The lore of medical education on the West Coast states that East Coast medicine is harshly unkind. Rumors, such as surgeons throwing things across the operating room, internists asking questions that have no answers to medical students in front of everyone in the hospital, nurses loudly announcing trainees’ inabilities to do anything correct, and everyone forever reminding you of your peon status, are abundant on the West Coast.

Well.

Having received the vast majority of my medical education on the West Coast and, now, nearly done with a year of “extra” training on the East Coast, I am in a position (not necessarily a meaningful position) to comment upon the differences between West Coast and East Coast medicine. I am but one person, of course, and my opinions and observations are just that: opinions and observations.

The last disclaimer is of my training experiences: As a medical student, I rotated through at least three hospitals in Sacramento, California. As a resident, I rotated through three major medical centers in Seattle, Washington. I am now a fellow in New York City and have rotated through three medical centers. (I look forward to the day where I only work at one location.)

Yes, it’s probably not fair to generalize two West Coast cities as “the West Coast” and New York City as “the East Coast”, but this is what I got. (Certainly, psychiatry in New York is probably unlike psychiatry anywhere else in the country. More on that on another day.)

The medical hierarchy is more obvious on the East Coast. Physicians wear one color of scrubs. Nurses wear yet another color of scrubs. Medical technicians wear a different color of scrubs from doctors and nurses. It’s very clear who is who… unlike the uniformly scrubbed people on the West Coast.

Doctors are addressed as “doctors”. Nurses are addressed as “Mr.” or “Mrs.” Medical technicians are generally nameless.

Even if a physician asks a nurse of a technician to address him or her by a first name rather than as “doctor”, the nurse or technician will continue to address the doctor as “doctor”.

Of note, though, there are fourth-year medical students who wear long coats on the East Coast. I never saw that on the West Coast.

Doctors do more physical work on the East Coast. And by “physical work”, I mean things like blood draws and transporting patients to radiology. It seems true: there are more ancillary services on the West Coast than on the East Coast. It also seems true that East Coast doctors are more comfortable with procedures than West Coast doctors.

Attending physicians are not meaner on the East Coast. As a population, the may be more blunt, but they are not intrinsically more salty, curmudgeonly, or whatever synonym you want to use for the word “mean”.

Those attending physicians who are mean are notably meaner. I can honestly say that in all of my time on the West Coast, no physician ever yelled at me with malice. In my time in New York, a physician has yelled at me—but that has happened only once. He said things he really should not have said (and by “said”, I mean “shouted loudly to the point that I had to remove the telephone receiver from my ear”), though I think he was just trying to manage the situation as best as he could. Shouting was his way of coping with it.

We all have bad days; some have more bad days than others. And then there are the very few who seem to generate bad days for everyone involved. That’s the same on the West and East Coasts; these individuals just seem more salty (curmudgeonly, whatever) on the East Coast.

Surgeons, specifically, are not meaner. In fact, the vast majority of my interactions with surgeons on the East Coast have been, at least, civil, and, at most, pleasant. The physician who yelled at me was not a surgeon. The surgeons here have been notably gracious when requesting psychiatric consultation. The surgeons here are also the most efficient in communicating their requests.

Surprisingly, I had the most difficulties with surgeons (which sounds more dramatic than I intend, as these “difficulties” were the exceptions, not the rule) in Seattle.

East Coast physicians are more blunt when they communicate. This, however, is a function of the East Coast. If someone doesn’t like what you are doing or they don’t agree with what you’re doing or they question what you’re doing, they’ll let you know. But this isn’t limited to criticism alone. If someone likes what you are doing or they are curious about what you are doing or they want to thank you for what you’re doing, they’ll let you know.

The above sentence also applies to patients. And their families. And bus drivers. And that person who is standing next to you on the ferry.

Medicine is not more formal on the East Coast. … but this could be an institutional thing. While people generally dress better here on the East Coast, I’ve seen my share of housestaff wearing tired khakis with white socks and not exactly dress shoes. White coats are hanging open all the time with the pockets spilling over with papers. The men are not all wearing neckties and the women are not all wearing skirts (or makeup, for that matter). No one is always giving presentations from memory. Medical students are not quivering with any more fear here than they are over on the West Coast.

In regards to psychiatry specifically, psychiatrists are neither more nor less respected on the East Coast compared to the West Coast. The culture of psychiatry in New York City vexes me, but again, that’s another story for another day.

I will say, though, that psychiatrists on the East Coast dress significantly more fashionably on the East Coast than on the West Coast. Full stop.