Jennifer Marie J. Yang, MD

The interns nowadays at the Philippine General Hospital (PGH) wear short white coats with short sleeves. When we were interns, the only thing distinguishing us from the rest of the medical students was a red nameplate; the other students had white nameplates pinned to the all-white uniform that was common to first- to fifth-year medical students at the University of the Philippines College of Medicine. I don’t know when interns were allowed to have short white coats, but I do remember having to take the Physician Licensure Examination wearing our white uniforms… and seeing all the examinees from other schools wearing white coats. We viewed them with a tinge of jealousy, for (at that time) PGH uniforms dictated that only the residents got to wear white coats, signifying they were real doctors, already licensed by the Professional Regulatory Commission. Anyway, allowing the PGH interns to wear white coats must have been some sort of a victory. At PGH, short white coats signify that you are a trainee – residents also wear short white coats, which may have short or long sleeves. Long white coats are reserved for the consultants (faculty).

In contrast, American medical education has a different system: medical students get a short white coat at a “white coat ceremony”, a sort of induction into the medical profession (other healthcare professionals like pharmacists and physical therapists have a similar ceremony, but we’ll leave them out of this for now… the “who gets to wear a white coat” debate is a whole ‘nother ballgame and will open up a discussion that we don’t have room for here – it’s a can of worms!). Once the medical student graduates and starts specialty training, he/she receives a long white coat. Granted, some specialties like pediatrics and psychiatry eschew the white coat because it can scare patients (pediatrics) or make patients not want to share more of their emotions or whatever (psychiatry). But in general, a physician who wears a long white coat is has graduated from medical school and is qualified to be called “doctor”.

I wore a white coat a lot during my clinical career in the United States. Everyday at work, for utilitarian and “costume” reasons. Coats have pockets to hold all the stuff I needed – stethoscope, reflex hammer, pocket reference books, cell (mobile) phone. I was happy to ditch the pocket reference books when smart phones came along, because I could get those books electronically. Coat pockets were much lighter. But at the end of the day, all that stuff in your pockets still weighs you down and can cause long-standing shoulder and back pain. Unfortunately – at least to me – the pockets were a necessary evil.

The other major reason for wearing a white coat (and an ID badge): without it (them), I do not look doctor-y. The white coat is part of a costume, and medicine is theater (patient gowns can be considered costumes too, as are scrub suits). A young-ish short Asian female [despite the few strands of white hair] generally does not appear competent to medically treat patients, despite being specialty trained and board certified. Having the coat lends an air of authority and belonging to the medical profession. It is a symbol of power. One extreme example: during a family team conference, the patient listened intently to every word my tall, white male resident said, and ignored me – despite the fact that I was the leader of the treating rehabilitation team. A less extreme example occurred when I was new to the inpatient rehabilitation unit, and did not have a coat issued to me yet: one of the nurses asked me, “Are you the medical student?” Um, no, I am the physiatrist covering for Dr. K. today. And this is why the white coat is important.

After I took a break from clinical practice in 2019, the next time I wore a white coat was one day in June 2022 for department pictorials at the St. Luke’s Medical Center College of Medicine. That was an ill-fitting, borrowed white coat for picture taking purposes. I did not get my own till February or March 2023; despite this, I did not wear a coat for months, until it was needed again… for more portraits. Since then, I have worn a white coat while helping facilitate a class for medical students which happens about every 4 weeks or so. During this class it is not necessary to wear a white coat, but the majority of the teachers do so. I do not wear a white coat on a regular basis anymore, unlike during my entire American clinical career. I am happy wearing a scrub top with my name and specialty embroidered on it, it is doctor-y enough for me to use in clinic and on clinical rounds with the residents. Scrubs are matchy-matchy with the clinic color scheme! May or may not be a good thing. (see accompanying photos)

But the white coat gets used weekly on Fridays – just not on me, but on a hanger in the car. Metro Manila has this thing called a “number coding scheme” to reduce vehicular traffic on the road during rush hour. It is formally known as the Unified Vehicle Volume Reduction Program (UVVRP) but no one calls it that. Essentially, if your car’s plate number ends in 1 or 2, you are “coded” on Mondays and are not allowed on the road, 3 and 4 on Tuesdays, and so on. You get a ticket and an associated fine from the traffic enforcers. Well, our vehicle’s number ends in 9, so it (and other vehicles whose plate numbers end with 9 and 0) cannot be on the road during AM and PM rush hours. Exceptions are made for physicians… thus the white coat hangs prominently in the passenger side window on Fridays to reduce the chances of getting flagged down for violating the coding scheme.

What am I trying to say here? The white coat is a symbol more than anything else. A shortcut way to communicate being part of the medical profession, status and power that goes with it. There have been scholarly articles written about how white coats can change the degree of trust, professionalism and comfort in the physician-patient relationship. The results of these studies also differ based on which country they were conducted, demonstrating sociocultural differences as well. I don’t think there has been one in the Philippines, but the experiences of people in Japan, Portugal and the USA have been documented.

After a lot of back and forth – I decided to put it on for a medical school assembly that included students, laypeople, and members of the school and hospital administration in the audience. I did not know whether I would blend in or stand out by wearing the white coat, but I wore it anyway. It was useful for distinguishing myself from the “everybody else” as a physician on faculty. Granted, some of the physician faculty did NOT wear their white coats and the only way to tell they were on faculty (if you didn’t already know they were faculty) was their location in an assigned seating section. Besides, it was cold in the auditorium and I needed the extra layer 🙂 so might as well use something that is both functional and symbolic.