Whither the White Coat Ceremony?

White Coat Ceremony at Virginia Commonwealth University

Along with the current media frenzy about the fate of the doctor's white coat, largely in response to the SHEA expert guidance paper on HCW attire, here a is a posting on Kevin MD by Dr. Richard Levin on the hallowed white coat ceremony.

I am in full agreement with Dr. Levin that the caring, humanistic provider likely yields a better patient experience and better health outcomes with the added benefit of supporting the practitioner to be more resilient and avoid burnout.

I also believe in the power of symbolism. Like the stethoscope, the white coat  is a symbol of the medical profession and humanism. For most medical students, white coat ceremonies are transformative experiences. 

However, humanism in medicine transcends the symbol of the white coat. 

No one is calling for the white coat ceremony to be abandoned. Perhaps our use of the white coat as both a symbol and a utilitarian garment should be more nuanced. Attire and stethoscopes may become heavily colonized with bacteria during routine patient care (for recent stethoscope bacterial contamination study click here). There is theoretical and biological plausibility that practitioner attire may play a role in bacterial cross transmission. Coats sleeves and ties, unlike hands and stethoscopes, are not easily washed or wiped down in between patients. Rolling up the sleeves or hanging up the white coat for inpatient care is simple and not likely to cause harm. Patients do not perceive physicians to be less professional in the absence of white coats, particularly when they are informed about the potential infection risk of infrequently washed white coats.

Rest assured, white coats still have a role in the outpatient setting where the risk of healthcare associated infections is exceedingly low and where much of medicine is still practiced.  There also may be suitable alternatives to the white coat such as scrub uniforms and cool black vests.

So press on with the white coat ceremony as a rite of passage that promotes professionalism and humanism in medicine but dismiss the notion that the doctor is unprofessional or lacks humanistic qualities in the absence of the esteemed white coat. This is particularly true for medical students who feel that they will be judged as unprofessional when not wearing a lab coat on inpatient clinical rounds.

In the name of patient safety, wash your hands, tuck in your tie and roll up your sleeves or hang up the coat during inpatient care.