CLEVELAND, Ohio — The days of the iconic white doctor’s coat may be numbered.
The American Medical Association (AMA), concerned over the spread of infection, is considering a white-coat ban. Some European countries already have altered their dress codes to kill the coat, and a number of American institutions and specialties usually go without it, anyway. These institutions assail the white coat as elitist, scary and even a symbol of the barriers to medical care (see white coat syndrome).
Yet among the youngest of would-be physicians — those you would most expect to break from tradition — there isn’t much sympathy for the idea of doing away with the coats.
The 199 freshly minted medical students who on Sunday went through the annual White Coat Ceremony for the Case Western Reserve University School of Medicine talked largely of ways to salvage the coat. They consider wearing it a rite of passage, and necessary to maintain a physician’s identity and authority.
“It’s needed for the patients,” said Tammy Wang, a San Diego native waiting with classmates to enter the ceremony at Cleveland’s famed orchestra venue, Severance Hall. “If we look like any schmuck off the street, they’ll think, ‘I can just look it up online and make (the decision).’ ”
Health systems globally are scrutinizing white coats to stop the spread of infections. While there are no studies to support the assertion, institutions worry that long-sleeved coats and other attire can pick up germs and infections from one patients and take them to another.
Britain two years ago announced its ban on the long-sleeved white coat, ties, jewelry and other items. Scotland went further to stop infection, and at the start of this year, nixed the coats entirely, banned ties, and create a national nurses’ uniform.
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The AMA isn’t so far behind. It considered a similar measure at its annual meeting last month, but decided to continue studying the concept. Some members raised questions  (pdf) about the lack of scientific evidence around the spread of infection, as well as some of the proof that a white-coat dress code enhances physicians authority.
Some studies suggest that patients are more likely to heed doctors’ advice when they’re in white coats. And some physicians think they should stand out from others in the profession. “I think it’s your identity as a physician,” medical student Shiraz Rahim said.
So talk at the White Coat Ceremony, which honors the start of a new medical student’s career, was more about adjusting the white coat than scrapping it. Shorten the sleeves, was one suggestion. Or require it removed before contacting patients, was another. Just don’t kill it.
“You could make the long sleeves unbutton so you could pull them back,” said Rachel Katz, a new Case medical student from St. Louis.
Dr. Lina Mehta, the school’s associate dean of admissions, suggested a middle ground: a kind of formal scrub that can preserve a physician’s identity while addressing concerns about infections.
“I personally like the white coat,” Mehta said. “I don’t mean to say I need a prop to feel like a doctor, but it’s my uniform. What you are doing as a doctor is … meddling in other people’s lives in a way most people don’t. I like the idea that I put the coat on, and it reminds you of that.”
White coats aren’t as ubiquitous as they once were. Many pediatricians don’t wear them because they think it unnerves children, for example. Medical student Arsalan Azem is from Minneapolis, which is near Rochester where Mayo Clinic physicians are in “Mayo wear,” the dress code that eschews white coats for business attire. “If doctors are there for the patients, and the coats are making people sick, then get rid of them,” Azem said. “We can wear a hat and pin.”
Dr. Daniel B. Ornt, the Case medical school’s vice dean for education and academic affairs, doubts the white coat is the key to winning patient confidence. “It’s how we present ourselves and how we act,” Ornt said. “The critical issue is patient safety.”
So what would you get from a white coat ceremony if you didn’t get a white coat?
“A stethoscope would be nice,” said Drisana Henry, a medical student from Boston. “Then I wouldn’t have to spend the money to buy my own.”
