I Ditched My White Coat During COVID

Working through the first surge of the COVID pandemic, it quickly became clear that wearing a white coat was problematic. When the hospital became overwhelmed by patients with COVID, the white coat had to go. At the time, we wore head coverings, goggles, two masks (an N95 covered by a plain surgical mask), gowns, gloves, and booties. There were too many donning and doffing transitions, too many episodes of being overheated and dizzy, and too many unknowns about viral transmission. (Remember those early days when people slept in their garages and wiped down all of their groceries?)

I stopped wearing business clothes or a white coat and opted for scrubs that I could easily remove and wash at the end of the day. I hadn't worn hospital scrubs since residency, and now I remember why. Why don't they have more pockets? Why do they fit me so funny? Why isn't the material softer? I've since upgraded to a collection of more comfortable and pocketed scrubs made for women my size (at my own expense), but I've come to miss my white coat.

Over the last 15 years or so, there have been ongoing conversations about the fate of the white coat. Certain facilities have purposely chosen to forgo white coats for one reason or another. At Mayo Clinic, staff physicians wear business attire to convey professionalism and expertise. Virginia Commonwealth University School of Medicine provides doctors with a sleeveless black neoprene vest to wear instead of a white coat, encouraging attire that keeps the lower arms bare to lessen potential for transmission of pathogens. In the UK, white coats have been banned altogether.

Yet, there has not been convincing evidence to suggest that white coats have contributed to the transmission of infectious diseases to patients. In addition, as a study published in BMJ Open suggests, most patients still prefer a provider (whether male or female) in formal attire with a white coat, and a decent number agreed that the physician's outfit influenced how happy they were with the care they received. Other studies have shown that patients disapprove of clogs, jeans, sneakers, and earrings. Even providers themselves have something to gain by wearing a white coat, which has been shown to increase selective and sustained attentiveness to tasks.

As we've shifted away from formal attire and white coats toward scrubs and vests, I think interactions with both patients and colleagues have become more casual, too. This may not be all bad — I don't miss the enforced hierarchy of my medical student days, and I don't have a problem being called by my first name. What concerns me is that casual attire can result in a level of informality that seems to correlate with a perception that the wearer also deserves less respect or has less expertise.

For patients, it has been suggested that providers in casual dress are perceived as having less authority (among other qualities). I'd argue that this holds true among colleagues, as well. Both patients and staff often presume I'm not a physician, even if I'm wearing a badge with MD or PHYSICIAN in big letters after my name or after I've introduced myself as a doctor. Students and residents recognize that I'm an approachable consultant, but I've also been treated as an ID reference on speed dial.

During patient care conversations with other attendings, they've maintained eye contact only with the male residents in white coats on my team, even when I'm the one talking. And, especially through the pandemic, recommendations I've made as a requested consultant have increasingly been taken lightly or not at all. (Though I recognize there are many ways to approach a case, it can be hard to watch an abscess fester without being drained, a persistent bacteremia remain unaddressed, or COVID pneumonia treated with unnecessary antibiotics.)

The concern for worsening workplace informality as a result of the pandemic has been discussed elsewhere, most often in reference to remote office workers; see this recent article in The New York Times, which notes that the circumstances of COVID have "contributed to the erosion of boundaries between co-workers" that can "result in a failure to treat other people professionally." Though medicine is practiced in a unique environment, the pandemic has accelerated a trend toward casualness beyond attire in our world, for better or for worse. I don't know what this might mean for patient-provider and provider-provider interactions moving forward, but personally, I think I need to start wearing my white coat again.

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About Dr Roni Devlin

Roni K. Devlin, MD, MBS, is an infectious diseases physician currently residing in the Midwest. She is the author of several scholarly papers and two books on influenza. With a longstanding interest in reading and writing beyond the world of medicine, she has also owned an independent bookstore, founded a literary nonprofit, and published articles and book reviews for various online and print publications. You can reach her via LinkedIn.

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