Prescription for professionalism: Doctors white coats

It’s a white coat, a cotton-blend garment worn over a dress or a shirt and tie with no extraordinary intrinsic value.

Except for this: Who would you rather see standing beside your bed when you wake up from surgery? Someone wearing that white coat? Or somebody wearing a Metallica T-shirt?

Exactly.

For patients — and for doctors and medical students, too — the white coat is more than a piece of practical apparel. It’s a symbol, and an often subconscious one, of knowledge, comfort, cleanliness and caring. And, as with the nun’s habit, the priest’s collar and the uniforms worn by soldier, firefighter and police officer, the white coat packs considerable iconic significance.

The same is true of a nurse’s uniform, at least the more traditional uniforms nurses wore before scrubs became the working nurse’s garment of choice. But both the doctor’s white coat and the nurse’s uniform even today continue to serve purposes beyond the merely utilitarian.

At many medical schools doctors in training receive their first white coats during special ceremonies. At Touro University of Nevada College of Osteopathic Medicine’s white coat ceremony Sunday, 135 first-year medical students, as well as students in the school’s physician assistant and physical therapy programs, were to be given white coats symbolizing the beginning of their medical education.

Second-year Touro medical student Rob Wills received his white coat during last year’s ceremony and said he “definitely felt different” when he donned the coat onstage as faculty and family watched.

Even today, he adds, “I definitely feel different when I wear my white coat. I feel like I’m more on my way toward being a doctor than when I just wear my street clothes. I feel it has a little bit more of an aura about it and a rich history.”

Granted, Wills jokes, “I still feel like I’m wearing a costume sometimes. I think that’s because it’s still early. But there is an intense feeling putting it on. I feel more like a doctor.”

Dr. Ronald Hedger, Touro’s assistant dean of clinical skills training, says white coat ceremonies have been a landmark event for medical students for decades.

The presentation of a white coat to a student marks, he explains, “the transition between the academic medical student and the clinical student or physician. That’s what we’re celebrating. It’s the welcoming of the student into the clinical world.”

Different medical schools hold white coat ceremonies at different stages of a student’s career. At Touro, it’s held around October, several weeks after the first-year student has begun his or her classroom studies.

“But some schools wait until they actually begin their third year. Some do it the first week,” he says.

The notion of white-coat-as-medical-symbol began to arise around the late 1800s, an era when medicine was evolving from a sort of folk art into a real science. Before that, Hedger says, hospitals weren’t necessarily places of healing but, rather, “a place to go to die.”

But as antiseptics and antibiotics transformed medicine into a science, “hospitals really began to become thought of as a place to get better,” Hedger says, and physicians, like the scientists and Ph.D.s before them, adopted the white coat as a symbol of their newly minted status as “medical scientists.”

Even today, Hedger says, the white coat denotes that “we’re clinicians, but we are also scientists.”

But not every white coat is considered equal. In fact, Hedger notes that the length of a medical student’s or doctor’s white coat reveals where he or she is on the hierarchy of medicine.

“When you get a white coat here at the medical school, it’s a short white coat,” he says. “When you transition into a residency, it’s a longer white coat. And when you’re a physician, it’s longer yet.”

Of course, a doctor’s white coat also is a practical garment. For example, its oversized pockets are handy carrying places for the various things a working clinician might need during his or her day.

“There is a functional part,” says Hedger, whose pockets typically hold a stethoscope, a reflex hammer, a notepad, pens, alcohol swabs, Band-Aids and ChapStik. “They’re going to have notes and patient files and information, a stethoscope and physical exam tools with them.”

Also practical: White coats can help to keep the clothes a doctor wears under it from becoming soiled. And, Hedger notes, hospitals typically will purchase, and launder, white coats for physicians on staff.

Nurses’ uniforms also are steeped in tradition and history.

Maureen Matteson Kane, emeritus faculty member of the University of Nevada, Las Vegas’ School of Nursing, graduated from nursing school in New York City in 1959 and received her bachelor’s degree in nursing as a member of UNLV’s second bachelor’s nursing class. From 1977 to 2004, she taught pediatric nursing and other subjects at UNLV.

The modern nurse’s uniform, as well as the transformation of nursing into a medical profession, owes much to Florence Nightingale. According to Matteson Kane, nursing schools based on Nightingale’s precepts had opened in the United States during the late 1800s, although the schools were “not structured about what (nurses) should wear.”

At the time, nurses likely wore their own dresses, later adding aprons to keep their clothes clean. Later, nurses began to wear caps to cover their long hair in designs inspired, perhaps, by nuns’ garb.

Eventually, students of various nursing schools came to design and wear caps unique to their schools, which made a nurse’s alma mater identifiable to those in the know.

For example, Matteson Kane says, “my school (in New York) was established in 1881, and my cap is a crinoline cone with a black ribbon around it. It’s something like an upside-down ice cream cone.

“When I came to Las Vegas, I worked at Desert Springs Hospital. One evening, as I was going down the corridor with my cap on, someone called out, ‘Hey, Miss Mount Sinai!’ It was one of the doctors who trained there. You were known by your caps.”

The presentation of caps and pins to nursing students became the focus of ceremonies much like medical schools’ white coat ceremonies. Then, over the decades, caps began to disappear.

They were hard to keep clean and time-consuming to launder, Matteson Kane explains. “Women started wearing shorter hair and had to put them on with hairpins. They always seemed askew and were always falling off. And, of course, if you were working pediatrics, as I did, you’d have to put your head into a croup tent with kids and have to take your cap off, and I was always leaving it somewhere.

“Nurses eventually said, ‘I don’t want to wear them anymore.’ And men were now in nursing, and men had never worn caps.”

“What has evolved from the old capping ceremony is the pinning ceremony,” Matteson Kane says, while nurses are apt to wear scrubs for practicality’s sake and in colors other than traditional white.

“I know in pediatrics they wear colorful things,” she says. “But nobody wears white anymore.”

Hedger says doctors’ use of white coats has varied among specialties. Surgeons, for instance, typically have worn scrubs as a matter of convenience, although “if they went out on the floor, they had a white coat on over the scrub suit. In the office, they’d (wear) the shirt and tie.”

Then, he says, “on official rounds in the hospital, you’d be expected in a shirt and tie and clean white coat, and let me emphasize a clean white coat, ironed and pressed.”

Actually, medicine may be the last bastion of the workplace dress code. Hedges says Touro’s male medical students are expected to wear coats and ties and women suitable attire with their white coats whenever they’re in a clinical setting.

In fact, Hedger adds, “a lot of times in class, if we have a clinical setting — if we have a guest speaker — they’re required to wear that coat. And if you’ve ever walked into a lecture hall with 135 people in white coats and ties or (women’s) dresses, it’s very overwhelming.”

Still, medical dress evolves. For example, Hedger says, some pediatricians have stopped wearing ties in the office, spurred by studies that indicate that ties can collect bacteria and spread it from patient to patient.

Similarly, some pediatricians will forgo a white coat so as not to frighten children, he says. (By the way, the phenomenon of adults having higher blood pressure in an doctor’s office than at home has been dubbed “white coat hypertension.”)

However, the symbolic weight a white coat carries probably will keep it a physician’s staple for some time to come.

When the time comes to put one on, almost all medical students “accept it very willingly,” Hedger says, and invariably are “thrilled to get to that point.”

Contact reporter John Przybys at jprzybys@reviewjournal pt 702-383-0280.

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