Financial Times Weekend Magazine | September 9, 2011

By Kiran Gupta

It is a symbol of professionalism, yet some claim it creates a psychological barrier between physicians and patients

When I first qualified as a doctor, I struggled to introduce myself to patients, who were usually much older than me. I had preferred simply being “the medical student”, a generic appellation whose anonymity afforded safety. I hesitated to call myself “Dr Gupta”. It sounded so formal. Moreover, that title belonged to my father. Sometimes I said I was an “intern”, thinking that patients would realise this meant I was a doctor. Other times, I introduced myself by my first name, telling myself that patients would see the “MD” on my name tag. I hoped that these signals – and my white coat – would be enough for them to accept me as their doctor

However, residents in my training programme are provided with short white coats – which are typically worn only by medical students in America, unlike the long coats given to doctors in most hospitals. Late in the evening during one of my first calls, I walked into Mr C’s room with a medical student by my side – both of us wearing our short white coats. Mr C was an elderly gentleman coming in for further evaluation of his chest discomfort. His wife sat protectively at his bedside. Before I could decide how to introduce myself, his wife interjected: “We want to see the real doctor, the one with the long coat. How old are you, anyway?”

The US medical profession adopted white coats in the 19th century to signify that the practice of medicine required the rigorous application of scientific knowledge. At a time when medicine was fraught with quackery, the long white coat became a symbol of professionalism. At my institution, however, the unisex, short white coat creates a unique dilemma: its length makes it difficult for patients to distinguish residents from medical students. While our coat pockets are undoubtedly useful for carrying papers, phones and pocket references, most of my colleagues choose not to wear them because of the shortness issue.

To substitute for the deep pockets of their unworn white coats, many male residents in my programme carry a “murse” (or man-purse) while some women carry bags of various sorts. Still others wear fleeces embroidered with the hospital logo – both for warmth and pocket capacity.

Length aside, this debate over what to wear raises broader questions about the coat’s meaning. Several studies suggest that white coats, when worn by doctors, inspire patient confidence. It identifies its wearer as one who can apply scientific knowledge for the sake of healing. Yet some claim that it creates a psychological barrier, serving as an archaic reminder of a time when physicians lorded over their patients. This may be why pediatricians and psychiatrists are the physicians least likely to wear their white coats. Others believe that white coats may increase the rate of hospital-acquired infection.

As Mrs C interrogated me about my role in her husband’s care, I realised why many of my fellow residents had shunned their short coats. With some convincing, Mr and Mrs C accepted me as a physician on their care team. Nevertheless, my short white coat has remained in my locker since that day. Now, almost halfway through my residency, I have a variety of fleeces, vests, holsters and purses in which to store my gear. While some patients still comment on my youth or ask specifically for the attending physician, I now introduce myself as “Dr Gupta” without hesitation, even though I am not wearing a long white coat.

Link to original article