Dean's Update
August 16, 2024 - Aron Sousa, MD
Friends,
We are more than six months into the full implementation of the Rx Kids program, supporting all Flint babies with a prenatal cash prescription to the mother and $500 per month in the first year of life of the baby. So far, the program has been, in the words of its founder, Mona Hanna, MD, MPH, “AMAZING!” You can find a wealth of data at the Rx Kids website, but here are some highlights:
- Nearly 100% of 2024 City of Flint families (>900) have been prescribed nearly $2.5M
- 70% of survey respondents have an annual income under $10,000.
- The top five spending categories are baby supplies, food, rent, utility bills, and transportation.
- 72% of respondents feel that Rx Kids has improved their own health as well as that of their child.
First and foremost, Rx Kids aims to improve health equity and the future health of children and families by reducing child poverty. We will know more about many of these outcomes over the course of the program, and enthusiasm for Rx Kids is high. With $20M in the state budget supporting the public private partnership, Rx Kids will be expanding into other high need communities. Based on the tremendous success of Rx Kids and the advocacy of its leaders, national momentum is building. Both parties are proposing an expansion of the child tax credit. Inspired by the success of Rx Kids and reflecting some of its structure, the Harris economic plan includes a $500 per month tax relief for middle- and low-income parents in the first year of their child’s life.
The College of Human Medicine White Coat Ceremony is tomorrow, Saturday, August 17, in Grand Rapids. Our matriculating students gather to be coated by members of the profession, usually faculty and sometimes family members from medicine, sometimes the coating family members are also faculty! There will be more than 60 guest coaters, and the stage at DeVos Place will be full. It is a special day and family members will travel from far away for the event. It was not always this way.
The first White Coat Ceremony I attended was in one of the Big Ten rooms in the Michigan State University Kellogg Center in 2005. I was chair of the curriculum committee, and the room had 106 students, about a half a dozen faculty, a few education administrators, and group of relatively local family members in the back of the room. Each of the faculty coated about 20 students, and I do not think there were any guest coaters. After the ceremony we had punch and sheet cake. It was small and sweet. The event, I mean. The sheet cake was also very sweet, but it was quite large.
There was no white coat ceremony when I started medical school elsewhere. We witnessed an odd “welcome to medicine” lecture by a seriously primeval physician who referred to all doctors as “he” and counseled us to drive something like a Buick. He specified doctors should have a car that signaled more success than a Chevy and less opulence than a Cadillac. For those of you keeping score at home, I’m just about to mourn my 2012 Chevy Volt, which suffers from a frumious transmission. While there was no white coat ceremony, we did get our picture taken in our white coats, and I remember the conversation in my little community group about whether we were going to button our coats or leave the coats unbuttoned. We decided it looked more friendly to have our coats unbuttoned.
White Coat ceremonies are pretty recent and are designed to be a rite of passage, including an oath and donning the short white coat of a medical student. They are suiting up to be a medical student. Or, perhaps we are coating over their previous persona? It is supposed to engender professionalism with a focus on caring for patients, and that would be an interesting dose-response curve if there was one. More realistically, the ceremony provides a welcome and time for everyone to reflect on what we want to see in our profession. At the least, the short white coat helps identify students as a medical student. For patients and care teams, it is probably a help that you can tell the difference between residents and students by the length of their coat (students have short coats and residents and attendings have long coats).
Except that in my neck of the woods, residents don’t wear white coats anymore – they wear a black fleece jacket with some kind of program branding on it. When I go on rounds, I am often the only one in a white coat. It’s been a minute, but it used to be that we all carried multiple books, papers, job aids, wound dressing supplies, and hemoccult testing cards and fluid in our pockets. A resident’s white coat was a medical convenience store and often quite heavy. You might have liked the look of an unbuttoned coat, but when it weighed in at a few pounds it was more comfortable to button it and spread the weight from just your neck to across your back, chest, and shoulders.
Now medical residents carry a paper census with their to do lists, a stethoscope, and a laptop. Most of the stuff in my pockets is in the computer. Surgical residents still stash dressing supplies in their coats, but even the ubiquitous pen light was replaced with the phone flashlight. Somewhere in all of that there is still a cup of coffee – some things never change.
A core life skill for a resident of my generation was your clock speed with a pharmacopoeia or Sanford or the Washington Manual. Now the core skill is one handed typing – hold the laptop in one hand while you access data, find images, and write orders with the other while walking down the hall or up the stairs without spilling your coffee. I get the sense my white coat is no longer a practical necessity, and it is clearly out of fashion.
That’s probably just fine. White coats scare kids and some adults. They are laboratory coats and are meant to be a barrier to protect us from fluids and mess – they are also a barrier to patients. They are probably germ-ridden, but so are the black fleeces and computers that are ubiquitous in clinical care. Of course, white coats do helpfully identify your role, and they look professional, which patients want. Most people prefer their airplane pilot to look professional, and the same is the case with their doctor, barely.
It seems unlikely to me that white coat ceremonies have made the profession of medicine more professional. But, at the end of the day, or by midday tomorrow, our newest medical students and their families will meet more of their fellow students, hear from faculty, and learn a little about how the College of Human Medicine approaches medicine and medical educations. About fifteen hundred people will attend the ceremony, and that is too many people for a sheet cake. That said, if the assembled feel a bit more of our history and mission, and if our newest medical students see themselves continuing our collective work to make the world a better, more sanative home for all, then it will be a fine day. So be it.
Serving the people with you,
Aron
Aron Sousa, MD, FACP
Dean, Michigan State University College of Human Medicine