The White Coat hierarchy

When I jokingly posted about the White Coat effect several weeks ago, I got a number of comments from other medical students about how their hospitals give out white coats (long and short) to everyone from physician assistants to nurses to dental students. So I started thinking about all of the white coat-clad people that I’ve seen wandering the halls of my own university hospital system, and there are actually quite a few. More, even, than I had the patience to include in my comic above.

White coats have long been a symbol of the medical profession, and surveys indicate that “easy recognition by patients and colleagues” is a chief reason that doctors and medical students choose to wear white coats. One thing that I don’t think I ever thought about or realized before I started medical school is that medicine is as much about putting on a show as it is about interpreting test results and handing out prescriptions. We perform mysterious physical exam maneuvers, speak using an unnecessarily complicated vocabulary, make small talk, smile, and yes, wear white coats, all (at least in part) to convince our patients (and sometimes our colleagues and superiors) of how smart or competent or compassionate or kind we are. We need to be able to make our patients trust us as much as we need to to actually be able to take care of them, and wearing white coats has traditionally been part of that equation. In fact, studies have shown that patients are more likely to trust physicians who wear white coats.

Of course, if the white coat inspires confidence, trust, and respect among patients, it’s no wonder that every health care professional under the sun (or anyone with any connection at all to health care) would want to wear one. But the white coat is as much a symbol of hierarchy as it is a symbol of competence. At most institutions, medical students like myself are required to wear short hip-length white coats, while residents and attendings wear long knee-length white coats. Some institutions have gone so far as to introduce different white coat styles/identifiers for med students, interns, residents, chief residents, attendings, and so on. As other health care professionals join the fray, the need to distinguish them from one another and from physicians at all levels of training, sometimes results in even more elaborate variations.

A friend of mine suggested that all the doctors and medical students should start wearing capes, just to see how quickly it would catch on in the rest of the hospital.

The White Coat effect

Last year, while I was doing my clinical rotations, I got used to being able, essentially, to go anywhere and do anything in the hospitals. This included using physician computers, accessing restricted areas, boarding staff elevators, and feeling free to ask staff members for the door codes to physician workrooms and lounges. Security guards cheerfully waved me through metal detectors with a “C’mon in, Doc!” despite the fact that my pockets were bulging with metal equipment, and nurses held the doors to medical supply closets open for me. And this is with my short med student white coat– few lay people seem to know the difference between the short white coat that medical students wear and the long white coats that the MDs wear.

I’m taking a year off to do research this year. I’m about 2 months in now. Among other things, doing a research year means that I’m spending a great deal of time hanging around the medical campus without my traditional medical student get-up on. More specifically, it means I’m leaving my white coat at home most of the time. And I’ve noticed the difference. I look young for my age, and I often get mistaken for being college-age, or even, on occasion, high school-age. The white coat seems to give me an air of importance/authority that I otherwise don’t seem to have. It could be that I just feel a little more self-conscious without it, but I swear that I’ve been getting just a few more questioning glances and “Can I help you?”s and just a few fewer welcoming smiles and “Have a nice day!”s. It’s odd how one little piece of clothing can make all the difference in how people look at you.