Invited Commentary | Medical Education
Has the Physician’s White Coat Seen Its Day?
Amalia Cochran, MD; Gilbert R. Upchurch Jr, MD
Prior to the last part of the 19th century, physicians in the United States traditionally wore black
attire, emphasizing the solemnity and formality of the doctoring profession. Attire changed rapidly
as medicine became more scientifically grounded, particularly with the advent of antisepsis
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principles, resulting in a shift to white coats for physicians and white dresses for nurses.1 Throughout
the 20th century, the physician’s white coat provided its wearers with a mantle of authority and
trustworthiness; building on that tradition, in 1993 the Arnold P. Gold Foundation initiated the ritual
of the White Coat Ceremony for entering medical students.2 White coat ceremonies have been
widely adopted for those entering clinical professions and are now conducted for nursing, physician
assistant, physical and occupational therapy, and pharmacy students.
Resistance to wearing the traditional white physician’s coat has mounted over the last 20 years.
Although white coat hypertension—the phenomenon of patients having falsely elevated blood
pressure when seen at a physician's office—is a widely touted phenomenon, the evidence for this
physiologic derangement is poor at best. Slightly better data are available to implicate the white coat
as a potential source of nosocomial infection, although no study has shown a definitive transmission
from white coat to patient.3 Some see it as a symbol of power and hierarchy and have therefore
questioned the relevance of the white coat in relation to the humanistic delivery of medical care.4 In
pediatric and psychiatric practices, the white coat has generally been disposed of in the interest of
patient psychological safety.
Xun et al5 offer new information that may further the dialogue regarding the role and relevance
of the physician’s white coat. They effectively considered the relatively recent trend of institutional
casual attire, specifically exploring layperson perceptions of physicians wearing either fleece or softshell jackets in place of the white coat. The broader acceptance of this attire by younger respondents
from the Western United States provides a signal that if this sort of physician uniform were placed
into more widespread use that it is likely to gain acceptance with increased familiarity. Perhaps the
most challenging finding in their study was that professionally attired women in a white coat were
viewed unfavorably in comparison with their male counterparts; the implicit bias that underlies this
finding clearly requires more than a white coat for remediation. While one would hope that wearing
a white coat would help patients and families to appropriately identify women physicians in their
designated role, it seems probable that the expansion of white coats to almost all team members has
diluted its value as a signal.
Previous assessments of attire and professionalism have reasonably asserted that tailored
policies on physician attire should account for patient, health care professional, and context.6 The
article by Xun et al5 reinforces the idea that physicians should dress in a manner that inspires the
confidence of patients and that best supports physician job performance. Although public
perceptions related to expertise may still favor white coats, perceptions of expertise also still widely
favor older male physicians. It is therefore intriguing that for women physicians, no clear benefit to
the patient-physician relationship can be attributed to wearing a white coat. In addition, this work
still does not help us to unravel the relationship, if any, between patient biases and clinical outcomes.
Perhaps the message embedded in the article by Xun et al5 is simply that the white coat’s importance
is primarily symbolic and that it is no longer a prerequisite for physicians to provide high-quality and
compassionate clinical care.
Open Access. This is an open access article distributed under the terms of the CC-BY License.
JAMA Network Open. 2021;4(7):e2119881. doi:10.1001/jamanetworkopen.2021.19881 (Reprinted)
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JAMA Network Open | Medical Education
Has the Physician’s White Coat Seen Its Day?
ARTICLE INFORMATION
Published: July 30, 2021. doi:10.1001/jamanetworkopen.2021.19881
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Cochran A
et al. JAMA Network Open.
Corresponding Author: Amalia Cochran, MD, 5535 Westmorland Dr, Bozeman, MT 59718 (amalia.cochran@
aggienetwork.com).
Author Affiliations: Bozeman, Montana (Cochran); Department of Surgery, University of Florida Health,
Gainesville, Florida (Upchurch).
Conflict of Interest Disclosures: None reported.
Disclaimer: Dr Cochran is web and social media editor of JAMA Surgery but was not involved in any of the decisions
regarding review of the manuscript or its acceptance.
REFERENCES
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2. Arnold P. Gold Foundation. White Coat Ceremony. Published 2021. Accessed June 8, 2021. https://www.goldfoundation.org/programs/white-coat-ceremony/
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Hosp Epidemiol. 2014;35(2):107-121. doi:10.1086/675066
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1998;129(9):734-737. doi:10.7326/0003-4819-129-9-199811010-00010
5. Xun H, Chen J, Sun AH, Jenny HE, Liang F, Steinberg JP. Public perceptions of physician attire and
professionalism in the US. JAMA Netw Open. 2021;4(7):e2117779. doi:10.1001/jamanetworkopen.2021.17779
6. Petrilli CM, Mack M, Petrilli JJ, Hickner A, Saint S, Chopra V. Understanding the role of physician attire on patient
perceptions: a systematic review of the literature—Targeting Attire to Improve Likelihood of Rapport (TAILOR)
investigators. BMJ Open. 2015;5(1):e006578. doi:10.1136/bmjopen-2014-006578
JAMA Network Open. 2021;4(7):e2119881. doi:10.1001/jamanetworkopen.2021.19881 (Reprinted)
Downloaded from jamanetwork.com by guest on 12/26/2023
July 30, 2021
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