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Hospitals Debate the Pros, Cons of White Coats for Doctors

Karen M. Cheung, March 8, 2010

The physician's white coat can be a godsend to any indecisive dresser; the doctor has a set uniform each day, not giving it a second thought. However, it can get complicated in the hospital with the variety of choices, as each article of clothing has its own symbolic meaning—short coat, long coat, no coat, tie, no tie, and scrubs.

The politics of the iconic white coat runs deep in most institutions' hierarchy and tradition.

"At most places, your coat length increases with seniority," said Jeffrey H. Spiegel, MD, FACS, chief of facial plastic and reconstructive surgery, medical director of head and neck otolaryngology, and associate professor at Boston University School of Medicine.

According to Spiegel's recent article, "Wearing White—Right or Wrong? A Satirical Analysis of Medical Attire," published in the February issue of the Journal of Hospital Medicine, the white coat length is akin to the military stripes, representing a badge of rank.

In most institutions—although not at all—shorter white coats denote a student status, including medical student, intern, and sometimes, resident, depending on the institution. The longer white coats are reserved for a senior physician, such as an attending physician on staff.

And in many academic institutions, such as Boston University, students undergo their "white coat ceremony," a robing ritual marking students' official welcome to medicine, according to Spiegel.

The purpose of the white coat isn't simply to reinforce the pecking order. Perhaps most importantly, the white coat serves as an identifier.

"Those of us who work there can identify quickly who is and is not qualified," Spiegel said. "At my institution, if you see someone in a short coat, it's going to be a student; you wouldn't expect them to take a responsibility role in patient care, [but] more of a learning role," he says.

Despite its practical value, there has been a backlash against the white coat. For example, the Mayo Clinic has a no-white-coat zone, instituting business attire for its physicians, according to Spiegel.

In recent years, the white coat has been criticized as a mean of transmitting infections.

"You go into one patient's room and you lean over to listen to them or look in their mouth, your coat might drag against the bed, and you go into the next patient's room and drag it against their bed, and then you hang it up in your office and put it on again the next day," said Spiegel about its potential hazards.

Just as medical professionals might resist the white coat for safety reasons, patients sometimes have shown physical distain for it as well. Known as "white coat hypertension," patients sometimes show falsely elevated blood pressure at the sight of a white coat.

"For patients, the white coat has mixed reactions. Sometimes, people like it because it's professional and clean. Other times, people feel it's distancing [and] creates a barrier."

Spiegel, who works in clinical, administrative, teaching, and research settings, chooses to opt out of the white coat tradition.

"I think the white coat would look too intimidating; it would imply disease too much," he says about his work in his facial and reconstructive surgery. "A lot of the people that I see are there for issues sometimes they are uncomfortable talking about. … A white coat would probably increase those feelings. For me, a more casual professional dress than a white coat makes sense."

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