
Toga Alba: The Mysterious White Coat
The art of creating patient-centered care requires effective collaboration, not only between psychiatrists, but between physicians in a bevy of other specialties as well.
[[{"type":"media","view_mode":"media_crop","fid":"14186","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6753535789298","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"704","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 4px;","title":" ","typeof":"foaf:Image"}}]]The white coat is closely linked with the emergence of science and medicine throughout the ages. In ancient societies, the way healers dressed played an important part in their rituals, a practice described by Hippocrates who stated, “The physician must be clean in person, well dressed, and anointed with sweet-smelling unguents.” In medieval times, doctors donned brown or gray gowns just like lawyers did. A 15th-century Islamic medical textbook shows illustrations of psychiatric treatment methods drawn by
Across the globe in the Western world, physicians, as well as religious ministers, cloaked themselves in black and in paintings were portrayed in black garb until the late 19th century. In
As a senior medical student searching for a residency specialty years ago in Ankara, Turkey, I found myself drawn to psychiatry for many reasons. I was impressed by psychiatry residents’
After I moved to the US, I worked as a research psychiatrist and, not surprisingly, none of my postgraduate mentors wore white coats either. As a faculty member at Vanderbilt University, my mentor attended administrative and research meetings in a business suit, but he changed into a white coat during his interactions with patients in the
We physicians live in a new era, with integrated care in service for psychiatry patients. In the past, psychiatrists mostly invested themselves in de-medicalizing their discipline. However, that focus has been further refined, and psychiatry has been re-medicalized.
The coat might well be a
With the emergence of medicine, the white coat moved from laboratory to bedside, portraying the new power of modern medicine. Most patients view the white coat (“toga alba”) as a robe of compassion, a symbol of caring and hope they expect to receive from their physicians.
On the other hand, although psychologists I worked with have all agreed with the need for a professional dress code, in their world, the white coat has always been regarded as an unwelcoming mantle of authority, one that could impede communication in therapy sessions. In settings such as these, white coats might just induce white noise. I decided to test the white coat effect on medical ICU patients during my consultation-liaison rotation. The result should not come as a surprise. I have by far received a better response from patients and their families, as well as from the nursing staff, when I wear the white coat.
The mystery and the aura surrounding the white coat will never cease to fascinate me. Facing the daily challenges that our profession imposes on us, the coat, together with all that it symbolizes, serves as a gentle reminder to us of our purpose and our pride in our profession. The white coat symbolizes strength, courage, and the will to alleviate and heal mental suffering-which I believe to be in and of itself the most priceless reward imaginable.
Disclosures:
Dr. Kose is a third-year research-track psychiatry Resident in the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston.
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