Dear pharmacists: Are those white coats really necessary?
Many healthcare-related schools recognize student achievements in what is known as a âwhite-coat ceremony.â A relatively new ritual in such professions as pharmacy, medicine, dentistry, nursing, etc., it marks the student's transition from the study of preclinical to clinical health sciences. Over 100 U.S. medical schools now have such a ceremony, and many students consider it a rite of passage in the journey toward a healthcare career.
Critics believe that these ceremonies create a sense of entitlement to trust and respect that is unhealthy and likely to foster an elitism that separates patients from healthcare professionals.
Many allege that white-coat ceremonies have taken on a quasi-religious significance that symbolizes the âconversionâ of a lay person into a member of the healthcare profession, similar to ordination of a priest into a religious hierarchy.
Along related lines, in 1979, Robert Mendelsohn, MD, a pediatrician and faculty member at the University of Illinois, wrote the controversial classic Confessions of a Medical Heretic. In that book, he laid out the case that most of modern medicine is in fact a religion, rather than a science.
As to the origin of medicineâs priestly robes, Wikipedia states:
In the nineteenth century, respect for the certainty of science was in stark contrast to the quackery and mysticism of nineteenth century medicine. To emphasize the transition to the more scientific approach to modern medicine, physicians sought to represent themselves as scientists and began to wear the most recognizable symbol of the scientist â the white laboratory coat.
Many observers say that white coats increase the distance between patients and doctors. During my career, I avoided wearing a white coat, because I felt that it increased the distance between me and the customers whose prescriptions I filled.
Of course, my district supervisors weren't pleased when they walked into the chain drugstore where I worked and saw that I wasn't wearing the corporate-issued white pharmacist's smock.
The chains I worked for strongly encourage pharmacists to wear the company-issued smock. Pharmacists who balk at wearing it are seen as not being team players and are likely to be admonished to wear it.
Corporations want uniformity. That includes wearing a white coat and tie. My admittedly unscientific observation is that, in contrast to chain pharmacists, independent pharmacists wear white coats much less often. Independent pharmacists donât have to conform to chain standardization and what I call the robotization of pharmacists.
White coats clearly intimidate patients, as evidenced by the well-recognized phenomenon of âwhite-coat hypertension.â
In our fast-paced managed-care universe, patients are lucky to spend 15 minutes with their physicians. Patients with white-coat hypertension can take their own blood-pressure readings at home and theyâll fall within normal limits. When readings are taken at their doctorsâ offices, their blood pressure is elevated.
These people are stressed and intimidated by white coats. In consequence, they may be prescribed unnecessary drugs â possibly for the rest of their lives â and have to contend with any associated side effects, when in reality, they may not actually have hypertension at all.
If the physician prescribes blood-pressure drugs to patients who, in reality, have only white-coat hypertension, that would be substandard medical care.
I doubt that such events are rare. According to a WebMD article titled âBeyond White Coat Syndromeâ (webmd.com/anxiety-panic/features/beyond-white-coat-syndrome), âAs much as 20 percent of the population suffers from âWhite Coat Syndrome,â in which blood pressure surges when measured in the doctorâs office.â
In my opinion, that statistic alone should be adequate reason for physicians to abandon their white coats.