Docter's White coat/Medical Apron

Medical apron is a symbol of Doctor -Patient Relationship.

1. Doctor's White Coat (Medical Apron)   Dr. Mhaske Sunil Natha M.B.B.S., M.D. (Paediatrics), M.B.A. (Hospital Administration), M. A. (Public Administration), PhD Scholar (Paediatrics)                                 Dean Dr. Vithalrao Vikhe Patil Foundation’s Medical College, Ahmednagar (M.S.) India- 414111.

2. A white coat , also known as a medical apron, laboratory coat or lab coat. It is a knee-length overcoat or smock worn by professionals in the medical field or by those involved in laboratory work. The coat protects their street clothes and also serves as a simple uniform. The garment is made from white or light-colored cotton, linen, or cotton polyester blend, allowing it to be washed at high temperature and making it easy to see if it is clean.

3. The white coat has served as the pre-eminent symbol of physicians for over 100 years. Prior to the late 19th century doctors wore not white but black garb. Physicians dressed themselves in black and were painted in black garb until the late 19th century. Consequently until about 1900, physicians wore black for their patient interactions since medical encounters were thought of as serious and formal matters. Possibility for the dark garb might be that until the late 19th century seeking medical advice was usually a last resort and frequently a precursor to death. Until the last third of the 1800s, an encounter with a physician rarely benefited the patient. In fact, up to that point, virtually all of "medicine" entailed many worthless cures and much quackery.

4. Doctors adopted white coats from lab. Scientists Before the middle of the19th century, only the scientists who worked in laboratories used to wear LAB COATS which were beige( a pale-pinkish-yellow color). In the middle of the 19th century, science (Laboratory scientists) had damaged the prestige of medicine (physicians) by demonstrating that the so called CURES by medicine were worthless, thus convicting the then physicians as QUACKS. While scientists were admired by public and rulers, physicians were distrusted at that time. So the medical profession turned to science. Thus physicians decided to become scientists. After all, it was thought, the laboratories inventions could certainly provide breakthrough advances in curing disease. Physicians, seeking to represent themselves as scientists, thus adopted the scientific lab coat as their standard of dress. And the physicians began to wear the most recognizable symbol of the scientist, the laboratory coat in the year 1889AD. When lab coats( originally beige colored) were adopted by the medical profession, they preferred the color of their coat to be white.

5. British surgeon Pioneer of antiseptic surgery. Joseph Lister

6. Remarkably this progression was documented in Eakins' 1889 operating theater masterpiece entitled "The Agnew Clinic" from the University of Pennsylvania. D. Hayes Agnew, MD, can be seen in a white smock, with assistants also wearing white, suggesting that a new sense of cleanliness pervaded the environment. Historians say the painting helped popularize white coats among American physicians. The patient is swathed in white sheets and the nurse has a white cap.

7. White versus black Until the mid-1920s, students who were examining cadavers would wear black lab coats to show respect for the dead. Black lab coats were used in early biomedical and microbiology laboratories. The "whiteness" and "pureness" concepts that were established in medicine pervaded that environment at the end of the 19th and beginning of the 20th centuries and physicians changed the black for the white coat.

8. The modern white coat was introduced to medicine in Canada by Dr. George Armstrong (1855–1933) who was a surgeon at the Montreal General Hospital and President of the Canadian Medical Association.

9. The white coat as a symbol of medical excellence and purity continued to gain momentum as the 20th century progressed. Some believed street clothes helped spread germs easily, and there are many theories about why white coats became more and more popular for doctors. By 1915, white coats were standard garb for surgeons. By the end of World War II, with the advent of antibiotics, white coats became standard for medical students, residents and fellows, doctors, and nurses in North America. In the 20th century, the white coat continued as the symbol of medical authority and respect as advance upon advance firmly established the patient-doctor relationship as a beneficial encounter.

10. At the end of the 19th and the beginning of the 20th centuries, when medicine became the truly scientific enterprise we now know, the "whiteness" or "pureness" of medicine became reflected in the garb of physicians and, interestingly, nurses.

11. The word  candor (means- unreserved, honest, or sincere expression)  is derived from the Latin  candidus  which means white. In fact, the foundation of all professional societies is candor or truth. The term "candidate" comes from the fact that Romans seeking public office wore the white togas. The depiction of justice over the millennia has been a statue or painting of an individual clothed in white. The converse, of course, is evil or death depicted in black.

12. Why Do Doctors Wear White Coats: Faster recognition by patients, nurses and other doctors. Large pockets for carrying items such as stethoscopes. Protecting clothes from being soiled. Emphasis on status as physician. Following social expectations for doctors. Protecting self against contamination from surroundings and patients. Exuding an impression of cleanliness. Protecting patients against contamination from self. Maintaining warm body temperature in often chilly hospitals. Erecting a psychological barrier and thereby not easily accessible.

13. It is called such after a 1978 report commissioned by the UK Department of Health and Social Security to codify standard clinical laboratory practices, chaired by James Howie. Among the codified standards was protective clothing; the type of wrap-around full coverage lab coat that had been in use in the UK for over a hundred years was nicknamed the "Howie-Style" coat to indicate its compliance with the provisions of this report. It has the buttons on the left flank, elasticated wrists and a mandarin collar, and is quite similar to a chef's uniform. It is designed to minimize pathogen contact with street clothes. Howie-Style coat

14. White Coat Length White coat lengths correspond to the level of training a physician has received after completing requirements for medical school. Dr. James Feinstein- short white coat has come to epitomize the role of the medical student. Dr. Karnath notes that the length of white coats “is a mechanism used by patients to identify the role of each care provider.” Residents wear a mid-length white coat. Only fully licensed physicians wear long white coats . At some hospitals all physicians wear the short coat to symbolize their status as lifelong learners.  In other hospital systems, coat length is a very accurate indicator the longer the coat, the higher the status and experience of its wearer.

15. The term "white coat syndrome or Hypertension" is used to describe unrepresentative high blood pressure recordings due to a patient's anxiety upon seeing a doctor in a white coat. “White coat Hypertension"

16. Image of the white coat has also become so intimidating that Paediatricians and Psychiatrists generally choose not to wear it in order to reduce anxiety on the part of their patients. Anesthetists strongly opted for theater clothes. few consultants indicated that they wore suits to make themselves stand out from more junior doctors.

17. In 1993, Dr. Arnold P. Gold, a teacher and pediatric neurologist, created the first full-fledged WCC at Columbia University College of Physicians and Surgeons. Before this ceremony, medical students typically received the Hippocratic Oath for the first time at commencement. This ceremony marks a change in tradition, introducing students to the Oath before starting their first year of study. This was intended to provide students with well-defined guidelines regarding the expectations and responsibilities appropriate for the medical profession prior to their first day of class. "White Coat Ceremony"

18. The white coat ceremony (WCC) is a ritual in some schools of medicine and other health-related fields that marks the student's transition from the study of preclinical to clinical health sciences. At some schools, where students begin meeting patients early in their education, the white coat ceremony is held before the first year begins. Moreno Valley College has a White Coat Ceremony for the Physician Assistant students at the end of their final term, where the short coats are discarded and long coats are given as a symbol of being equal clinicians to others who have earned the long coats. in many medical schools around the world students begin wearing their white coats during first-year anatomy class, so there is no official white coat ceremony. by giving them this powerful symbol of compassion and honor. It also gives them a standard against which they must measure their every act of care to the patients who trust them.

19. Landry M, Dornelles AC et al. Patient Preferences for Doctor Attire: The White Coat’s Place in the Medical Profession. The Ochsner Journal 13:334-342, 2013. “Patients prefer white coats, and they contribute to greater comfort and confidence in their physicians….” Major et al. Attitudes regarding surgeons’ attire. Am J Surg 2005;190:103-106. “Patients expect surgeons to be dressed in a white coat with a nametag and to be addressed by their surname. Patients do not want their surgeon dressed in blue jeans.”

20. Summary… Prior to the late 19th century, physicians wore black, similar to clergy. Antisepsis and the rise of scientific methods in medicine led to the shift to white coats Ironically, a debate now rages about risk of transmitting infections from white coats. Today the white coat is symbolic of humanism and professionalism in medicine Patients sometimes prefer the white coat to more casual dress, but this is highly variable. The white coats may symbolism hierarchy within medical students, doctors, and other health professionals. It may be a symbol of power or trust. It is a symbol of professionalism, a symbol of humanism, or purely tradition.

21. References- https://journalofethics.ama-assn.org/article/doctors-white-coat-historical-perspective/2007-04 https://en.wikipedia.org/wiki/White_coat_ceremony https://en.wikipedia.org/wiki/White_coat https://www.medicolinen.com/medical-white-coats/ https://www.umhs-sk.org/blog/white-coat-ceremony https://mypatraining.com/white-coat-ceremony-origins/ https://www.quora.com/Why-do-doctors-wear-white-coats https://drdipendrapandey.wordpress.com/2013/07/02/the-history-of-doctors-apron-white-coat/

22. Thanks a lot