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    Dear pharmacists: Are those white coats really necessary?

    Dennis MillerDennis MillerMany healthcare-related schools recognize student achievements in what is known as a “white-coat ceremony.” 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 “conversion” of a lay person into a member of the healthcare profession, similar to ordination of a priest into a religious hierarchy.

    See also: Pharmacists and phone etiquette

    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 medicine’s 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 — the white laboratory coat.

    Distance

    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.

    See also: What kinds of pharmacists get under your skin?

    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.

    Uniformity

    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 don’t have to conform to chain standardization and what I call the robotization of pharmacists.

    “White-coat hypertension”

    White coats clearly intimidate patients, as evidenced by the well-recognized phenomenon of “white-coat hypertension.”

    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 they’ll fall within normal limits. When readings are taken at their doctors’ offices, their blood pressure is elevated.

    These people are stressed and intimidated by white coats. In consequence, they may be prescribed unnecessary drugs — possibly for the rest of their lives — 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 “Beyond White Coat Syndrome” (webmd.com/anxiety-panic/features/beyond-white-coat-syndrome), “As much as 20 percent of the population suffers from ‘White Coat Syndrome,’ in which blood pressure surges when measured in the doctor’s office.”

    In my opinion, that statistic alone should be adequate reason for physicians to abandon their white coats.

    Dennis Miller, RPh
    Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at [email protected] His books ...

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    • stevenblount12@------.com
      Thanks for sharing this article. I agree with you as you said that white coat is worn as a sign of authority and expectation of respect and I truly believe. A white coat is a sign for medical profession and yes, it gets dirty very easily in labs and in hospitals, but if we have more than one white coat, we can wear it alternately. But I think it is not necessary to wear only white coat, you can try different colors also. One of my friends recommended me some online stores like salusuniforms,scrubandbeyond, cheroke to get varieties of coats with different colors.
    • DougBennett
      Considering the problems with holdups in retail pharmacies, we probably should wear white coats to help conceal our shoulder holsters.
    • Mrs. cFazio Boss
      Poppy cock. Give pharmacist credit. We strive to be TRUSTED, we strive to STAY CURRENT, we strive to give the BEST HEALTHCARE ADVICE to patients and doctors even if we have to spend hours researching to do it. For decades the coat has been a protection from spills, a depository for pens and references and an identification to non healthcare people as a medical resource. In 30 years I have not known ONE SINGLE pharmacist who was pompous because he/she wears a white coat!!!!
    • Anonymous
      As a along-time pharmacist, graduating at the height of non-conformity (not the 1960s), I could see where wearing a 'white coat' might impart some false sense of something, but the main reason is that it for the non-sight impaired it affords a certain degree of noting 'who's in charge'. Many patients, I think, are under the mistaken opinion, sometimes that whoever works in the pharmacy knows about drugs, and I have worked many times with the gal newly promoted from the jewelry department who projects the opinion that she thinks she knows the answer to a worried mother about what kind of cold medicine is best for a baby. I've even had technicians in the hospital try to give the impression that they know more than the pharmacist. That, and the fact that jackets usually have nice large pockets.
    • Anonymous
      Torn on this one. I feel that there is definitely many patients who have been brain-washed into thinking white-coat= awesome health care provider, so for the sake of those shallow folks we can argue to continue the white coat thing. By the way, the most talented, respected and experienced neurosurgeon in the area (not only spinal surgery but brain surgery as well) often does not wear a white coat. I still would go to him any day, and would never consider someone else, especially not just because they always wear a white coat. Non-greasy hair and obvious dirt on hands, face and clothes might be more of a no-brainer, if only for perceived or real concern about in-advertently being infected Many health care providers, including sometimes pharmacists, are arrogant, and I can see where the white coat increases the "sub-ordinate" mindset from the perspective of both the patient and the provider. We both put on our pants one leg at a time, and there are many folks that I would rather have as a friend, rather that someone who is ugly in their heart Do not twist my words. I am not saying there are not a lot of compassionate health care providers wearing white coats. I am saying a white coat says virtually nothing about a person, and sometimes a white coat can be a hindrance to real relationships and actually focusing on the highest priority (what is on our inside)
    • Mr. BLamparelli
      I feel uncomfortable NOT wearing a shirt and tie (nice shirt, nice tie and tied correctly). Along with acting professionally, maybe looking like a professional gives a better chance of be treated like one, even if you work for a chain. Coworkers have always said they treat me different than they do themselves. Gray hair might also help but I'm not advocating that for all quite yet.
    • Mr. SLefkow
      Allow me to support, in the strongest possible terms, the wearing of a white coat (or jacket, or "sideswipe"). I have visited pharmacies where the RPh was wearing street clothes in which I would not be caught dead. The lack of respect for his customers as well as for himself was clear. In my tenure as a community pharmacist, when my customers would ask "Hey, Doc, what d'you have for......" and then trust my advice and recommendation, I found that the white "sideswipe" implied professionalism and confidence. My techs wore light blue coats or conservative street clothes. In addition , I do not subscribe to 'white-coat hypertension' for a moment. If. in fact, there is such a thing, I feel it is transient and depends on the attitude of the wearer. Sincerity, empathy, concern set my pharmacy apart from the double-sized, same-services pharmacy opposite -- and I feel that my white outfit had a lot to to with it. When I go into a white-coat chain or a street-clothes indie, and can't tell the Tech from the RPh, even as a pharmacist I lose a droplet of respect for the "guy behind the counter".
    • AmeliaHartmann
      I have never viewed my white coat as anything other than what it is...a coat with pockets where I can stash my pens, my super secret doctor cell phone list, and my little black notebook filled with important numbers and passwords. As a relatively young, diminutive, female pharmacist, my white coat also identifies me to patients as the pharmacist - the one to talk to if they have a question about their medication. On the relatively few days when I have forgotten my jacket, I notice that people don't take me quite as seriously when I'm trying to talk with them about their prescriptions. They tend to look around, trying to find the "real" pharmacist (i.e., the one with the white coat...or the man...). You likely never had very many, if any, patients, doubt what you told them simply because of your gender or your height. "In addition, the white coat is worn as a sign of authority and expectation of respect. The white coat conveys this message: “I am the expert. By comparison, in my presence you are uninformed and ignorant.” I couldn't disagree with this more...I don't hold an expectation of respect simply for wearing a jacket - I earn your respect by what I do while I wear the jacket. And any pharmacist who is a jerk enough to treat their customer as uninformed and ignorant will likely be a jerk with or without a white coat on.
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