Tuesday, October 16, 2007

... And A Pink Carnation*


Before arriving in town to begin life as a practicing surgeon, I got a call from my pre-assigned medical assistant, asking what size and style white coat I'd prefer. Well, I thought, these guys think of everything. This private practice stuff might be cool. But then I wondered, who says I have to -- or even want to -- wear a white coat? Having spent the past ten years or so wearing the white coats of learning, and despite thinking those thigh-length ones that some of the professors wore looked pretty spiffy, I couldn't wait to get out of them. I'd also noted that in the teaching hospitals at which I'd spent all my time, the full-time professors were generally the only ones who wore white coats. The private guys mostly didn't. Not that I was emulating one or the other. But it said there was a choice, and I went nolo-alba.

I've only owned a couple of suits in my life, but I do have a few sport coats, and that's what I wore in practice. Always, back then, with a tie. Gathering dust in my closet are a couple of racks of generally garish and outlandish ties which, for some reason, I chose to wear for several years.

Ahead of my time (recent reports have, disgustingly, showed the amount of bacteria lugged from room to room on doctors' ties), I long ago ditched the ties. Within a couple more years, it was shirt and slacks sans coat, and that's where it stayed for the rest of my time in practice (now, as an assistant, I show up in jeans and whatever.)

Without any data or real basis for it, I'd always felt that white coats were off-putting; a barrier, of sorts. There is, after all, the white coat syndrome. But it really wasn't a plan, or even an overtly thoughful decision. I just didn't feel right in a white coat in my office, and the subsequent divestments were simply a matter of comfort. The only time I got negative feedback was when my mother asked my wife why she couldn't get me to dress better. A generational thing, on several levels.

It changed when I did my surgical hospitalist gig. Then, it was a considered decision. I figured it most practical if I were to spend the day wearing scrubs, and whereas there are usually available some scruboid cover gowns for running out from the OR to the floors, I figured a little decorum was called for. In particular, since I'd be seeing patients only in a hospital setting, people acutely ill having a surgeon thrust upon them cold, I thought some visual cues would be good. So I ordered, for the first time in about twenty-five years, some of those nice patrician thigh-length jobbies. With my name, MD, and Department of Surgery embroidered thereon.

Funny thing. I really liked wearing them. And it wasn't just because of the capacious pockets (I'm a surgeon: the stethoscope does NOT go around the neck. Plus, there's note cards, several rolls of paper tape, couple of gauze pads...) As I frequently lacked the time to establish rapport which the office setting tends to afford, that coat was an anthropomorphic business card. This guy's legit, it said. To a potential patient already in tough shape and low on time to think things over, that's good. Worn with scrubs, it was a way to be comfortable and appear serious. Looking back, I suppose I could have been wrong all those years.

*Only old people and/or dorky ones will get the musical reference.

21 comments:

SeaSpray said...
This comment has been removed by the author.
Buckeye Surgeon said...

After ruining a bunch of nice shirts (blood, drain grunge, stool, vomit, etc), I decided to start wearing my white coat again. It does lend a certain aura of legitimacy. I see some internists at the more rural hospital I cover show up for rounds in jeans and polo shirts and it just looks so tacky. Weekends are a different story. And I'm a fan just throwing on a pair of scrubs in the morning if I didn't get much sleep the night before.

rlbates said...

As a female, the white coat helps in the legitimacy department. It also helped protect my clothing a few times.

Now, Dr Sid, those old ties--I'd be glad to make you a quilt out of them.

midwest fp said...

I like the thought that when I peel off the white coat I am removing a large part of my fomite burden before going out to my car.

And it does lend a certain gravitas--I need all I can get as I look younger than I am. Back when I first started, though, I wore them because I worshiped my (former) division chief, who was VERY old school and believed white coat was a necessary sign of respect for self and patient.

Lately I like the practicality of them. Easy to bleach, nice pockets,
conceals any VPL, too!

Anonymous said...

In recent years, we have done patient surveys, and our patients prefer the physicians to be in business attire and/or a white coat. We had gone more informal than this, and our patients did not like it.

The Enormous Clinic

Sid Schwab said...

And along those lines, TEC, when I first went into practice, in a non-enormous clinic, I had an older and old-school nurse, who always wore her nurse's cap. I had several patients mention how much they liked it. Should have been a clue, I guess.

Harry said...

they recently decided to ban white coats in the UK - http://news.bbc.co.uk/1/hi/health/6998877.stm

I think it makes sense, we've had a few lectures on MRSA and I think if there is a real practical reason then it makes sense.

2nd year vet student said...

You know, it's funny you posted about this now. We have client communication exercises in vet school, and this issue just came up. The "client" is told that we're to follow a certain dress code when we act as the veterinarian. Our most recent exercise involved giving the "client," with whom we supposedly had a 10+ year relationship, some very bad news regarding their well-loved cat. I choose not to wear the white coat because I felt like it would be another barrier between the client and me, especially in that situation. My only negative comment in the review was that I wasn't wearing it.

We're also encouraged to wear them to lend legitimacy to our profession as a whole - assurance to the general populace that yes, your vet is a doctor, too. I wonder sometimes if the emphasis on the white coat helping lend us that legitimacy clearly coincides with the shift from being a male dominated profession to a strikingly (>85%)female one.

Bruce said...

There are times when a coat is not just a coat...

One of our previous chairs of Surgery, a regal professor truly from the old school, always wore a perfectly pressed white coat that had Gordian knots instead of buttons. I'm not certain why, but I always thought those knots were cool. I don't think anyone would ever have dared order a coat with the knots for buttons because that was the Chairman's personal thing.

Lynn Price said...

You know, this dress code thing goes both ways. I remember when I was a kid many moons ago, my mother always made me dress up when she took me to the doctor. I could never figure that out since I was going to have to strip for him anyway. Like who was going to be impressed? The chair?

Greg P said...

I think the whole tie thing is overblown, no doubt by someone who never liked wearing ties.

It depends a lot on how much fear you want to generate, but it would be interesting to culture hospital staff's pens, pocket change, wallets, and while they're at it, computer keyboards, countertops, hospital charts. Most of these things are never cleaned in an antiseptic way. I'd like to see hospitals start a program to disinfect stethoscopes periodically.

valleygirl said...

Great post! I'm new to this blog, but I think I'll keep on reading. Thanks for the good (and amusing) read.

mark a said...

Nice post Dr. Sid. I think I know where that Enormous Clinic is. Although when I see patients in the hospital on the weekends I have asked many of them how they would feel if I didn't wear a tie. ALL of them were OK with it. Of course there may be a bias associated with that type of 'research', and perhaps because they already have seen me in a tie they don't doubt my 'legitimacy'. Oh and despite not being a surgeon, I still carry my stethoscope in the pocket of my white coat.

Celeste said...

You're a Parrothead on top of every other wonderful thing?! I love it!

Anonymous said...

Mark A, I doubt that your enormous clinic is the same one being referenced by Dr. Schwab and myself, noting that you live in the Midwest. The clinics there are enormouser.

The Enormous Clinic

Eric, AKA The Pragmatic Caregiver said...

My mom prefers a doctor in, at the very least, a jacket - tie = better, white coat = better still. Not quite a generational thing (she's Our Humble Host's age) - but the doctors who treated her early in life were all Quite Old and much of the white coat school.

I can point to a recent example of my perception of a provider being negatively impacted by a white coat.

We recently took The Old Guy to a plastics consult - he needs a minor touch-up to cope with the ravages of gravity. Nice office, GREAT medical assistant...but fellowship-trained, board-certified plastic surgeon walks in looking like he came straight out of the pits at Daytona....

Dude has on a *sponsored* white coat. (and not the highest quality, for that matter - bad tailoring). On each shoulder is a logo for the sponsor's flagship products, and on the breast pocket, there's the company name, embroidered.

Every morsel of credibility was gone in an instant. Dude charges $250 cash-pay for an office consult on acne scar revision. Waiting room is packed with the moderately affluent. Cash flow looks *REALLY* good. He doesn't need the medical equivalent of a gimme cap.

I'm not anti-Pharma, per se. I am anti-idiocy, and I can't help but think that, no matter how good the sponsor's product (and from what I can determine, they are very good), in the back of his mind, he's choosing them because the rep is so nice to him. I'm sure it's not true, but . . . that scintilla of doubt shouldn't be entering my mind when I'm considering healthcare for my loved ones.

mark a said...

Anonymous, fair enough, although it must be pretty prevalent to do those type of surveys as it is now policy (wearing a tie when seeing patients) at a particularly enormous err 'health care facility' due to, in large part, the results of a patient survey.

eric, seriously? LOL. I couldn't agree with you more. Sounds like someones been watching too much of Dr 90210.

Sid Schwab said...

Eric: what little is left of my mind may now be considered officially blown. A "sponsored" white coat. It's astoundingly awful in so many ways...

Like the bowl games? "May I recommend the Taco Bell Tummy Tuck? Or perhaps you'd like to consider the Mervyn's Mammoplasty?"

Eric, AKA The Pragmatic Caregiver said...

Swear. To. (Insert Deity Here).

This guy is in private practice in Tacoma. His coat was sponsored by Allergan. Botox on the left, Juvederm on the right.

I could not make this stuff up.

Maybe it's just the novelty factor I find off-putting. I'd be more in favor of it if I saw:

Colorectal surgeons sponsored by Fleet and Miralax.

Infectious Disease specialists by Lysol, Hibiclens and Levaquin.

OB-GYN sponsorship from Monistat, Massengill and Always (the coats could have little winged epaulets).

In thinking about this, I can't help but come to the conclusion that more is better. I need more opportunities to be marketed to, in-office. Pens, clipboards, Kleenex boxes, hand soap, lotion, santizer, stethoscopes, garbage cans, notepads, clocks, cookies, popcorn, paper clip dispensers...clearly, what makes the set complete is my provider's coat.

If any MDs want to stage an intervention, let me know - maybe you could go tear off the embroidered patches like some sort of stripping of military rank appliances.

E

Bongi said...

hate the white coat. never wear it. ever.

Anne said...

All right, I'll be the newbie. I can't wait for my white coat. I've been wearing one for four years doing chemistry (it does come in handy - I learned that the hard way.) Sure it's too damn hot, and the sleeves are always too long on me, but come on, give me the white coat! It's also wonderful for disguising that, "I really should work out more," tummy. Also, it hides the fact that I'm a vicious pen-thief - until the pockets get too full. . .