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The White Coat: Symbolic & Utilitarian

Published: Friday, January 7, 2005 at 2:07 p.m.
Last Modified: Friday, January 7, 2005 at 2:07 p.m.

William Shakespeare's Hamlet provides us with time-honored words of wisdom such as "Neither a borrower nor a lender be," and "This above all, to thine own self be true." Lesser known, but useful to this article, is the adage "For the apparel oft proclaims

the man."

Since the late 19th century, the white coat has proclaimed that its wearer is a physician. No symbol, other than perhaps a stethoscope, more quickly identifies a physician. Although in recent years, it seems that a growing number of the health care community have adopted white coats, the public still associates white coats with physicians. There are multiple studies reported in medical journals showing that nearly two thirds of adult and pediatric patients prefer physicians in white coats. Ease of identification may be one reason for this preference, but much of the appeal of the white coat is its confirmation of knowledge and ability.

While recognizing importance of the public perception, many medical schools emphasize the symbolic importance of the white coat. Medical students participate in a White Coat Ceremony, first established by the Arnold P. Gold Foundation, to emphasize the importance of humanism, compassion, and humility in the practice of medicine. The Foundation promotes this ideal by encouraging "humanistic values and behaviors in the medical education experience to help medical schools and teaching hospitals provide and safeguard compassionate healthcare.

Aside from serving as an identifier, the white coat has two other widely recognized attributes. The coats serve to keep underlying garments clean, and its large pockets enable physicians to carry multiple tools of the trade.

Dr. Lawrence J. Brandt, in his article "On the Value of an Old Dress Code in the New Millennium, points to the importance of the white coat as protection from contamination. He cites a study of physicians' white coats for microbial matter that found approximately 30% of the coats' cuffs, front pockets, and backs harbored staphylococcus aureus.

Physicians at the University of Pennsylvania Medical Center took on the question of exactly what physicians carry in their white coat pockets. They published their findings in the article "Portable Knowledge: A Look Inside White Coat Pockets. Their findings,

in descending order were:

1. Medical equipment, i.e., stethoscopes, reflex hammers, pen lights, etc.

2. Pocket Manuals: (descending order) Sanford Guide to Antimicrobial Therapy, Pocket pharmacopoeia, Facts and Formulas, Institution-specific guidelines

3. Work Notes ("to do" lists)

4. Telephone numbers

5. Photocopied articles

6. Prescription pads

7. Personal digital assistants (The position of PDAs may have increased by 2004)

8. Personal calendars

9. Handouts from lectures

10.Disease management strategies or clinical pathways

11.Family photographs

The study also revealed that the number of items in white coat pockets decreased in direct proportion to the number of years of experience of the wearer. Medical student pockets, as expected, were full of items to assist with the learning process, while the

chairman of the authors' department carried only a pen.

Much of the current literature available on the white coat addresses the controversy over the perceived elitism embodied in this traditional garment. Dr. Brandt addressed this issue in his article, pointing out that despite its positive values, the white coat "also can symbolize more nefarious values, such as power and authority, in a hidden curriculum. He cautions that physicians need to avoid "becoming the coat," thus losing sensitivity to the patient, and the willingness for self-reflection.

In conclusion, it seems that patients respond well to physicians in white coats. The coats serve as a reminder of the highest ideals of the healing art, they protect underlying garments, and provide storage for a host of useful items. The appearance of a physician has been, and it seems, will continue to be, of importance. If in public perception, apparel proclaims the man (or woman), then it appears that the white coat proclaims the physician.

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