Monica Lypson, MD, keeps a white coat hanging on the back of her office door, just in case she needs it.

As a professor of medicine at Columbia University Irving Medical Center in New York City and the vice dean for medical education, Lypson occasionally needs to wear it in her role as an administrator. When she’s on hospital service, though, she’s much more likely to wear a navy fleece jacket embroidered with her name and title.

Ericka Gibson, MD, OBGYN with Kaiser Permanente in Atlanta, received her medical training in the era of the fleece jacket. Because delivering babies and performing surgery can be a “messy job,” she never bothers with a white coat in the hospital, just in the office.

“Usually, the decision comes down to whether I’m wearing something where I want to cover my arms because it’s chilly in the office or I need the pockets,” said Gibson. “It’s never about the status of the white coat.”

According to the results of a 2021 study in JAMA Network Open, survey respondents believed physicians wearing a white coat were more professional and experienced that physicians wearing casual attire.

But a more recent study published in March in the Journal of American Medicine suggests it doesn’t really matter to patients what a physician wears. It’s not the attire that creates trust between a patient and their doctor.

So perhaps it’s become a choice: a white coat, a fleece jacket, both, or neither.

Just a Symbol?

For decades, the white coat was considered “the pre-eminent symbol of physicians,” as Mark S. Hochberg, MD, described it in the AMA Journal of Ethics. Medical students received their first white coat to start their medical education. The ritual continues in medical schools today.

And for many years, patients expected their physicians to be clad in a white coat.

But that expectation seems to be evolving. In fact, today patients can’t be sure if a person wearing a white coat is even a physician. They might encounter any number of hospital staff members in white coats, from phlebotomists to x-ray technicians to occupational therapists to nursing administrators.

“Everybody’s got a white coat now,” Gibson said. “It doesn’t mean ‘doctor’ anymore.”

Yoshua Quinones, MD, internal medicine physician with Medical Offices of Manhattan in New York City, wears a white coat himself but noted it can be confusing in some institutions where lots of people wear them.

“In that case, wearing a clearly visible name tag is even more important than the coat itself,” he said.

As a result, the white coat has become largely symbolic for many physicians now.

“I have not worn a white coat since probably my internship, which was about 37 years ago,” said Jeffrey Burack, MD, HIV/AIDS medicine specialist and professor of health systems science with the Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) in Pasadena, California.

Family medicine physician Alex McDonald, MD, has adopted a more casual approach to his work attire over the years. He wore a dress shirt, tie, and white coat to work when he first moved to Southern California in 2012.

“I sort of lost the ties after the first 6 months, and after the first couple of years, I stopped wearing the white coat quite a bit,” says McDonald, KPSOM assistant professor of clinical science.

Today, he rarely, if ever, wears a white coat in the clinic setting, especially around pediatric patients. However, he’ll occasionally put on a white coat in the hospital, mostly when he needs to carry along his pocket ultrasound.

Amy Edwards, MD, associate professor of pediatrics at the Case Western Reserve University School of Medicine in Cleveland, developed a habit of wearing a white coat during her training years, when it was required. She still wears one when seeing patients in the hospital.

“Though lately, I have been slowly starting to not wear it when I am seeing patients in the outpatient clinic to try to seem more approachable and less intimidating,” said Edwards, who is also a senior attending physician for pediatric infectious diseases at UH Rainbow Babies & Children’s Hospital in Cleveland.

Plus, there’s the dirt factor.

“We laugh at the white coat ceremony that your white coat will never be this clean again,” Lypson said.

The Benefits of the White Coat

The white coat hasn’t quite gone the route of the traditional nurse’s cap, which largely disappeared a few decades ago. At least not yet.

The white coat still offers a few practical advantages, according to some physicians.

Margaret Manus, MD, wears her white coat every day, preferring to have ready access to the coat’s deep pockets and its ability to keep her warm in a chilly, air-conditioned building. “I also feel like it brings a level of professionalism,” said Manus, internal medicine physician with Houston Methodist in Houston.

Darian Esfahani, MD, clinical associate professor of clinical science with KPSOM and pediatric neurosurgeon with Kaiser Permanente in Los Angeles, also likes the combination of pockets and professionalism afforded by the coat.

“It lets us put our best foot forward,” said Esfahani, who often stashes an eye chart and penlight in his coat pockets. “It kind of reinforces the physician role.”

Some also suggest the white coat confers some advantages to women and people of color, who tend to be more frequently mistaken for nurses, despite increasing representation.

For that reason, internal medicine physician Eileen Barrett, MD, MPH, wore her white coat more frequently as a young physician.

“For much of my career, I did feel it was part of me being taken more seriously,” said Barrett, president emerita of the American Medical Women’s Association, adding that it’s less of an issue for her now that she’s over 50. “No one says to me anymore, ‘You’re so young!’”

As a Black woman, Lypson also wore her white coat more frequently earlier in her career. But as she aged and gained more experience, she felt more comfortable shedding the white coat and relying on herself to represent herself as a physician.

“I know how to handle it if you don’t see me as the doctor,” she said. “I don’t need it as a cloak in the same way.”

Patients have sometimes mistaken her for a nurse or even a cafeteria worker. “Because people come with their preconceived notions,” she said. “Sometimes the white coat helps and sometimes it doesn’t.”

Professionalism Without the White Coat

The authors of the Journal of American Medicine study explored the perceptions of 274 patients on their physicians’ attire. Using the modified Trust in Physician Scale survey, they assessed the level of trust that the patients put in their physicians, based on their attire. According to the results, it didn’t matter to the patients if their physicians wore surgical scrubs or traditional attire with a white coat.

The implication is that physicians don’t necessarily need to wear a particular item of clothing to demonstrate professionalism.

“How you exhibit professionalism is really how you treat the patient,” Lypson said. “So conveying respect is all about demeanor; it’s all about respect for the patient.”

Burack, who teaches a seminar to medical students on how to establish trust with patients during the first encounter, also suggested that physicians focus more on body language and developing a rapport with the patient.

“The important things are speaking respectfully to the patient, introducing yourself, asking them what they would like to be called, making eye contact with them, not walking into the room with a bunch of other people and just assuming it’s okay for the patient to talk in front of all these other people,” Burack said. “Dress is going to be way, way, way down the list.”

What’s the Future of the White Coat?

What does the future hold for the white coat?

“I think it will continue to be a ceremonial object,” said Lypson, adding some environments may be more suitable than others for wearing a white coat. When she worked for the US Department of Veterans Affairs, for example, the patients seemed to expect it, and that may continue to be the case in the future.

McDonald agreed. “I think the white coat is probably going to stick around for a while longer,” he said. “It’s so ingrained in our culture.”

While the white coat is not as entrenched in physician culture as it once was, Esfahani said he hopes some physicians will continue to choose the white coat. But everyone is different, he said.

“I think as long as everybody acts professionally, that’s what matters,” he said.

Disclosure information for Lypson, Gibson, Quinones, McDonald, Edwards, Manus, Esfahani, and Barrett was not available at the time of publication.