When Endocrine Today adopted a new look earlier in 2008 it
began to feature a large photograph of a physician interviewed for its cover
story. Since then, many of the physicians photographed have chosen to wear
their white lab coat for the picture.
The white coat has been a traditional symbol of the medical profession
since the late 19th century. Television, films, advertisements and paintings
all frequently depict physicians in a white coat, most likely with a
stethoscope slung around the neck. It is an easily recognized
“uniform” of the profession that says, “I am a doctor.”
At its inception, the white coat served a few practical roles, mostly
symbolic. First, the white was meant to symbolize life and hope. Black was
widely recognized as a color of death or mourning. When medicine and hospitals
began to make scientific progress and to represent healing, wearing white
uniforms was a physical representation of this change. Nurses wore white and
hospitals had white walls; so naturally physicians, who were usually dressed in
suits, also began to wear white. This was especially true for surgeons.
The Agnew Clinic by Thomas Eakins, 1889, is a portrait of
Professor D. Hayes Agnew, MD, of the University of Pennsylvania. In it the
doctor is performing surgery for medical students in an amphitheater.
Source: The University of
Pennsylvania Art Collection
People alive at the turn of the 20th century were also witnessing a
scientific boom. Science, which every year was producing new breakthroughs and
inventions, was gaining more trust with society than medicine. Slowly, as the
medical profession began to incorporate more of science and scientific
technique, the adoption of the white lab coat was inevitable. Physicians were
now viewed as scientists.
Finally, the white coat was a representation of cleanliness and the idea
of causing patients no harm. It was a professional barrier between the
physician and the patient. This barrier cloaked the physician with a sense of
authority but also reminded physicians of their professional responsibilities
to the patient.
Today, the meaning and purpose behind the white coat is very similar to
what it was at the turn of the 20th century. Wendell Rosse, MD,
professor emeritus at Duke University in Durham, N.C., said that donning the
white coat came with a clear sense of responsibility.
“I got my first white coat during the second year of medical school
when we were preparing to go out and work with patients and do physical
exams,” Rosse told Endocrine Today. “It was made clear
to us what the white coat meant. It meant that now we were joining a group that
takes care of patients, and we had certain privileges and responsibilities
because of that.”
When Gregory M. Vercellotti, MD, recalled first wearing a
physician’s white coat, he laughed.
“I felt like a waiter,” said Vercellotti, professor at the
University of Minnesota. “In those days students wore short coats and I
felt just like I was a waiter. There used to be a hierarchy; you didn’t
get to wear a longer coat until you were an attending.
“By dressing the part, though, you feel the part. It reminds you
that you are part of a profession, that you have a responsibility for caring
for the patient,” he said. He also said that the white coat has a more
practical purpose as well: It has pockets. “You can put your peripheral
brain in there,” Vercellotti said.
“In the old days, we all had our ‘peripheral brain,’
which was a bunch of notes and notebooks. Now you can carry your personal
digital assistant, your stethoscope, etc. So it is in fact very useful to have
Despite any practical purposes, both physicians emphasized a more
symbolic meaning of the coat: the sense of responsibility that accompanies
wearing it. “One of the most difficult things for medical students is
making the transition from being a nonphysician to a physician — that is,
assuming the responsibility of acting like a physician. The white coat helps
symbolize that for them,” said Rosse.
To help remind medical students of the responsibilities that come with
being a physician, the Arnold P. Gold Foundation of Columbia University College
of Physicians and Surgeons, N.Y., began a white coat ceremony for its students
in 1993. These ceremonies, which have been adopted throughout the country, are
meant to be a rite of passage and to serve as a reminder of their Hippocratic
Oath. Similar to hooding ceremonies, medical students are gathered, and each
student is presented with and helped into their first white coat.
“I started the white coat ceremony here at the University of
Minnesota,” said Vercellotti. “It has now become a milestone in the
education of physicians here. It occurs in the first year of medical school and
sets the tone for their commitment to professionalism and humanism.”
Biren Saraiya, MD, assistant professor of medicine at the
University of Medicine and Dentistry of New Jersey, got his first white coat
during a white coat ceremony. He said that he first realized the value and
responsibility of the white coat when he saw his first patient.
“As part of a community service project for first-year medical
students I was assigned to work with an elderly woman who was undergoing
chemotherapy for her cancer,” Saraiya said. “I believe that because
of the white coat, she opened up to me and talked about her fears and
expectations. It allowed an unprecedented access to a patient’s innermost
thoughts. Along with that access came the responsibility of helping her in the
best way possible.”
Despite this, there are some critics of the white coat. Some may view
the white coat as a negative barrier between physicians and their patients and
their ability to effectively communicate.
Conditions such as white-coat hypertension suggest that patients may be
intimidated by physicians. Additionally, although they were originally meant to
represent a sense of cleanliness, study results have shown that they may in
fact represent quite the opposite. Instead of being a barrier to infection,
they may carry infection from one patient to another.
In 2007, guidelines were issued in the United Kingdom that encouraged
physicians to stop wearing their white coats, long-sleeved shirts and neckties,
all in an attempt to reduce the spread of infection.
No matter if you are a proponent for or against physicians wearing the
white coat, it is difficult to deny that it remains a universally recognized
symbol of the profession. – by Leah Lawrence
For more information:
- Arch Intern Med. 2003;163:1277-1281.
- Med J Aust. 2001;174:324-325.