The White Coat

One of the privileges of being the GLMS President is to be able to take part in the annual University of Louisville Medical School's White Coat Ceremony. I thought I might be suffering from early onset cognitive decline when I could not recall my own white coat ceremony until I discovered that this is a relatively new tradition, started in 1993 at Columbia University. Students are welcomed into the practice of medicine with the official donning of their white coats, while receiving comments from their dean and others (including the president of the medical society). Having to speak to this new group of physicians to-be made me wonder, why is it a white coat? Before the turn of the 20th century, medicine and the "healing arts" were practiced by many quacks and charlatans. In an effort to improve the image of physicians, the lab coat was adopted as a sign of scientific credibility. Although the traditional lab coat was beige, doctors adopted the white color to symbolize life and purity. In the early days of hospitals, caretakers used to wear black robes as patients in those times typically did not survive their hospital stays. Students in the 1920s also apparently wore black lab coats while examining cadavers. The change to white lab coats signaled the change of medicine to a healing art and a sign for hope. The white coat, however, is more than just a symbol of science. It is the principal object used to depict the physician. The media use it to depict knowledge and authority. While advertisers also use this to sell their pills or devices, the white coat should remind us of the responsibility bestowed upon us as physicians. Some would argue that white coats should not be utilized (do white coats actually cause "white coat syndrome"?). The Mayo Clinic's physicians do not wear them. They only wear business attire, and there is some evidence that white coats can contribute to the spread of infections. However, some studies suggest that patients prefer their physicians to wear them. The white coat helps define the relationship between the physicians and their patients. It helps to demonstrate that the interaction is purposeful and serious, providing confidence that a patient's complaints will be handled competently and compassionately. The white coat (whether we choose to be wear it or not) is a symbol, and symbols can affect and reflect certain behaviors. This symbol is a reminder of the awesome privilege and responsibility that we have as physicians. We are not only allowed respectful access to patients' bodies, but also to their innermost feelings and secrets. It is a symbol of trust that reminds us of our professional duties. It is also a visual reminder of our commitment to "do no harm." Seeing the frightened look in the eyes of many of the incoming students (maybe it didn't help that I also reminded them of the symbolism of the white coat - the awesome privilege and responsibility they will have as a physician) reminded me of the immense commitment that they have made and that we all made many years ago. Fortunately, a few very thoughtful physicians many years ago developed a resource to help medical students navigate these challenging years. Dr. Leah Dickstein originated the Health Awareness Workshop (now called Med School Matters, overseen by Dr. Toni Ganzel). It emphasizes the risk factors involved in being a medical student and the importance of maintaining proper nutrition, sleep, exercise and relationships. It provides students a resource for depression, substance abuse or other problems that might threaten a successful education. The GLMS Foundation helps support this very important program. Having a few moments to speak at this year's white coat ceremony was a special moment. Thank you for the opportunity to do this as the GMLS president.

Sincerely, Lynn T. Simon, MD GLMS President