The White Coat

The familiar white coat worn by physicians as their distinctive dress for over 100 years, has been courting controversies lately.

It has been observed that patients who have their blood pressure measured in a clinic or hospital by a white-coat-wearing-doctor have higher readings than they do when measured at home by their relatives.  This is apparently due to the anxiety that the white coat and the hospital setting seem to evoke in patients, and has been termed “White Coat Hypertension”. Mature clinicians often routinely subtract a few points from these measurements when entering records in case charts or calculating the dose of anti-hypertensive medications to be prescribed.

Anxiety is also apparent in children who encounter pediatricians wearing the unfriendly white coat.  Kids often express their dislike for this dress by crying and screaming in protest. Casually attired personnel are more often allowed by small children to have access to their bellies or chest for examination. Many pediatricians across the world have folded up their white coats and taken to informal colourful dressing to get closer to their little patients and win their cooperation.

Sounds of protest are pouring in from psychiatrists as well, often portrayed as cold insensitive “clinical” people, dissecting human feelings and forcibly dragging their emotionally disturbed patients to the horrific “shock chambers”. Their reason for a changed dress code is to break their stereo-typed image.

The ‘white coat’ or the ‘lab coat’ is a knee-length overcoat worn by professionals in the medical field or those involved in laboratory work to protect their street close, symbolize professionalism and indicate a closeness to science. The modern white coat was introduced to medicine in Canada by Dr. George Armstrong (1855–1933) who was a surgeon at the Montreal General Hospital and President of the Canadian Medical Association. It was used in the late 19^th century by physicians to represent themselves as scientists, from whom they borrowed the dress, in contrast to quacks, faith-healers and butcher-surgeons who wore the black coats.

In sharp contrast to what the mutinous splinters might say of the white coat, opinion of patients and the public seem to be overwhelmingly and unwaveringly in its favour. A recent study conducted in the United Kingdom found that the majority of patients preferred their doctors to wear their white coats. Patients feel more confidence in doctors who are “professionally” attired than those dressing casually in jeans and T-shirts.

A white coat ceremeony (WCC) is a relatively new ritual that marks one's entrance into medical school and, more recently, into a number of related health- professions. It originated in Columbia University’s College of Physicians and Surgeons in 1993 and involves a formal "robing" or "cloaking" in white lab coats.

Over the last century, the white coat has protected not just the clothes of doctors but their staure in society too, and given them their distinct identity to represent “care” and professionalism as well. Those who wear it must do so with suitable dignity and uphold what it represents.

As published in HT City (Hindustan Times) dated 22 May, 2011.