White coat or no?
Subtitle: Unpacking the modern debate of should you wear a white coat as a physician?
White coats are still synonymous with being a physician.
The very first ceremonial act in medical school is the “White Coat Ceremony”, at which students obtain their first (short) white coat as they embark on their journey to doctor-dom.
However in current medical culture, white coats are worn less and less often (1).
I’ve gone back and forth on whether to wear one over the years - ultimately, sometimes I do, sometimes I don’t.
The following article aims to help you decide whether a white coat is right for you.
Where did white coats even come from?
As a fairly analytical person, I like to know some details, background, and historical context when making a decision. *cough cough, nerd
In the case of white coats, they are actually only a recent 19th century social convention.
Previous to this, physicians wore black, similar to clergymen (seen as professional attire… not to be the grim reaper) (1).
Thomas Easkins. Portrait of Dr. Samuel D. Gross (The Gross Clinic). 1875.
However, around the time of Joseph Lister’s antisepsis discoveries, the concept of sterile, white fabrics became a core feature of modern medicine’s focus on cleanliness, antisepsis, and grounding in science.
White coats, smocks, and other garb began to be worn by physicians and nurses.
Over time, the white coat began to symbolize medical authority, establishing trust in the patient-physician relationship (1).
And yet, this authority has consequences. “White-coat hypertension” is the phenomenon where a patient’s blood pressure is high, but only when measured in the doctor’s office (i.e. when they are stressed out by the presence of a physician).
Today, some specialities like paediatricians and psychiatrists almost unanimously avoid white coats for the intimidation that they can produce on their vulnerable patients.
What do patients think?
Our primary responsibility as physicians is to take care of our patients. It seems logical then, that what they think of our white coats, might hold some influence over what we decide to do.
A study found that younger patients prefer their physician not to wear a white coat, while older patients prefer that they do (2,3).
Having a strong patient-physician relationship of trust and rapport is essential to our recommendations intended to help patients. If a patient doesn’t trust their doctor, they won’t do the exercise, take the medications, or even come back for follow-up appointments.
Perception, as in much of life, is very important.
I have personally found that as a 5’2” female, my 90 year old patients tend to respond much better to me when I’m in white.
While this might make the feminist part of me irate, I understand that my job is not to be political or judgemental. My job is to help the person to the best of my ability.
This was one of the biggest reasons why I now wear a white coat in the majority of my clinical encounters. I work primarily as a geriatrician, which means almost all of my patients are >65 years of age.
If it helps them to trust me more if I’m in a white coat? Why not.
However, an interesting narrative review in 2022 by Crutzen and Adam points out that this can also be a nuanced topic - check out their paper for more.
What should you do?
As with most things in life, this is a matter of opinion.
To many, the white coat represents professionalism, scientific rigor, trust, and compassion.
To others, it might be anxiety-provoking, intimidating, or paternalistic.
For my patient population, it is largely the former, and for this reason, on Wednesday’s I wear white (pop-culture reference for my millennial readers).
Finally, as with all my style advice - wear what makes you comfortable.
How you feel will impact how you act, which is just as important (if not more) when working with patients, as what you might look like to others.
What coat do I wear?
As a medical student, you’ll get a short white coat at your White Coat Ceremony. When you finally have your MD degree, you can start to wear white coats that are longer.
My long white coat is from Medelita, and was gifted to me by one of mentors when I entered my geriatric medicine fellowship (shout out to Dr. Marr).
It’s monogramed with my designation (Dr. Olivia Geen, Geriatric Medicine), which I find almost all of my patients look at and read, much more than they do my badge where my name is printed in minuscule writing (another perk of wearing white).
I went with the Rebecca fit, but there are other styles available,
(Image source: medelita.com, accessed on Jan 28 2024)
I hope that this article has widened your understanding of the white coat dilemma, and that you feel more confident making a decision that’s right for you and the patients you care for.
xoxo
Olivia
Dr. Geen is an internist and geriatrician in Canada, working in a tertiary hospital serving over one million people. She also holds a masters in Translational Health Sciences from the University of Oxford, is widely published in over 10 academic journals, and advises digital healthcare startups on problem-solution fit and implementation. For more info, see About.
References:
1. Hochberg M. The doctor’s white coat: a historical perspective. AMA Journal of ethics, History of Medicine, April 2007.
2. Anvik T. Doctors in a white coat - what do patients think and what do doctors do? Scand J Prim Health Care, 1990:8(2):91-94.
3. Crutzen C, Stephane A. “What if it’s not just an item of clothing?” - a narrative review and synthesis of the white coat in the context of aged care. Psychologica Belgica, 2022:62(1);62-74.