Why I Don’t Wear a White Coat… and Neither Should You

Editor's Note: I used to wear a white coat, because it was like a tool belt. But now that we have scrubs with multiple pockets, I no longer need it. Scrubs are washed every day, but my white coat only got laundered when it was grossly contaminated. After the show ER and other medical shows, patients’ expectations of what the doctor wears has changed significantly. Newer studies show that patients expect their emergency doctors to be wearing scrubs. Lastly, if you are coming in for a true emergency, the whole point is moot. – Sanford Glantz, MD

By Darryl Wenner, DO, Medical Director

This piece is a response to a past blog post, Why I Wear a White Coat, and You Should Too.

Let’s get one thing out of the way quickly: the title above is terribly misleading, however catchy. Granted, I do not wear a white coat during my clinical duties as an emergency department physician. However, I don’t really care whether you choose to wear a white coat or not. My goal here is simply to provide you with all the information you need to make your own decision. It is not my goal, in my personal or professional life, to dictate behavior to people. I think people should make their own well-informed decisions, and that’s kind of the point of this whole article.

I think a little history lesson is probably in order. Most people think that physicians have always worn white coats, but this isn’t true. In fact, physicians wore black up until the late 19th century. In the late 19th and early 20th centuries, health care providers finally figured out that keeping things clean reduced the chance of infection and improved the outcomes for their patients. In light of this, physicians started to wear white coats in order to project an image of cleanliness, in tune with the new paradigm of medicine. Since that time, the white coat has become a symbol of the physician and his/her knowledge and authority. The irony of all of this is that while physicians’ original goal was to project an image of cleanliness, white coats have become a significant carrier of deadly bacteria, to the point that they are no longer allowed to be worn by physicians in the UK since the beginning of their “Bare Below the Elbows” initiative.

At this point I feel like I can start addressing what I perceive to be faults in the arguments for the white coat as well some of the reasons why I, and many other physicians, feel that the white coat is antiquated and its day has passed. Before we jump in, please realize these are just my opinion; I am not attacking anyone’s personal preferences or practices. I ask that you read this with an open mind and, if nothing else, perhaps it will make you more mindful of some of the downsides of the white coat. Following are some arguments in favor of the white coat, followed by my rebuttals.

Argument: There are no studies showing actual detriment to patients when physicians wear white coats.

Really? Seriously? Okay, I agree with you: in my exhaustive (read: half-hearted) search of the research, I did not find a single multi-centered, double-blinded study that showed harm to patients when their provider wore a white coat. But here’s the thing… do we really need one? There are countless studies showing that white coats are covered in bacteria and that they are rarely, if ever, washed.

Argument: But, dude, I look so cool in my white coat. Chicks dig it!

No, you don’t, and no, they don’t. It’s covered with blood and other gross bodily fluids.

Argument: Patients identify me as a physician because I wear a white coat.

How is your white coat any different from the long white coat worn by nurse practitioners, physician assistants, pharmacists, pharmacy techs, dentists, or chiropractors? The reality is, we aren’t the only game in town when it comes to long white coats. Sure, you could join the movement of physicians who say, “Hey! We earned our white coats through grueling training and we should be the only ones to wear them.” But that just brings up another negative aspect of the white coat, which is that it gives off an air of superiority… not cool. How about trying a different approach to getting people to identify you as a physician: introduce yourself as such. I’ve been told more times that I can count: “you’re too young to be a doctor.” I’ve mitigated this by doing the following:

The Dr. Wenner Approach to Being Identified as a Physician

  1. Introduce yourself! Try this one on for size: “Hi, I’m Dr. _______ and I’ll be taking care of you today.”
  2. I wear the same thing every day to work: wrinkle-free black scrubs embroidered with the words “Dr. Darryl Wenner” in blue thread. I also wear the identification badge issued to me by the hospital.
  3. Talk to your patient about their illness, your work up of their complaints, and your plan of care.
  4. There is no #4. It really isn’t that difficult.

Argument: My patients want me to wear a white coat; it makes them feel safe.

You’re partially correct here. Studies have found that older patients have a slight preference for their physician to wear a white coat, and as age decreases this margin continues to shrink. There is, however, a strong preference of young patients for their physician not to wear a white coat. But at the end of the day, even if your patients are mostly older now, the new generations of patients coming in don’t want you to wear the white coat.

Argument: My white coat shows patients that I’m an authority figure, and they respect me for it.

This is my biggest issue with the whole white coat debate, but I will admit that this is completely a style decision. The style of medicine that lends itself to the white coat seems to be the old school idea that “Doctor knows best”. For some patients, like my grandmother, this is exactly what they want. I admit that I and my fellow non-white coat wearers can be at a disadvantage with this type of patient. I have found that being confident and straightforward usually is more than enough to overcome this issue, but at times it still isn’t enough. However, the current trend in medicine is to provide patients with all of the information that they need, along with the physician’s recommendations, then let them make their own decisions based on that information. I find that when using this strategy, one where I place myself on the same level as the patient, treat them as a teammate, and have them take an active role in their care, a white coat can be an insurmountable barrier.

If you made it this far, I applaud your dedication! I hope that reading this has given you some food for thought as to why white coats may not be the best choice of wardrobe for physicians. And just one last thought: I can’t think of a single “syndrome” that contains something good or desirable: yet White Coat Syndrome is a very real thing. It’s tough to argue against getting rid of them after you put it that way, right?