Dear pharmacists: Are those white coats really necessary?

Dennis 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.

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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.

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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.

In pharmacy school

Many of my classmates wore their white coats to all their classes, not just for the lab exercises where the coats were required.

I can understand wearing a white coat to protect one’s clothes from the chemicals we were exposed to in pharmaceutics lab. But why wear a white coat to class lectures?

I think it primarily involves ego. Some of my classmates wore their white coats so consistently that I couldn’t imagine them without the white coats.

In a drugstore

The word “uniform” is derived from “uni” (one) + “form,” i.e., one form. The uniform serves to establish order within the ranks of those who wear it by suppressing individuality. Uniformity and conformity are the basis of chain pharmacy. The goal is for every outlet of the chain to be identical with the others.

At some chains, techs wear white coats, which makes it difficult for customers to determine who is a pharmacist and who is a tech. Similarly, uniforms often cause hospital patients to have difficulty determining which of the people entering their rooms are actually physicians. A uniform identifies an individual as a healthcare worker, but does little to indicate exactly what type of healthcare worker.

What is the justification for pharmacists wearing smocks or white coats at work?

Do you get enough powder on your clothes from counting pills on a pill tray to justify wearing a smock or white coat?

I worked for chains for my entire career. I can’t recall ever handling toxic substances or even messy substances, with the possible exception of when I was compounding.

I assume that if you work in a hospital and handle toxic substances such as cancer chemotherapies, then wearing a smock or lab coat would be a good idea. But what kinds of messy or hazardous substances do chain pharmacists handle, when they’re not compounding medications? Why not reserve the white coat for compounding, if it’s necessary to protect clothing?

Prestige

In my experience, many pharmacists enjoy wearing a white coat at work because it conveys prestige: I am a healthcare professional.

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.”

Is that really the message we want to convey? And if so, why?

Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at dmiller1952@aol.com. His books "Chain Drug Stores Are Dangerous" and "Pharmacy Exposed" are available at Amazon.com.