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msJAMA
February 3, 1999

The White Coat: Why not Follow Suit?

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JAMA. 1999;281(5):478. doi:10.1001/jama.281.5.478-JMS0203-5-1

One Halloween I opened the front door to welcome a group of candy-craving children that included a 412-foot-tall vampire, 4-foot-tall angel, and 312-foot-tall doctor. The latter child had a circular mirror bound to her forehead with black electrical tape, a pair of horn-rimmed glasses balanced tentatively on her button nose, a stethoscope dangling about her knees, and a white coat that fit like a box tent. I wondered, "Is this what she thinks a doctor looks like?" That night I had come face-to-face with a caricature of my own image as a future physician.

The white coat is a universal symbol of the medical profession. A study of how the media depict physicians revealed that the most common accessory adorning physicians is the white coat, followed closely by the stethoscope.1 How did the white coat become accepted as the physician's identifiable uniform?

Adopting the Lab Coat

In the middle of the 19th century, science had damaged the respectability of medicine by demonstrating that its cures were worthless, thus relegating much of medicine to the realm of quackery and healing cults. While scientists were admired, physicians were distrusted.

The medical profession turned to science. After all, it was thought, the laboratories whose inventions could transmit messages instantaneously and had revolutionized transportation, could certainly provide breakthrough advances in curing disease.1 Physicians, seeking to represent themselves as scientists, thus adopted the scientific lab coat as their standard of dress.

The Evolution of the Lab Coat

Originally, lab coats were beige, but when adopted by the medical profession in the late 19th century, white was chosen. Early evidence of this change comes from photographs of surgeons wearing short-sleeved white coats over their street clothes at Massachusetts General Hospital in 1889.1

The change to white was appropriate for the times. Earlier in the history of medicine, clerical caretakers in hospitals donned black robes. The severe tone of these robes conveyed a sense of mourning and approaching death, sadly appropriate for the inevitable fate of those brought to the hospital in critical condition. With advances in medical care in the 20th century, however, hospitals were no longer regarded as houses for dying, but institutions of healing. The white uniforms of physicians symbolized this new hope in medicine.1

The Meaning of Whiteness

White was chosen with good reason as the new standard of the medical profession. This color, representing purity, is a visual reminder of the physician's commitment to do no harm. White represents goodness. Moses, Jesus, and the Saints, for example, are often described as being clad in white.1 White also conveys cleanliness and connotes a purging of infection.1 Further, the white coat symbolizes seriousness of purpose. It communicates the physician's medical intent and serves as a symbolic barrier that maintains the professional distance between physician and patient. Perhaps most importantly, the white coat is a cloak of compassion.2

Why Wear White Coats?

There are both advantages and disadvantages to wearing the white coat. Objections have been raised about the excessive formality that the coat may communicate. For this reason, most Scandinavian physicians, along with many US pediatricians and psychiatrists, have abandoned it use.3 However, the white coat is an important accessory to the image of the physician that should not be carelessly tossed away. Wearing a white coat need not make a physician seem cold or insensitive. His or her attitude matters most. A physician in a white coat may still be warm, friendly, and empathetic.

The white coat reminds physicians of their professional duties, as prescribed by Hippocrates, to lead their lives and practice their art in uprightness and honor. In accord with this sentiment, the Arnold P. Gold Foundation of Columbia University College of Physicians and Surgeons initiated in 1993 a "White Coat Ceremony" that has been adopted by many US medical schools. In 1997, 83 of the 142 accredited medical and osteopathic schools in the United States conducted this rite of passage.4 The ceremony is typically performed for the incoming class at the beginning of each academic year. Students are welcomed into the family of medicine by reciting the Hippocratic oath and receiving admonishments to practice medicine with honor and compassion, after which they join with faculty and staff as they don their new uniform.

The white coat, as one of medicine's most important symbols, signifies that, in the words of Dr Gold, "a physician's responsibility is not only to take care of patients, but also to care for patients."4

References
1.
Blumhagen  DW The doctor's white coat: the image of the physician in modern America. Ann Intern Med. 1979;91111- 116Article
2.
Lewis  LD White Coat Ceremony Keynote Address.  Presented at: Columbia University College of Physicians and Surgeons August 26, 1994 New York, NY
3.
Anvik  T Doctors in a white coat—what do patients think and what do doctors do? Scand J Prim Health Care. 1990;891- 94Article
4.
Enochs  BE The gold standard.  J Coll Phys Surg Columbia Univ. 1998;1811
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