Overheard in Medical School: Indelible Impressions

on a Short White CoatHillary Eichelberger, MS4

White CoatsOriginally a symbol of cleanliness,

white coats have been worn by people in the medical field since

the 19th century. Since then, they’ve come to represent the

scientific underpinnings of modern medicine, providing a

stark visual contrast between the physician and patient.

Patients’ Attitudes to White Coats

• We routinely learn in school to remove the white coat when we want to make vulnerable patient populations (psychiatric, pediatric) feel more comfortable.

• However, a 2007 study in the UK found that white coats increase patients’ confidence in their physicians.

• Peter Provonost, MD, suggests that we need a new symbol that says, “I am a physician.”

A Medical Student’s Coat• Once clinical rotations begin, the white coat takes on a

variety of meanings for a medical student.

• The length—just reaching the waist—provides an overt clue to patients, residents, attendings and any passers-by that this person is only a student. It serves as an invitation for complaints, “pimping,” pop quizzes, unsought errands, stress relief and sometimes, pity.

• The coat is continually stained by all things from pen and highlighter ink to various body fluids. Though these are washed out, the coat begins to wear.

• Initially, the pockets of the white coat contain all manner of helpful objects. Clipboards, notecards, 2-dozen pens, a penlight and a reflex hammer—you name it and the burgeoning 3rd-year will produce it.

• Eventually, the student becomes less reliant on these tools. Still, the white coat remains as a required uniform.

• When we graduate, these short coats are destined to gather dust in our closets as we abandon them for their longer and more distinguished counterparts.

Recording Four Years of Memories

• For my project, I wanted to use my old white coat in some way, to preserve the significance it has held in my life during my medical education.

• I decided to record phrases and stories that I have heard from patients, residents and attending on the coat itself. I began by writing patients’ words on the left side of the coat, and doctors’ words on the right side. This meant that as the coat filled up, the words met together on the back of the coat.

• To the project more interesting, I color-coded the phrases based on the emotion of the statement or question.

Red: powerful negative emotion (fear, anger, etc.)

Orange: anxiety, nervousness

Blue, purple: powerful positive emotion (gratitude, happiness, etc.)

Black: neutral

Purposes of the Project• To serve as a physical reminder of my

experiences as a medical student, even as the memories may fade.

• To visually illustrate the multi-faceted nature of clinical experiences. We may be present for the absolute worst or best day of someone’s life.

• To demonstrate the dichotomy present in medical student training. We enter the clinical years feeling so much closer to the patient’s perspective as an outsider to medicine, and we leave indoctrinated into the prejudices, black humor and attitudes of physicians. It is up to us to productively join these two together to become fulfilled professionals.

Finally, I wanted to reclaim my white coat and my medical training experience. Rather than

representing another requirement for school, or remaining associated with the many exams I’ve

taken, I wanted the coat to reflect the meaningful, emotionally-fraught years of clinical training that I’ve endured on my years toward

becoming a doctor.

References• Hochberg MS. The Doctor's White Coat--an Historical

Perspective. Virtual Mentor. 2007;9(4):310-4.

• Landry M, Dornelles AC, Hayek G, Deichmann RE. Patient Preferences for Doctor Attire: The White Coat's Place in the Medical Profession. Ochsner J. 2013;13(3):334-42.

• Gouraud D, Dumont R, Asehnoune K, Lejus C. White coats: how long should doctors wear them?. Ann Fr Anesth Reanim. 2014;33(1):e23-5.

• Provonost, Peter. “Why it’s time for doctors to ditch their white coats.” KevinMD.com. http://www.kevinmd.com/blog/2016/01/time-doctors-ditch-white-coats.html