The White Coat: Ceremony, Origins, Meaning, and Controversy

Posted By: Kubin   |   The Basics

The Origin and Evolution of the White Coat

The white coat has become a ubiquitous symbol of medical professionals, but it wasn’t always this way. In fact, black coats were originally used to dissect cadavers by physicians, both because the color black was associated with respect for the dead, and because black made bloodstains less noticeable. Only in the 19th century did white coats begin to replace black ones. White became associated with purity and cleanliness, and white was seen as more appropriate attire for medical professionals.  As the science of germ theory developed, cleanliness and disinfection became a crucial aspect of medical practice. Where as black coats faded the high temperature washings that were required to kill germs, white coats looked better when washed at high temperatures.

Adoption of White Coats in Medicine

White coats became popular among physicians when aseptic surgery was developed in the U.S. in the late 1800s. At the time, physicians at Massachusetts General Hospital wore them to prevent patients and physicians from contaminating each other. By associating themselves with science, physicians aimed to build credibility and assure the public that hospitals were safe and trustworthy. By the 1920s, the white coat had become a symbol of the physician as a scientist of medicine.

Controversies Surrounding the Use of White Coats

Despite its symbolic value, not everyone in medicine likes the white coat. Surveys of providers demonstrate that practitioners feel that white coats are hot, expensive to launder, and can intimidate patients. To some, the use of white coats by clinicians perpetuates an unhealthy power dynamic that can lead patients to idealize the clinician and devalue their own knowledge. This distancing in the context of the patient-provider relationship can be detrimental to patient care. Another concern is the potential to spread infection when clinicians wearing the same coat see multiple patients, and this concern has led to the a movement away from their use in some nations. In some countries, short-sleeved coats have replaced the long-sleeved ones, and in the United Kingdom, they have been banned altogether, along with jewelry and neckties, since clothing and personal items can become sources  of infection.  In the US, the American Medical Association considered banning white coats in 2009, but eventually stopped short, siting a “lack of scientific evidence” that the garments spread infection.

The White Coat Ceremony

The earliest documented white coat ceremonies were in 1989 at the University of Chicago and in 1993 at Columbia University in New York City medical schools.  The formalization of the white coat ceremony is credited to Arnold P. Gould, MD, a pediatric neurologist at Columbia.  Since then, it has become a standard tradition in most medical schools and PA programs in the US. During the ceremony, students receive their first white coat as a symbol of their commitment to their patients and their profession. While some schools have switched from the traditional white coat ceremony to a stethoscope ceremony, most medical and PA students still receive their short coats during the white coat ceremony.

Coat Length and Style

Originally, physicians wore white coats of varying lengths depending on personal taste and traditions of the hospitals in which they worked. However, the more recent trend is to associate shorter, hip-length coats with those in training.  Most medical and PA students receive short coats during their white coat ceremony, while faculty members wear long ones. Until 2018, John’s Hopkins made all physicians, no matter how experienced, wear short white coats to remind them that they are always learning.  But these days, the longer coat is seen as a symbol of seniority and experience.

What about Your Own White Coat?

The white coat ceremony is an important tradition for medical and PA students that signifies a practitioner’s commitment to his or her profession and patients. Although controversies surrounding the use of white coats continue, it remains a symbol of the healthcare industry, and it is .  If you are interested in becoming a physician assistant, Inside PA Training offers coaching for every step of the PA school admissions process.  Why not book a consultation call with us to see how we can help you get your own white coat?  Click this link to learn more about our phone consultation service.