Role of a white coat in the medical profession

Doctors were advised to be “clean in person, well-dressed and anointed with sweet-smelling unguents” by Hippocrates. ^[1] Thus, the supposed influence of physicians’ attire on doctor-patient relationship has been established since the time of Hippocrates. ^[2] The white coat has been a universally accepted medical uniform since the late 19 ^th century. ^[3] Historically, the white color symbolized purity and peace. A person wearing a white coat with a stethoscope slung around the neck is commonly portrayed as a physician in most of the advertisements, movies, paintings, syndicated comic strips and posters. With gradual progress in public health and medicine, the concept of hospitals evolved in response to changing health care needs of the people. Hospitals began and still continue, to symbolize healing, purity and cleanliness. Since the early 20 ^th century, hospital staffs, especially nurses, laboratory technicians and surgeons started wearing white coats to depict this change and to further associate the medical fraternity with scientific excellence.

In 1993, the Arnold P. Gold Foundation of Columbia University College of Physicians and Surgeons, New York, initiated the “White Coat Ceremony” to welcome the new medical students by cloaking them in their first clinical white coats that signified their status as medical students. ^[3] This symbolic event, now a rite of passage through medical schools across America and several other countries worldwide, marks the beginning of a student’s formal medical studies and reminds them of their defined roles, responsibilities, trust, honesty, and compassion necessary in the healthcare profession. ^[3]

Despite the nobility of the concept, white-coat tradition is gradually becoming less vibrant. Being viewed as a sign of separation and distinction, now-a-days it is often considered to be a barrier of effective communications between doctors and patients or their keens. Being true to the cause, whereas some physicians still prefer to wear the traditional attire to express cleanliness, authority and professionalism, others prefer casual attire to overcome any potential barrier in doctor-patient relationship. ^[4] In addition, the fear of increased risk of hospital-acquired infections, many physicians today chooses not to wear a white coat. It is depressing to note that the concept of white coat is often misunderstood by considering it a superfluous relic while originally it was supposed to be adjudged as a symbol of responsibility, respect, trust and honor associated with medical profession.

Responses of patients’ preferences for doctor’s appearance and mode of dress revealed conflicting findings across studies. A survey among patients attending a tertiary care hospital in New Zealand revealed that most patients preferred doctors to wear semiformal attire followed by white coat while older patients were more conservative about their preferences. ^[5] In another study, majority of the patients attending the Gynecology Clinic in Ohio, US showed no preference for their physicians wearing white coats but the perceptions of physician’s competence and their own comfort level were observed to be highest with physicians dressed in professional attire. ^[6] Satisfaction of the patients attending the out-patient Department of Gynecology, New Jersey, was found not to be associated with physicians’ dress codes. ^[4] In contrast, a study among patients and visitors of an out-patient department at South Carolina indicated majority of the respondents preferred the professional attire with white coat and preference for professional attire was found to be significantly associated with their trust and confidence. ^[1] Similar findings were also reported from a survey in England where the respondents clearly preferred a white coat with formal attire to casual attire and stated white coat was not a barrier to their trust. ^[2]

The myth of white coat syndrome seems to be most prevalent among pediatricians treating young children. They fear that wearing white coats may negatively influence their relationships with their pediatric patients and will dissuade them from accepting the intended treatment readily. Contrary to this popular belief, a study among children aged 4-8 years demonstrated that the white coat was favorably rated over casual attire by majority of the children and their parents. ^[7] Most of the school children aged between 6 and 14 years in a study in Maharashtra, India preferred dental professionals to wear traditional attire with a white coat with a name badge over casuals. ^[8]

It appears that doctors’ attire does have some impact on a patient, especially making a good first impression of their treating physician. In general, physicians in traditional attire are perceived as most competent, by majority of the patients, though physician attire may not be a reliable indicator of his/her skill or competence. A successful doctor-patient relationship remains the cornerstone of receiving well-perceived optimum care. Although wearing proper attire is important, the most crucial is to establish trust and rapport so that patients can communicate openly and truthfully. In addition, physicians should be friendly, understandable and patient enough, so that they can carefully listen to their patients’ concerns while respecting their privacy all time.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.144994