Hylton I Lightman MD DCH(SA) FAAP

Ever wonder why doctors and other health care professionals wear white coats (albeit I do not)?

It’s called “Symbols.” The ancient world had symbols for fertility, wealth, birth and death. Today’s world is replete with them. The blue-and-white wheelchair occupied by a stick figure. The red circle with a line imposed over a black lit cigarette. The peace sign. The list is endless.

The power of symbols endures because symbols are creative, useful tools in generating awareness and building knowledge. Interestingly, using a symbol does not bring about conditions. Rather, the primary central reason for how a particular symbol is seen lies in its use over time. Symbols give form to concepts and ideas, thereby defining a world.

The white coat is an excellent example of a symbol.

For over 100 years, the white coat has served as the physician’s symbol. A child’s earliest memory of a doctor is the person in the white coat. In fact, at almost all medical schools – 97% to be specific – the first symbolic act is the “White Coat Ceremony (WCC).” This rite of passage for medical students, which was created in 1993 by Dr. Arnold P. Gold at Columbia University College of Physicians and Surgeons, entails a “ceremonial cloaking” as one embarks on a medical career. It is combined with the recitation of the Hippocratic Oath. Some health care training programs for Physician Assistants, Nurse Practitioners, Occupational Therapists and others conclude with the WCC.

The WCC is a once-in-a-lifetime milestone. Spouses, parents and others flock to watch their loved one’s big moment as they are launched, hopefully with the highest standards of integrity.

How did the White Coat come into being?

In the late 19th century, physicians wore black because it connoted more somber attire. Medical encounters then were rather solemn in nature as seeking medical advice was considered the last step in life. With the advent of the new century, medicine began to shift from home remedies and more into the realm of bioscience.

Further, the Flexner Report of 1910, which was published under the aegis of the Carnegie Foundation, called for restructuring medical education around laboratory science, in addition to other recommended changes. Physicians – both full-fledged and those in training to-be-physicians – embraced the White Coat as a way to distinguish themselves from the quacks and snake oil healers who shunned evidenced-based medicine.

As the field of medicine evolved and changed in the 20th century, the White Coat emerged as the symbol of medical authority and respect. It is an uniform that elicits trust and respect.

The closing years of the 20th century witnessed some doctors choosing not to wear the White Coat after their professional training had concluded. In particular, pediatricians and psychiatrists said many patients found it too intimidating and distancing from patients. Others said that the coat, unless washed regularly, is a “hotbed” of germs.

Today’s statistics show that 72% of hospital physicians and almost all medical students wear White Coats at least 75% of the time. It sure is an easy way for people to determine that they are medical professionals. In a study conducted by the University of Michigan, over one-third of the 4,062 patients who were polled said that the White Coat influenced their satisfaction with the care rendered.

So perhaps it is true that clothes do indeed make the man. Or woman.

The takeaway lesson: Whatever we do in life, we should do our best. We should constantly strive to learn and grow. We don’t always know the answers – and nor are we expected to. The White Coat Ceremony with the recitation of the Hippocratic Oath is at the beginning of one’s medical education. It is the goal of a long journey. But having that goal is so important in all matters in life.

As always, daven.

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