Why I Wear a White Coat, and You Should Too

By Joe Blackston, MD, Medical Director

Yes, I’m an ER physician, and yes, I wear my white coat.

Why? Because it makes my job easier!

How could that be, you say? How is it possible that just putting that coat on over your scrubs makes being an Emergency Physician easier? I’ll tell you how.

First, we have to assume that you (as well as I) practice in the 99.98% of the world that is not San Francisco, lower Manhattan, or maybe Denver, Colorado. I’ve got nothing against any of these cities, but I’m sure that in some of them, patients may have a different expectation of what a physician is supposed to look like. Outside of those places, if you are dangling your stethoscope around your neck while wearing socks with sandals and blue jeans—most patients are not going to have the same level of confidence in you, even if you look like George Clooney. Heck, even if you are George Clooney. You might look like their weed dealer, but not their physician.

Sure, this reinforces stereotypes. So what? Stereotypes are bad, you say. They are prejudicial, you argue. They promote male-centrism, and racism, and lots of other bad “isms,” goes the politically correct tome. “It shouldn’t matter what I look like, just whether I am good at my job,” you insist. And I would agree with you completely on the last statement, even if I might disagree with the former.

But for good or bad, we are not generally judged as physicians on how pretty our stitches look, or how quickly we can pop in that central line, or whether we have to look up the drug of choice for erysipelothrix infections. Most of what I do in medicine is to simply give people advice. Sure, we all like doing procedural things like central lines and intubations and suturing, but even in the busiest hospitals, most of the time you are really just talking to people, even before (and after) you stitch them up, right?

And when I run a code, or deal with major trauma, it doesn’t really matter what I am wearing (mainly because I have to put on protective garments anyway). But it does matter when I get ready to go out and talk to the family. When I have to discuss a possible DNR, or give the “bad news,” it helps me tremendously if during my first (and maybe only) appearance with them I actually look like a doctor, instead of an X-ray technician.

Put yourself in their position. Your family member is taken by ambulance to the ER, in critical condition after an accident. The person walking through those doors toward you is either wearing a long white coat over (matching) scrubs, -OR- jeans, camo “crocs,” and a gray T-shirt with a caduceus logo that says “EMS Rocks”. Which one inspires more confidence?

It simply makes people more willing to accept your advice if you appear authoritative and consistent with the classic role model. And this has nothing to do with being male or female.

Again, maybe this doesn’t seem “fair” to you. But this is human nature, and it’s also simple psychology. Consider this concept for a moment: how do we identify a policeman? A soldier? A firefighter? A priest? Toss aside any male/female stereotypes, and just think about the uniform that these professional people wear, and how that serves to identify them as such.

But I already hear you saying, hey Dr. Joe, lots of cops work “undercover,” and a firefighter can be in a tie or a t-shirt or even his “turnout” gear with mask and coat, etc. A soldier or a football player isn’t always in a “uniform.” But a fireman doesn’t have to come out and talk to the family after fighting the fire. And the undercover cop is only dressed that way to “fool” the bad guys into thinking he is one too. And when the solider goes into battle, he wears all the appropriate gear, including his uniform, to do his job. Otherwise, he might get shot by his own guys.

So when I’m talking to patients and families, I want them to have confidence that I’m knowledgeable and skilled. If I look like a doctor, they are more likely to view me positively. I want them to be assured. If they don’t feel assured, they are much more likely to be skeptical, unhappy, ask lots of extraneous questions, or demand useless CAT scans, leave AMA, or any number of issues that slow down or otherwise derail the emergency department encounter. As we all know, even the most straight forward case of pharyngitis can devolve into a mess if the physician-patient relationship breaks down.

So things simply run more smoothly, with fewer hassles, when doctors look and act the way patients expect them to. And smooth is what we like in the ER. Smooth is fast. Smooth is efficient. Smooth gets patients treated quickly, and either discharged, admitted, or transferred, and that’s what ER doctors, ER nurses, ED directors, and hospital administrators all like. And the patients and families too!

So that’s why I wear my white coat. I don’t need it to massage my ego. I don’t wear it because I think I’m God. I don’t do it because I’m some sort of tired, gray-bearded old school dinosaur. I don’t even wear it to keep my scrubs clean. I do it because it makes me look like a doctor, and that’s whom the patients came to see. And sure, I’d like to think that patients and families have confidence in me because I’m brilliant, experienced, professional and caring in my brief, limited encounter with them in the ER, but their first impressions are important, and I’ve usually only got a few minutes with them to convey 1) what’s wrong, 2) what I think we should do about it, and 3) how we are going to fix it.

But if you really aren’t convinced that appearances matter, consider this hypothetical: you are the ED doc, and you pick up the chart that says “flank pain, possible kidney stone.” You go to see the patient, and find a restless, uncomfortable 40 year-old white male wearing conservative dress slacks, a white cotton button-down shirt, a silk print tie, and Italian loafers. He is diaphoretic and wretching into an emesis basin. His UA has 15-25 RBC/hpf.

Do you think he has a kidney stone?

Now suppose same chart, same history, except when you go to see your patient, you find a restless, uncomfortable 40 year-old white male, covered with cheap tattoos, with poor dentition, and wearing a filthy t-shirt and cargo shorts. He is barefoot and the soles of his feet are black with dirt. He is tremulous, diaphoretic, and holding an empty emesis basin. His UA has 15-25 RBC/hpf.

Do you think he has a kidney stone?

If your confidence in the diagnosis differs at all in these two presentations, then appearances matter to you. And it matters to your patients too.