December 10, 2008
4 min read

The white coat — a universally recognized medical uniform

Hippocrates advised: be ‘clean in person, well dressed and anointed with sweet-smelling unguents.’

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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.”

Historical meaning

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 patient.

The Agnew Clinic by Thomas Eakins, 1889
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

Modern meaning

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 physician’s 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 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 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.

White coat ceremonies

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 patient’s innermost thoughts. Along with that access came the responsibility of helping her in the best way possible.”

Evolving meaning

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 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. 1999;281:478.
  • Van Der Weyden MB. White coats and the medical profession. Med J Aust. 2001;174:324-325.