The Dirt on the White Coat

by by Maggie Lange

illustration by by Charis Loke

The American Biology Teacher Journal conducts an experiment called the “Draw a Scientist Test,” in which elementary school students are asked to illustrate their image of a scientist. The test ostensibly reveals people’s most basic understanding of someone that represents the scientific or medical community. Overwhelmingly, the sketches show a scientist bedecked in a lab coat. Most are male; some have frizzy hair and hold fizzing beakers, in conjunction with the mad scientist stereotype. There are other props—a stethoscope, a briefcase, a clipboard, a syringe—but it’s the white coat that identified the doctor. Out of the mouths of babes, the white lab coat serves as the universal signifier of science and medicine.

Bare below the elbow
Though this piece of material culture formulates part of the doctor’s distinctive and distinguishing identity, the white coat has come under recent criticism. Currently, the lab coat is a contentious article of clothing for doctors—ironically, for many of the same reasons it was adopted. Physicians initially espoused the coat because of its symbolic whiteness: a sign of germ-free, aseptic, clean, and modern medicine. Now, researchers like the American Medical Association’s Council on Science and Public Health strongly indicate that the coats contain a veritable pupu platter of germs--especially C. diff (Clostridium difficile), which causes infections that sicken about half a million people in a year in the US. According to The Wall Street Journal, this is six times more than estimated before 2009. In 2007, the British National Health System established a “bare below the elbow” rule--banning long fingernails, ties, jewelry, and lab coats. Both lab coats and scrubs have come under criticism for spreading germs, but it is the lab coat that has come under the most attack, because of its deceiving reputation of white cleanliness.
Despite the evidence of the coat’s incubator-like qualities, the majority of patients prefer their doctors to wear them. A Postgraduate Medical Journal study in 2004 found that 56% of those surveyed want their doctors to don the coat. In the UK, the Royal Free Hospital found that white coats were twice as popular with patients than with doctors. In this study, patients said it helped to identify doctors, while doctors complained about the uncomfortable and oppressive fabric and the increased likeliness of infection.

Looking “fresh, neat, clean and scientific”
Patients willingness to keep doctors in their lab coats shows the power of its symbolism—though it’s a symbol that hasn’t been around very long. Until the late nineteenth century, doctors wore dark, gothic robes. The robes showed a connection to solemnity, formality, and death—more apropos for nineteenth century physicians, as they were usually called as a last resort. Before antisepsis, doctors were more often considered to be of the “quack” variety than not, as medicine had little connection to scientific foundations. At the end of the century, the emerging fields of chemistry and biology had fully dismantled doctors’ reputations, and the dark coats came to symbolize the quackery of non-scientific healing. Antisepsis and germ theory moved from the scientific communities in Europe to the medical realm, and doctor’s uniforms soon cottoned on. Physicians adopted the white coat of chemists, associating themselves with rationality, science, and reason, which gave them a sense of legitimacy. A white coat implied cleanliness: a doctor’s costume that looked germ-free must be germ-free. D. W. Cathell’s popular 1882 book The Physician Himself, encouraged doctors to “Show aesthetic cultivation… look fresh, neat, clean and scientific.” Following the increase in commercial laundries that could keep hospitals stocked with clean bleached whites, physicians made the official switch by the turn of the century.

Vital stats reconsidered
As cultural values transformed in the twentieth century, the connotation of the lab coat has changed. Rather than serving as an important signal of rigor and rationality, the coat became an embodiment of power and institution. Behind the lab coat, the doctor was separated. The coat indicated that this figure had privileged access to truth and knowledge, and therefore held a power over the patient. It is the costume of the white coat—not the title ‘doctor’ or the office with shining and clean equipment—that communicates this superiority.
In the 1960s and 1970s, theorists and artists took on the symbolic power of the white coat to criticize scientists’ relationship to authority and power. Michel Foucault reconsidered medicine as a metaphor, in his 1963 book, The Birth of the Clinic: an Archaeology of Medical Perception. He specifically focused on the power of the “medical regard” or the distancing gaze that a doctor holds over the patient. Two years after The Birth of the Clinic’s translation into English, a pioneer in feminist art, Martha Rosler, released her 1977 film Vital Statistics of a Citizen, Simply Obtained. In this film, a woman played by Rosler stands in front of a man wearing a lab coat, next to three female assistants. The white-coated male examiner inspects and measures Rosler in every possible way, rating her “Average,” “Above Average,” or “Below Average.” Rolser begins plainly clothed, is stripped naked, and ends wearing a wedding dress, as the man and three female assistants remain in their static white lab coats. Their costume is immutable and commanding. For Rosler, the lab coat provides a quick and visual symbol of power, science, legitimacy, and standardization. The piece makes a commentary that simply donning this uniform of the white lab coat gives these figures authority and control. With the lab coat, the man is backed by the whole institution of science. The white coat shows the power division between doctor and patient, man and woman; the white-coated man holds control, while the increasingly nude female is in position of vulnerability, to be judged, measured, and changed by the figure of science.
Around the time that the coat was questioned as a cultural symbol in feminist critiques, doctors in the medical community began to question the white coat as well, making arguments that the coat caused nervousness in patients. In the 1980s, a study confirmed their suspicions: “White Coat Hypertension” describes the increase in blood pressure experienced by 10% of patients when they are tested by a doctor. This increase reveals heightened stress in relation to the hospital setting generally, but the name of the syndrome reveals the importance of the symbolic quality of the uniform.

Reclaiming meaning
Despite criticism about the coat’s germy qualities and the anxiety it could cause, many doctors instead set about reclaiming their uniform on their own terms. The White Coat Ceremony was originated by physicians at University of Chicago’s Pritzker School in 1989 to mark the transition from preclinical to clinical training for medical students. Now, the New York Times reports, 94% of medical and osteopathy schools conduct them. The blessing of the coats invokes the original symbols of the white coat—purity of purpose and professionalism—but it also adds the notions of compassion and respect for the patients, a stress on empathy in reaction to criticisms of the distanced figure in power.
Still, as the costume initiates medical students into the world of medicine before they’ve actually undergone training, these ceremonies stress the image of power, trust, and respect that the coats convey, while not emphasizing responsibilities and obligations of the wearers. They also perceptibly communicate to the layperson that this coat is a vital symbol of practiced knowledge. As the white lab coat is a symbol of their profession, doctors have a vested interest in keeping the symbol of the coat pristine, despite proof that the fabric is filthy.

MAGGIE LANGE B’11 is an increasingly complicated symbol.