The white coat ceremony: a contemporary medical ritual.

T he white coat ceremony is a common practice at many American and European medical schools. Current justification for the ceremony is mainly based on the good will felt by participants and an assumed connection between the ceremony and encouraging humanistic values in medicine. Recent critiques of the ceremony faults its use of oaths, premature alignment of students and faculty, and the selective appropriation of meaning to the white coat itself. This paper responds to recent critiques by addressing their misconceptions and arguing that the white coat ceremony is a contemporary medical ritual with a key role for students and faculty in developing a professional identity. Since its inception in 1993, the white coat ceremony (WCC) has become a national and international phenomenon. It is now practised at the beginning of the year at more than 100 American medical schools and is supported by foundation grants dedicated to endorsing and encouraging professional development and humanism in medicine. While some literature addresses the symbolism and history of the white coat itself, few sources consider the meaning of the ceremony. A common appeal is to the emotion and good will felt at the event. 5 Although feelings are important, a deeper justification is called for. Criticism of the WCC is more explicit, charging that the ceremony: (1) uses the Hippocratic Oath inappropriately or, at best, prematurely; (2) fosters improper student faculty relationships, and; (3) interprets the meaning of the white coat selectively. 7 Critics suggest either that students not be asked to swear an oath together because it might conflict with personally held beliefs, or that students not be allowed to take the oath until they have demonstrated competence as physicians. Some also say that the WCC aligns students with faculty and against patients. The third category of criticism asserts that the historico-anthropological meaning of the white coat itself includes more than virtue and humanism and, in fact, represents an imbalance of power, separatism, entitlement, and paternalism in medicine. 7 To address only the positive connotations of the white coat in a ceremony is deemed disingenuous. Though critics have suggested that the WCC is misused, improper, an affront to professionalism, or even unethical, these objections have serious flaws of their own. 7 I will examine three criticisms and, in response, offer an interpretation of the WCC as a contemporary medical ritual that holds a beneficial place in the professional development of a medical student.