Opinion

White coat skepticism: How I overcame it

White coat hypertension exists, and I never wanted to wear a garment that created a barrier between my patients and me.

Editor’s note: This is an opinion piece; the views expressed are the authors’ own and do not represent the views of The DO or the AOA.

I’m sitting in a small office, waiting for my medical school’s psychologist to enter the room. It is my first month of medical school and I am not learning.

With a graduate degree and teaching experience behind me, I know enough to recognize that I’m neither storing nor effectively regurgitating the necessary information. I sit and fidget until she enters the room. She’s a kind older woman with a fashionable, dramatic personal style that I immediately like.

‘Am I going to fail out of med school?’

It’s the first time I’m meeting a health care professional for an issue that feels extremely present and extremely sensitive. Am I going to fail out of medical school?

She reassures me that I am not.

Then she asks me to visualize myself in my future practice, wearing my white coat. At that moment, this is very difficult. Not only can I not see myself being a doctor when I’m struggling to learn, but I don’t like the white coat.

White coat hypertension exists, and I never wanted to wear a garment that created a barrier between my patients and me. I begrudgingly try her exercise anyway. And it helps.

Kasey Johnson, OMS IV

When I went through the white coat ceremony at my medical school it felt like a rite of passage, but also like a superfluity, an exercise meant to instill in each of us the gravity of our profession and the honor of our service while also not predicting whether we would indeed carry out our professional duties with gravity and honor.

The white coat is, after all, just a symbol preceded by the somewhat morbid but telling black garments doctors wore when so many of their patients did indeed die.

I intended to leave mine far behind when I was finally practicing. I didn’t need a spotless white lab coat to signal my role as a healer.

The white coat and clinical rotations

Fast forward two years and I am on my clinical rotations, wearing my white coat and sitting in rooms with patients with their own issues, their own vulnerabilities.

On my internal medicine rotation, an elderly patient I am following is recovering from a stroke. When I first meet him I nervously introduce myself and begin the physical exam, haltingly testing each cranial nerve, which confirms the findings seen on his MRI. I’m hoping my voice doesn’t quiver as I relate these findings. I want to sound confident, but I’m also feeling insecure: he is the first person with a stroke I’ve ever examined.

Soon I’ve gotten to know his family: his wife and adult children who return to the hospital each day to cheer him on in his recovery. I visit him each morning and we delight in his progress.

One morning he shows me how he can extend his fingers and raise his leg, movements that were previously impossible. On his last day before being transferred he tells me I am going to be a tremendous doctor.

The white coat was not a barrier, but a tool to convey my intentions: to represent the evidence-based practices health care seeks to deliver and to further the dignity with which we approach one another, patient, provider, and health care team.

I still have my misgivings, but they have been mostly assuaged by the positive interactions I have with patients who react not so much to the presence of the white coat, but to the presence of the person wearing it.

‘A sense of individuality and joy’

At the same time, I look forward to a day when I do not wear a white coat, when I am a family doctor wearing work attire that reflects my role as a healer and gives my patients a sense of who I am. I want to wear muted, calming colors like blue and gray, colors that mirror the landscape of the Pacific Northwest where I was raised and where I am training as a physician.

While medicine demands practicality in so many ways, what we wear when we see our patients is one way to infuse our daily experience with a sense of individuality and joy. I hope to communicate those aspects of my personality through both my dress and the face-to-face encounters I’ll have with my patients. 

Related reading:

Does it matter if doctors wear white coats?

Physician dress: Is the white coat becoming a fashion don’t?

1 comment

  1. I’ve heard other physicians declare that they would never wear a white coat because it’s a barrier, but I see it a bit differently.

    What is it that patients seek when they’re going to the doctor? The answer depends on how sick they are, but most seem to want someone who is above all else competent, a superhuman who is dedicated enough to work long hours and remains energetic despite those long hours, someone who knows the secrets of life and how to cheat death, a tactician who skillfully commands the resources of a hospital to make things happen. In short, they want someone who is more than average, perhaps even more than human, and in the eyes of many that is what a white coat signifies.

    I never thought much of it until I ran into a medical student of mine in the hospital without my white coat on. Despite wearing business attire, she remarked, “you look so… different,” and seemed disappointed. My white coat, proclaiming my name and title, and offering utility with outer pockets containing medical tools and inner pockets containing a few papers and emergency snacks for my team, was nowhere to be seen. I was simply human again, and I could have been anyone or anything to those who didn’t know or recognize me right away.

    Of course, the white coat alone only goes so far. You can quickly lose the respect of your patients and staff if you don’t fit the role, and it’s not needed to attain it. But it makes that first impression and the atmosphere, and that counts.

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