The Last White Coat I’ll Ever Wear

I’m a big fan of the Men in Black movies. I’m not going to tell you how many times I’ve watched them on TV (78 million and if that number reminds you of a scene from Men in Black, you’re just as much a fan as I am, if not worse). One of my favorite lines is when Zed says to Edwards, “Edwards. Let’s put it on.” Edwards asks, “Put what on?” And Zed says, “The last suit you’ll ever wear.”

Today, I asked my secretary to order some new white coats for me. I went down to the Uniform Shop and checked on it. All they need is the requisition and they’ll get it.

Since I’m retiring after this year, these are the last white coats I’ll ever wear. There’s no Zed to tell me that. The Uniform Shop staff person won’t know it when the coats arrive—unless I tell her, of course.

I found a very long, involved discussion on the web about the meaning of Zed’s “last suit you’ll ever wear” statement. All I got out of it was that some people take that movie way too seriously.

But for me the last white coat I’ll ever wear means exactly that. I’m going to wear the coat until I retire (in about 14 months according to the countdown)—and then I’m never going to wear white coats again.

I can almost hear certain persons snickering in the background. I suspect there may be a few bets about this retirement thing being another temporary leave-taking, like the times I left for private practice and came back, sort of like bringing Agent K back after neuralyzing him at his request. He really did retire—temporarily.

But nobody is going to neuralyze me. I’ll keep a lot of memories about my time as a Consultation-liaison (C-L) Psychiatrist, even though some of them are sort of like Agent K’s memories of being swallowed by a giant interstellar cockroach.

However, that reminds me of a few thoughts I have about institutional memory. I’ve mentioned my concerns about being practically the only C-L Psychiatrist in a pretty big hospital and retiring. I’m a geezer, but I know a lot about the ins and outs and moving parts and what it means to be a one-man hit-and-run fireman psychiatric consultant in a large academic medical center.

Institutional memory…

Institutional memory has been defined as “the collective knowledge and learned experiences of a group. As turnover occurs among group members, these concepts must be transitioned. Knowledge management tools aim to capture and preserve these memories.”

Institutional memory can also be characterized briefly as:

  • Accumulated knowledge, skills, “this is the way we do things”
  • Some of it gets hardened into policies and procedures
  • Much of it “…resides in the heads, hands, and hearts of individual managers and functional experts.”- “How to Preserve Institutional Knowledge” by Ron Ashkenas, Harvard Business Review, 2013
  • Too much of anything for too long can be bad, including institutional memory

The bullet point that Ron Ashkenas makes above is relevant to employers of baby boomers like me who know informal procedures, and have the skills (and they chose us so they recognized the skills, so don’t be calling us sport, feisty, hon, sweetie, or anything like that) and knowledge that’s in our heads but may not be stored anywhere else.

That makes the baby boomer retirement phenomenon a real challenge. About 10,000 boomers will reach the age of 65 every day for the next 15 years. And most of us aren’t kidding around. There’s no way to just deneuralyze us to make us come back. You can’t make it happ’n Cap’n.

There are ways to package institutional memory into handy things like mentoring partnerships, knowledge wikis, snappy videos (just shoot the damn thing!) and other media that are easily accessible and geared for the adult learner.

You can’t beat the Internet Archives for history. You can borrow and read the first edition of the Massachusetts General Hospital Handbook of general hospital psychiatry published in 1978, just like checking it out from a public library. Read the chapter, “Beginnings: liaison psychiatry in a general hospital.” You can learn from Dr. Thomas P. Hackett about the difference between a consultation service and a liaison service:

digital institutional memory

“A distinction must be made between a consultation service and a consultation liaison service.  A consultation service is a rescue squad.  It responds to requests from other services for help with the diagnosis, treatment, or disposition of perplexing patients.  At worst, consultation work is nothing more than a brief foray into the territory of another service, usually ending with a note written in the chart outlining a plan of action.  The actual intervention is left to the consultee.  Like a volunteer firefighter, a consultant puts out the blaze and then returns home.  Like a volunteer fire brigade, a consultation service seldom has the time or manpower to set up fire prevention programs or to educate the citizenry about fireproofing.  A consultation service is the most common type of psychiatric-medical interface found in departments of psychiatry around the United States today.

A liaison service requires manpower, money, and motivation.  Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned.  He must be able to attend rounds, discuss patients individually with house officers, and hold teaching sessions for nurses. Liaison work is further distinguished from consultation activity in that patients are seen at the discretion of the psychiatric consultant as well as the referring physician.  Because the consultant attends social service rounds with the house officers, he is able to spot potential psychiatric problems.”—T. P. Hackett, MD.

By the way, have you seen my YouTube Channel? I’ve been beaming me up into educational videos for residents and medical students for a while now.

 Next year I’ll be doffing the white coat for good—but I’ll be on THIS planet.

Reference:

Hackett, T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.

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