Earlier this month, I had the privilege of presenting each of my six medical student mentees with their first white coat as they transitioned from preclinical course work to clinical courses and patient visits. They earned their white coats, having worked so hard to gain acceptance to medical school, and oriented themselves to new life coordinates while working hard through the first semester courses. They stood tall and proud, with gleaming smiles on their faces, soaking in the gravitas of the event. As for me, it was my first white coat ceremony ever. On one hand, I was so excited for my mentees. On the other hand, my mind traveled down the memory lane and relived my relationship with the white coat. While leaving the ceremony, I asked a colleague who also presented white coats to his medical student mentees, how he got his first white coat. He said they were told to go a store near the school and buy one.
More than three decades ago when I got the list of things to bring to medical school along with the acceptance letter, my mom and I went shopping. I was the first doctor on both sides of the family and my parents were on cloud nine. My mom took me to the best suiting store in the city, bought some expensive polyester wool fabric and got it stitched by the in-store tailor. It was a bespoke half-sleeved pretty whitest white coat, and probably the most expensive one in my class of 55 students. Most of them bought a pre-stitched white coat in dedicated stores, which we didn’t know existed. Because it stood out, it invited some funny looks and comments. The polyester wool fabric was particularly warm in the hot humid weather of Puducherry, and my subsequent white coats were made from a more comfortable fabric. The blood and body fluid stains were inevitable, in addition to the collar dirt, although our dorm “dhobi” (clothes washer) had a special touch and always managed to get the stains out. We used to place our laundry in a bucket with our name on it and drop off in a designated area in the ground floor of our dorm, and we had nice, spotless and pressed white coat and other clothes waiting for us in a different area for pick up two days later. Initially, it was exciting to wear the white coat. After some weeks, it was an inconvenience to carry around and keeping it clean was an effort. We usually carried it on our arm or on the shoulder when we had to step outside the campus to run some errands after school, conscious of the germs it may carry. When I was a busy intern, I used to carry so many things (notepads, research articles, flashlight, stethoscope, pager, etc.) in my coat pockets that I would occasionally joke that I felt like a mule with bags hanging off either side.
Fast forward several years, I became a healthcare epidemiologist at a large academic medical center and there was increasing awareness of pathogens being carried on doctor’s white coats. Particularly, the white coats in the US are long-sleeved, and “bare below elbows” as a way to prevent pathogen transmission in hospitals, was gaining traction. I sent my then boss an article highlighting pathogens carried on doctors’ white coats are and how the National Health Service in the UK was considering banning the white coat at that time. His email back to me was “Don’t even think about it.” At that time, I didn’t know about the tradition of white coat ceremony in the US.
A decade later, the Society for Healthcare Epidemiology of America recommended that facilities that mandate or strongly recommend use of a white coat for professional appearance should institute one or more of the following measures in their guidelines paper. 1. HCP engaged in direct patient care (including house staff and students) should possess two or more white coats and have access to a convenient and economical means to launder white coats (e.g., on site institution provided laundering at no cost or low cost). Rationale: These practical considerations may help achieve the desired professional appearance yet allow for HCP to maintain a higher frequency of laundering of white coats. 2. Institutions should provide coat hooks that would allow HCP to remove their white coat (or other long-sleeved outerwear) prior to contact with patients or the patient’s immediate environment. Rationale: This practical consideration may help achieve the desired professional appearance yet limit patients’ direct contact with potentially contaminated attire, and avoid potential contamination of white coats that may otherwise be hung on inappropriate objects in the hospital environment.”
Back to the white coat ceremony, I learned that it was established by the Gold Foundation in Columbia University in 1993 (not so long ago in the history of medical profession) to highlight the importance of humanism in the care of all patients. The idea is that taking the Hippocratic oath at the time of graduation is too late. Most medical schools in the US and some abroad embraced the white coat ceremony and it is now an important tradition and milestone in a medical student’s life. The timing of the ceremony is perfect – it is right after the preclinical courses and just before students start making patient visits. My own students wore their white coats with pride as we went to see the first two patients of their medical career. As proud as we are of the white coat, we are well aware that unlike decades ago, the white coat or the stethoscope do not differentiate a physician from other health professionals such as the nurses, pharmacists, and physician assistants. However, white is a symbol of purity, and donning the white coat signals transformation into a health professional and the white coat stands for purity of purpose that we should abide by. The story of the white coat itself is very fascinating. Check out this article if you are interested in learning more about the history of the white coat. Until the late 19th century, doctors actually wore black!