephen's goal is to provide one of a kind online resources for those interested in or practicing in the PA profession, to promote better access to healthcare for all and foster universal recognition/awareness of the PA profession

In April of 2012 the New York Times published an article on Enclothed Cognition that not only caught our interest here at Medelita, but it reinforced what most people intuitively understand:  what you wear impacts your level of self confidence. The thought process behind the common phrase 'the clothes make the woman/man,'  has been applied to situations throughout our lives, especially when we're striving to succeed.  Job interviews, special occasions; when there is a moment of importance in our lives, we step up our appearance to signify that importance. The New York Times article focused specifically on how wearing a white coat effected the cognitive process and made people  "think like doctors," citing that

physicians tend to be careful, rigorous and good at paying attention.

In the  Study on Enclothed Cognition, Hajo Adam and Adam Galinksy introduced the term “enclothed cognition to describe the systematic influence that clothes have on the wearer's psychological processes."  Three experiments were conducted with the following results:

1. Physically wearing a lab coat increased selective attention compared to not wearing a lab coat.

2. Wearing a lab coat described as a doctor's coat increased sustained attention compared to wearing a lab coat described as a painter's coat, and compared to simply seeing or even identifying with a lab coat described as a doctor's coat.

Testing the White Coat

The British Psychological Society's Blog describes how researches came to their conclusions about Enclothed Cognition; here is a quick snapshot of their post describing the tests:

58 students took part in a test of their powers of selective attention known as the Stroop Test

Half the students performed the task in a scientist's white lab coat

The other students just wore their own clothes.

The Key Finding: - students in the lab coats made half as many errors on the critical trials of the Stroop Test.

Next researches tested whether enclothed cognition effects depended upon the meaning or the wearing of the clothes.

The results?  Participants who donned a lab coat performed  far better than those who only  saw a lab coat on the desk or those who wore a coat but believed it belonged to a painter.

Doctors Who Choose Not to Wear a White Coat

Last week I spoke to an MD in his 3rd year of residency in relation to what the White Coat means to a young MD.   This doctor has a friend who is a chiropractor and had some insight into the chiropractor's practice, where the white coat is not standard uniform.  Our conversation centered on doctors who choose not to wear a white coat and why.

 My immediate question was: Why would a doctor choose not to wear a white coat?

There is a school of thought and some evidence that individual patients, especially children, find the white coat intimidating and therefore some doctors choose not to wear them.  Examples of a patient's blood pressure rising upon seeing their white coat-clad physician are fairly common.

This condition, sometimes known as "White Coat Hypertension," was once thought to be a purely temporary condition, but is now being considered as a possible indicator of future issues.  Perhaps that momentary spike in blood pressure brought on by the white coat can signal that special care in regards to blood pressure should be taken.

Why the White Coat Matters to Patients

In seeking out opinions on what the white coat means to those working in the profession, I came across this post by Dr. Michael Edmund, Professor of Internal Medicine and Chair, Division of Infectious Diseases, VCU Medical Center,  describing his stance on why it is ok for Physicians to shed the white coat.  I considered how I (a layperson and non-medical professional) would feel as a patient if my doctor walked into an appointment in jeans and a sweater.

At the beginning of his post, Dr. Edmund cites a paper from  JAMA Internal Medicine, where hundreds of people whose family members were ICU patients viewed photographs of physicians dressed in a variety of attire, casual, business, and in white coats.

Then the subjects matched  the doctors images with with specific characteristics.   Dr. Edmund writes, "...in a nutshell, they found that families deemed the doctors in white coats to be most knowledgeable, most honest, and best overall. Doctors in scrubs and white coats were deemed equally most competent and most caring."    Dr. Edmund rejects the findings based on his own interaction with patients, stating that he " never met a patient who chose their doctor on a sartorial basis."

I respect Dr. Edmund's experience and opinion of course, but needed to understand more.  In reading on the study I found that it was based on the experience of ICU patients. One note that stood out for me was "Patients admitted to the ICU typically do not have a preexisting long-term relationship with their ICU physician, and therefore trust needs to be established over a short time frame.7 "

A Patient's Perspective

I am not a doctor; I write this post clearly from a patient and layperson's perspective.  Because of my work with Medelita, I am in close and constant contact with many people who do work in the medical profession on a daily basis, which gives me a small insight into what life is like for them, and of course we talk constantly about 'the white coat' because it is one of Medelita's key products.

We found the Enclothed Cognition study interesting not only because it is impressive, but because it carries with it a sort of deja vu, or deep familiarity.  The idea that the clothes you wear impact how you feel reinforces something many of us understand: to look good, and to dress smartly, changes how we feel about ourselves, and how others perceive us.

The extra layer of depth that the study brings is that we now know is it isn't only about perception, but wearing a professional white lab coat actually effects the way we think; it directly impacts our cognitive process.  Considering that there are differing views on the topic, we'd love to hear your thoughts and experiences about the white coat and how it impacts your perception of the profession.

At the end of a long day at my medical practice, I am sitting at my computer catching up with friends via Facebook. Suddenly, a notification pops up: one of the patients I saw today has sent me a friend request. I know that the ACP, AMA and every other physician organization recommends strongly that doctors not connect with patients via social media, so I quickly click to decline the invitation. I spend the rest of the evening imagining the awkward conversation when the patient next comes to see me, where I have to explain why I had to decline the request. I know that digital communication with patients can lead to blurring of personal and professional boundaries, miscommunications and confidentiality breaches. But I wonder whether the dangers really outweigh the benefits. I have limited time available to see each patient in the office and an out-of-office communication channel such as Facebook could allow me to be more accessible to patients. I would be available to answer non-urgent questions in my free time and I could also take advantage of my social networks to send out public health announcements and advocate for important health causes.

Are Doctors Blurring Professional Lines with Social Media?

But what of that blurring of personal and professional? This is a question that goes far beyond the issue of social media. Doctors are constantly faced with the dilemma of how much to share of their own personal lives. Can empathy help a patient suffering from an ailment the doctor has experienced himself? Can a personal story make the patient feel closer to the physician and instill confidence in her? Numerous studies show that a positive relationship with the doctor promotes confidence, encourages compliance with treatment, and aids healing. I have occasionally shared a personal anecdote when it seemed to be in the patient’s best interests. My personal problems are of course not the concern of the patients, and they need to feel that I am giving them 100% of my energy. But on the other hand, I don’t want to be one dimensional and inaccessible. A small amount of sharing can go a long way in sending a patient home with a spring in his step and the hope that he will be healed.

Digital Communication Can Supplement, not Replace, Personal Attention

Miscommunications can happen through social media, but they can happen in short office visits as well. Social networking is not a short-lived trend; a whole generation has grown up communicating in a digital format. Patients are coming to see the doctor after they have Googled their symptoms and compiled a list of possible diagnoses. This being the case, a social network where the doctor can respond and explain has distinct advantages over the anonymous and often inaccurate information available on the Internet. Digital communication is obviously not a substitute for in-person medical exams, but can serve as a helpful supplement. Confidentiality breaches are a real issue but can be solved with strict guidelines regarding which types of content are appropriate for digital sharing and using technology to ensure safe communication.

A Glimpse Behind the White Coat

I think the strongest argument for the use of social media for patient-doctor communication is the sheer number of Facebook requests I have declined over the last few years. Patients are reaching out to doctors, wanting to have a direct line of communication without feeling they are intruding on their personal time with a phone call. They are telling us with each friend request that they want a glimpse into the real person behind the white coat. They are saying that they want to be more proactive and involved in their own care, letting their doctors know about their progress in between clinic visits. What kind of message does it send to our patients when they reach out and we take a step backwards? Perhaps some entrepreneurial, tech savvy person can develop a separate social network to handle patient requests, but until that happens we must decide how we'll deal with the networks as they exist, and the inevitable requests that come our way. Nathalie Majorek is co-founder, MDCapsule and can be reached on Twitter and LinkedIn. Note: This post originally ran on www.KevinMD.com

The medical field is at times fast moving and exciting; sometimes it is impossible to keep up with.  Every week or so we'll be bringing you the 5 most fascinating stories in Medical News.   Here's our first shortlist:

1. Virtual Reality Simulators to Practice Surgery

Physicians at the University of Minnesota are using virtual surgery to hone their skills. Dr. Robert M. Sweet, director of the U’s Medical School Simulation Programs, thought of the idea while he was a resident, training to conduct prostrate surgery.

The simulator will allow surgeons in training to get (nearly) real life experience before attempting surgery on a living patient.  Read the entire Star Tribune article here.

[caption id="attachment_2674" align="aligncenter" width="300"] (KYNDELL HARKNESS/STAR TRIBUNE)[/caption]  

2. Medical Glasses Allow You to See Through Skin

Evena Medical has developed glasses that allow nurses and other medical professionals to 'see through' skin to allow them to more easily target veins for needles and IV drips.  The glasses can be worn over other eye wear and can record images for future use.  Read more here.

   

3. Surgeon Live Streams Knee Surgery Using Google Glass

Dr. Christopher Kaeding of The Ohio State University Wexner Medical Center wore Google Glass and live streamed  ACL surgery to colleagues and students.  He said once he put the glasses on he almost forgot they were there.

Watch the report here:

 

4. Patient Sues Doctor for Posting Unflattering Pictures on Social Media

This story has more to do with common sense than breaking news, but with the rise in Social Media use by patients and physicians, we thought it an important story to include. The patient and doctor knew each other prior to her ER visit for consuming too much alcohol, but she never expected him to take and post images of her while in the ER. Read the full story here.  

5. Head Transplants

Yes, you read that correctly.  The  June Issue of Surgical Neurology International told the story of neuroscientist/neurosurgeon Dr. Sergio Canavero and his project to conduct the first human head transplantation with spinal linkage within the next two years.   The process involves putting the head to be transplanted into "hypothermia mode" for up to 45 minutes.

Read the full article on Medical News Today.

[caption id="attachment_2684" align="aligncenter" width="277"] MNT Photo[/caption]

For those of us who are not working in medicine, this is definitely the most mind blowing story we've read in quite some time.

We'd love to hear about the stories that fascinated you this week.

You may be aware that we have been growing our business since 2007, and we’re exceedingly grateful to the community of medical professionals that have embraced us. We set out from the beginning to make the finest Lab Coats and Scrubs available; if you own any of our products, you’ll know that they sell themselves. We have decided to transform our blog, The Right Fit, into a place that gives back. We will, henceforward, be featuring topics of interest to our medical community, including:

• Healthcare News
• Healthy Living for Medical Professionals
• Medical History
• Medical Technology
• Resident Life
• Medical Jobs

We are pleased to be partnering with Medical Doctors, PAs and other Medical Professionals who will be advising us on our journey. We will also be featuring some of the best guest bloggers on the web, and will constantly be seeking your input as to the topics that are most pressing to you. If you are interesting in submitting blog posts, or know a medical professional that is, please  email us. As always, we are very interested in hearing from our community; welcome to The Right Fit Blog, and please, send us your ideas, comments, and criticisms.

In theory the iPad was poised to change the lives of clinicians and patients forever by delivering mobile health solutions that allow for a dramatic increase in efficiency, the accurate flow of information, and plenty of other benefits across the entire value chain from clinician to patient, specialist, pharmacist, and so on.

I was recently approached by a friend who wanted to purchase a personalized Medelita lab coat for a new graduate, and could sense his apprehension immediately. While this would make the perfect gift, he explained, it required that the size, fit, style, and embroidery was perfect.

A few months ago Keila Valdz Mower, a Girl Scout leader in Utah, wrote a compelling email to Medelita requesting a donation of lab coats to support a STEM Education program. Medelita enthusiastically said YES!

Medelita offers Sanita Clogs on our professional medical apparel website because they are the best shoes for long hospital shifts.  We know this because Medelita founder Lara Manchik Francisco, PA-C worked for 10 years on her feet in a busy emergency room.  We also know it because they have been recommended by many others in the field.  A few blog excerpts are below and underscore the exact reasons why clogs are the best choice: Mary L. Brandt, Professor and Vice Chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, recently attested that, “Less than a 2 inch heel is best for Achilles.” She also adds, "If you will be standing for long periods on rounds or in procedures, think about getting shoes that slip on and off.  If you’ve been standing for hours it really helps to stretch your calves and change the pressure points.  When you are sitting, you can slip them off and let your feet breathe. There’s a lot of walking in the hospital, but there’s even more standing.  Running shoes don’t provide the right kind of support for standing, which means your feet will suffer if that’s what you wear." Here are a couple of other tips from Ted R. Melnick, MD Chief Resident, Department of Emergency Medicine at Mount Sinai School of Medicine:

• "More important, though, is the efficiency this type of shoe allows you in the call room. You can quickly slip out of them and get some rest during the limited time you have to sleep during an overnight call. And when a code is called in the middle of the night, you can slip your shoes on quickly and be one of the first to respond.“
• “If you have a well-cushioned walking or running shoe, it will keep you comfortable during the long walks from one hospital ward to another. However, during a long procedure in the OR or on long walk rounds (this is making rounds while standing as opposed to sitting or walking for that matter), that cushioning will do a poor job of distributing the weight of your body.”

Sanita Clogs are the original Danish Clog and have been handmade in Europe for over 100 years. They now offer non-skid soles and are easily cleaned with a damp cloth.  These reasons along with those above are all support your choice of Sanita Clogs as professional Medical footwear.

Residency is an intense time – really intense. The passion for the work is high, as is the dissonant combination of pride and self-doubt. The field of medicine is not a casual career path but a choice to truly face life, death, and every stop in between on an hourly basis. Combine braving hours of human pain and bodily fluids with the intellectual rigors of constant education (with little food or sleep) and you get, well, life as a medical resident. Although it is a given that we are all grateful for their dedication and assistance, there are actually some tangible gifts they would also appreciate this holiday season.

Top ten gifts for Medical Residents & Fellows:

1. $100 Starbucks card – cause they’ll need it

2. Embroidered Lab Coat from Medelita (instant boost of confidence and professionalism!)

3. On the go healthy snacks that can fit in a lab coat pocket: http://www.kindsnacks.com/

4. Sanita clogs – great support for people on their feet over 2,000 hours/year. Now offered with non-skid soles and 15% off with discount code: comfyclogs

5. 1 year worth of pre-paid dry-cleaning – make their life easier

6. Medelita gift card – the world is their oyster

7. An airline ticket to the medical conference of their choice

8. A bike, or other encouragement to get outside on their few days off

9. Medelita Scrubs – super soft with high performance bacteriostatic fabric

10. A hug