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• W4386575314 abstract "For over one hundred years the white uniform has been the standard dress for medical students and house officers working in hospitals across the U.S. Initially adopted by surgeons in the late 1800s, the white lab coat was a dramatic departure from the black frock coats that were customarily worn by physicians and patent medicine charlatans alike.1 Over time the white coat came to represent an image of cleanliness and purity, and later, professionalism, and it soon became the standard dress for a variety of health care professionals. When we (WHF, JA) were medical students during the 1960s, as third-years we wore white coats and white pants while at the hospital. Instead of trousers, female classmates wore white skirts. During fourth year, this garb was supplemented with the addition of white shoes to differentiate us from third-years. Both types of uniforms were called “whites” to differentiate from the surgical scrubs called “greens,” referring to the typical color in clinical use. Prior to 2020, the vast majority of medical personnel continued to wear white uniforms during their medicine internships and residences, as well as in the hospital wards and clinics. When, as residents, we needed to sleep during long on-call rotations, we were allowed to wear greens as pajamas. But when called to the emergency room or the hospital ward, we pulled on our white coat over the scrubs, with the understanding that we were never to approach the patient's bedside unless wearing our white uniform. In 1993, the white coat was elevated to a ceremony by the Arnold P. Gold Foundation. For decades, the White Coat Ceremony served as a rite of passage for medical students to signify their acceptance into the medical profession.2 Now it appears that the COVID-19 pandemic may have changed, perhaps forever, the custom of wearing white. During the pandemic, before infection control was fully understood, hospitals began doing away with white coats for students, house-officers and hospitalists, urging them to wear scrubs when treating patients. The lighter garb made it easier to don personal protective equipment and was believed to reduce contamination. Nowadays at our hospital, as well as many others, nurses and other hospital workers wear scrubs. But the custom has posed an unexpected problem for patients, who often can't distinguish between healthcare providers since all are now wearing scrubs. The fact that these scrubs come in many different colors (despite the nickname “greens”) makes it difficult to distinguish between a nurse, a student or a house officer. Knowing the role of every caregiver, practitioner and staff person in a clinical setting is vitally important to effective communication and clinical care. If the current trend in greens replacing whites becomes a permanent practice, patients must be informed of this change. Scrubs in different colors to represent the different roles of healthcare personnel can help relieve any patient confusion and restore confidence. Yet such color coding should be standardized nationwide. This brings us to more considerations: Should the symbol of the physician, which has changed from the black coat to white, and now to the surgical scrub, become the new standard? If so, who will ensure this takes place with consistency? And what about the White Coat Ceremony? Should the ritual continue to be carried out for its former symbolism, or should it be altered to reflect changes in the way healthcare professionals have adapted to clinical need?3 Lessons learned during the COVID-19 pandemic have brought about many other changes in clinical care and training, including telemedicine and virtual interviews for medical school and residency recruitment. If indeed the white coat uniform is no longer to serve as a symbol of bedside medicine, then what symbol or practice, if any, will emerge to take its place? Instead of debating about outdated symbolism, a better approach may be to ask ourselves what our patients need and respond accordingly. 1.Mahoney S. (July 31, 2018). The white coat: Symbol of professionalism or hierarchical elitism? Association of American Medical Colleges Website.https://www.aamc.org/news/white-coat-symbol-professionalism-or-hierarchical-elitism Accessed August 20, 2023.2.Arnold P. Gold Foundation (no date). White coat ceremony: Background and significance. Arnold P. Gold Foundation Websitehttps://www.gold-foundation.org/programs/white-coat-ceremony/background-and-significance/ Accessed August 20, 2023.3.Frishman WH. Ten obligations that come with wearing the white coat. Am J Med. 2020; 133(7); 777-778 None" @default.
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• W4386575314 date "2023-09-01" @default.
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• W4386575314 title "Greens Replacing Whites: The Death of the White Hospital Uniform?" @default.
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• W4386575314 doi "https://doi.org/10.1016/j.amjmed.2023.08.020" @default.
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