The Evolution of My White Coat

The significance and use of the white coat has been a topic of late. Most recently (and eerily coincidental to my drafting this post) there was a piece on Get Better Health about it. Thus, my post can be seen, perhaps, as an extension of those recent commentaries as I present some opinions from the “crowd” compiled by informally polling Twitter and Facebook regarding the question: Should doctors wear white coats?

Results on Facebook (total number of responses = 15):

Yes – 27%

No – 33%

It depends – 40% (unfortunately, those who responded with this answer did not provide further explanation, which would have been interesting)

Results on Twitter (instead of their Twitter handles, the parentheses indicate their background for reference):

(psychiatrist) Id say most psychiatrists typically avoid #whitecoats in the hospital setting as well, need to balance inherent power dynamic

(pediatrician) #whitecoats less about power more about pockets to hold stuff…and the things are dang dirty too like ties
More than docs wear white coats– often one in white coat is NOT a doc:)

(other) not at #hopkins. we have a 25-yr + tradition of white coats for many reasons, not least is de-stigmatizing psych. yes based on healer’s status assoc. w/ successful psychotherapy outcomes (Frank’s Persuasion & Healing) & white coats with status

(chiropractic magazine) It’s nice to see doctors wear #whitecoats or scrubs – some professional garment, to preserve

(a consultant to healthcare industry) All about 1st impressions & ppl r different. I don’t like cuz separates me from Doc. Many seniors do cuz they expect separation.

(a med student) Yes, I think it shows professionalism, not to mention there are pockets for holding things. 🙂
Yes, some patients only know it is a Dr they are talking to based on the coat. And some docs are bad with intros.

(unknown) IMO, #whitecoats show #professionalism which is sorely lacking these days.

(an RN) no but found the hospital experience to be daunting without identity….vulnerable time for those involved.

The white coat has its detractors. Apparently a Twitter conversation was devoted to the characterization of those who wear it as as egotistical or snobbish. There could be some – albeit rare, in my opinion – truth to that. An unfortunate example of this would be one medical student I knew who proclaimed that he loved being in medical school because he was surrounded by doctors in white coats, “like gods.” I kid you not. I was disgusted by that remark and it was evident he was not in medicine for the “right” reasons. But that is not the norm. Furthermore, the use of the white coat is not restricted to physicians. It has also been a uniform for lab techs, aestheticians, barbers, dentists, and Clinique salespeople at the department store counter.

Another reason that the white coat has been losing its appeal is for the same reason physician neck ties have been scrutinized in recent years – potential transmission of bacteria. This issue is referenced in a recent post by Dr. Westby Fisher and presents a quandary.

As for me, the white coat has had different meanings over time:

In medical school – It was a short coat, which looked a little silly, really. But it held a  library (before smartphones) and some tools. It was my identifier that said to patients “I am not a doctor, but I am not a random stranger. I am here to learn.”

In residency – it was a longer coat. It was my identifier that said, “Though I look young and I am a woman, I am a doctor.  And ,yes, I am the one writing your orders. No, I will not get a doctor. I am the doctor and I am practicing in real-time to be an attending. It is very important for me to get this role down.” It also kept me warm and held snacks and notes and patient checklists, and more tools. I had to wash it on my own – frequently. It got pretty tattered by the end. It was a frequent cause of neck pain.

Currently – My white coat holds my pen, stethoscope, cellphone, and some business cards. It seems to be 10 pounds lighter than it used to be. It keeps my clothes clean during potentially messy procedures. In a funny way, I feel it holds me accountable to every patient I see. Hopefully it relays experience, professionalism, and provides some reassurance to new patients that he/she is in well-trained hands even though I don’t have a head of grey hair yet.

Now, I have tried going without the white coat, but, invariably, I forget my stethoscope or need my cell phone. Or someone says, “You look too young to be a doctor” – is that the glaucoma talking? – at which point, I want to run to get it and say, “See? I am not too young. I spent many years training. You can trust me.”

In sum, I think the most notable features of the white coat are that it provides efficiency and protection and a reminder of my role as physician to educate and treat my patients as best as I can and to be as professional as I can. One particularly inspiring view can be found in a transcript of a speech given by Mary L. Brandt, MD during a “white coat ceremony.” She says to the bright-eyed medical students “You are putting [on] a coat of candor, of sincerity, of openness, of kindness and of self-care.” Physicians should read it whenever they need a reminder of what that white coat represents.

But, the white coat as a status symbol? Perhaps, but only for those patients and doctors who perceive it as such. But this is not the case for me. I am only too happy to take it off before I leave the clinic.

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6 thoughts on “The Evolution of My White Coat

  1. What is the general opinion of non-physicians wearing a white coat? There have been numerous occasions which I’ve seen nurses, PAs, RTs, etc… all wearing white coat. As a physician not only do I not know who the doctor is half the time but many patients have been confused as to who the doctor really is. Even within anesthesia, the CRNA will say “I’m John Doe, and I’ll be administering your anesthesia”. These patients think that the Anesthesiologist (physician) has just introduced them self. Most patient do not know what “PA” stands for or “NP”, “RT” but because there is an association between a person wearing a white coat and being “the doctor” much confusion does exist, especially for patients.

  2. I am a hospitalist, and have no convenient office. I wear mine for the pockets, and so the patients at least have to think twice before asking if I am their nurse. Why can’t woman’s pants have pockets? Why can’t I be an ER doctor and wear the cargo pants with pockets. I am only carrying around keys, my phones, at least 2 pens, a patient list, my ID that gets me through doors, some cash, my stethoscope, and one little reference book that I have “important phone numbers” stuck in. I notice that most of the male hospitalist don’t wear a white coat. I believe this is because their pants always have at least a few pockets, and because they are less pestered with the “aren’t you too young to be a doctor” and “are you my nurse” questions.

  3. Good post. I’ve not been wearing mine–primarily because it’s always dirty. Now that I am in solo practice I have to launder it myself. Too many ink stains. I have enough laundry to do, save the white coat. I do wear it when I visit my patients in the hospital–I want the staff to know that I am a physician….I’m not sure they’re hygenic–but for a youngish woman, it helps.

  4. Terrific post. I have been wanting to write about this one for ages. 🙂 Maybe I should. I have had a few pretty mortifying experiences with this thing myself…

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