Still Marching In A White Coat

Abstract

White Coat, Clenched Fist, first published in 1976, has now been rededicated by author Fitzhugh Mullan to a new generation of healers, instructing them to question, challenge, and change. It is in this spirit that Mullan, a professor of medicine and health policy at the George Washington University in Washington, D.C., arrived to medicine and continued through his remarkable career. His story, which he originally wrote as a guide for radical health activism and medical education reform, is that of a compassionate young physician deeply concerned about social injustices and a broken health care system. Mullan states that the book’s current edition retains those purposes, with added historical perspective and legacy as grounds for change. The story begins in rural Mississippi, with Mullan, a young white medical student and Civil Rights volunteer, defending a church alongside poor black farmers. After growing dissatisfied with the lack of creativity and humanity in the anatomy lab, and questioning the relevance of the preclinical years of the medical school curriculum, Mullan found in the life in the woods of Mississippi an opportunity “to escape the intellectual and spiritual oppression” for at least one summer. Despite their cultural differences, Mullan was inspired by the people he met in Mississippi and touched by their real-life struggles. There he appreciated the relevance of being a doctor: the poor and disenfranchised could use what he had to offer clinically and politically. Following his summer Civil Rights work, Mullan returned to medical school motivated to confront the medical establishment. His involvement started by supporting a fellow student in his refusal to shave off his beard upon starting clinical rotations as was demanded by the medical school administration; and continued with the formation of the Student Health Organization (SHO). With a focus on community work, critical student publications, and curriculum reform at health professional schools, the SHO brought together likeminded students excited to effect change. During the five-year experience with the SHO, Mullan and others defined their role as physicians as agents of social and political change. However, the organization’s demise was also an early realization that lack of cohesiveness impairs our strength to mobilize such change. In the next few chapters of the book, Mullan discusses his continued efforts to change the health care system, addressing the exploitation of house officers and the use of city hospitals’ patients for the purpose of teaching physicians in training. For his internship site, he chose Jacobi Hospital, a city hospital in the Bronx, New York. Although he appreciated the great learning opportunities and human contact at Jacobi, Mullan became a voice of criticism of the clash between medical schools, which run public hospitals, and the communities, whose residents use those public hospitals. Through the narratives about his time at Jacobi, Mullan describes the irony of using poor public hospitals to train physicians B o o k R e v i e w s