By DINOSAUR MD

I have not worn a white coat since I opened my own practice more than twenty years ago.

Not that I had anything against white coats in principle. I wore my short white one in med school with pride, and the longer one in residency too; their pockets filled to bursting with the 4 x 6 inch six-ring binder emblazoned with my name in gold, courtesy of Burroughs-Wellcome, the long-defunct pharma giant, which had presented one to each medical student in the US for many years, as well as assorted pens, note cards, alcohol wipes, hemoccult cards, and so forth. I even had a tiny teddy bear pinned to my lapel, my own way of personalizing the impersonal.

When I went out on my own, though, I made the conscious decision not to wear one. I confess that all these years later, I don’t completely recall my thought processes on the subject. It seemed pretentious, especially since I was the only doctor in the office and therefore not easily confused with other staffers. Little kids were scared of them, held the common wisdom. I decided that I wanted to project a warmer, less formal tone now that I was out on my own and could do whatever I wanted. Don’t get me wrong: I took pains to remain quite professional. I wore skirts, hose, and heels (sensible low ones, of course) at all times.

Patients noticed, and often commented. My explanations were accepted. It was my style, and I’ve always been comfortable with it. Even when a broken foot 10 years agoled me to begin wearing slacks instead of skirts, I never even considered wearing a white coat.

As a solo practitioner, I rarely see other doctors at work. I interact with them all the time, but mainly via phone and letters. Rare luncheon meetings were usually with other office-based physicians. If they wore white coats in their offices, they certainly didn’t wear them outside their own four walls. White coats seemed okay in hospitals. Wearing them in offices still felt pretentious; almost like a costume.

Then came this past summer. Suffice it to say, I found myself seeing a lot of doctors in a lot of different settings. And every single one of them wore a white coat. Every. Single. One. And all of them with their names beautifully embroidered over the left breast pocket. Gradually, the idea of a white coat in the office began to feel perhaps just a smidge less awkward. That, plus reading more studies documenting the error of “conventional wisdom” about kids. It’s not the white coat that scares them; it’s other stuff associated with doctors and their offices. Hey, all’s fair in love, war, and evidence-based medicine.

So about a month ago, after thinking long and hard about it, I made the momentous decision to begin wearing a white coat in my office.

I happened to have one lying around that I had worn only once. I think I had purchased it as a prop, for something or another. I remember it having been way too tight, but when I tried it on, I realized that had been 50 lb ago. It fit just fine.

Next step was, of course, the embroidery. After agonizing over all the permutations of first name/initial, middle initial or not, “Dr.” in front or “MD” (with or without periods) following, block or script, red or black, I trudged down the street to a friend with an embroidery business, self-consciously clutching the badge of my profession I was so belatedly embracing. It turned out that the all the font/wording/initial/Dr-or-MD choices came down to the space available. “Dr. #1 Dinosaur” on one line, “Family Medicine” below, in block lettering it was.

“I’d like it in red,” I said.

“No one does red anymore,” responded my friend. “They don’t do black either.”

“Oh.”

I looked through her bins of thread, finally spying a spool of lovely turquoise.

“Is that turquoise?” I asked.

“It used to be turquoise,” she answered. “Now it’s ‘California Blue’.”

“Oh.”

Two days later, I was the proud owner of a newly personalized white coat, my name boldly emblazoned in turquoise California Blue.

The next morning, I steeled myself as I drove to the office, rehearsing what I was going to tell my patients. I mean, after all these years, they were bound to be surprised — or even shocked — at this dramatic change in my appearance. I slipped the coat on, glancing at my reflection in the nearest window. Hm; not bad, I supposed. Just very, very different. I draped my stethoscope around my neck and, with great self-consciousness, went out to greet the very first patient I had ever seen while wearing a white coat in private practice after more than twenty years.

She didn’t bat an eye.

Neither did the next patient. Nor the next. In fact, the entire day went by and no one said a word about my brand new white coat; the one I had agonized over whether or not to wear and what color my name should be. Not a single word.

No one.

All week!

Finally, the second week, while finishing up a visit with one of the very first patients who had come to my practice, a lovely woman I had known for more than twenty years, I said, “Can I ask you something?”

“Sure,” she replied.

“Do you notice anything different about me?”

She eyed me carefully up and down.

“New glasses?”

“Well, kind of.” I actually now have eight different pairs; my goal is to never wear the same pair two days in a row. “That’s not it, though. Anything else?”

Again, she gazed carefully.

“New haircut?”

“No.”

“You’ve lost more weight? Different shoes? New sweater?”

“Um, I’m wearing a white coat.”

“Haven’t you always worn that?”

I’m not sure what the take-home lesson is here. Possibly that the white coat is such an ingrained part of a doctors’ identity that patients don’t actually notice whether we’re wearing one or not. More likely it means that I’m just furniture, and that patients don’t notice anything more about me than do my kids (as long as supper’s on the table and the wallet is always open).

In the meantime, I’ve discovered that the left-hand pocket is a handy place for the Rx pad, and the right-hand one is very convenient for carrying the wireless mouse between rooms. And as the weather gets colder, I’m coming to appreciate the extra layer of warmth. Just my luck, though: evidence is beginning to emerge showing that white coats are a source of nosocomial infections, and doctors are now being pressured to stop wearing them.

Notdeaddinosaur MD (aka, Lucy E. Hornstein, MD) is a solo-practitioner in Family Medicine. She is also a book author (Declarations of a Dinosaur) and posts frequently at her blog, Musings of a Dinosaur, where this post first appeared.