When HemOnc Today adopted a new look earlier this year 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.
People alive at the turn of the 20th century were also witnessing a
scientific boom. Science, which was every year spawning 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 only natural. 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
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
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 HemOnc 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
physicians white coat, he laughed. I felt like a waiter,
Vercellotti, professor in the division of hematology-oncology-bone marrow
transplant at the University of Minnesota, told HemOnc Today.
In those days students wore short coats and I felt just like I was a
waiter. There used to be a hierarchy; you didnt 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 those pockets.
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, who is also a member of the HemOnc
Today Editorial Board.
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, who is also a member of the HemOnc
Today Editorial Board. 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 and a member of the HemOnc
Today Editorial Board, 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 in an
interview. 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 patients 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
No matter if you are a proponent for or against physicians wearing the white
coat, it is difficult to deny that it remains an enduring and universally
recognized symbol of the profession. by Leah Lawrence
For more information:
- Brandt LJ. On the value of an old dress code in the new millennium.
Arch Intern Med. 2003;163:1277-1281.
- Jones VA. The white coat: Why not follow suit? JAMA.
- Van Der Weyden MB. White coats and the medical profession. Med J