Journal of Clinical and Diagnostic Research (Apr 2023)
A Ritual for Initiation of Medical Students to the Profession-White Coat Ceremony
Abstract
Medical practice over the years has changed from a final ritual before death to a skill that can reverse the process from illness to good health. The knowledge regarding the cause of illness, role of anti-sepsis and asepsis, newer diagnostic facilities, availability of medications for controlling the disease and treating infections has resulted in better outcomes. Medical knowledge and skills have evolved over the years. Before the late 19th century, seeking medical advice was often considered a last resort before death. Encounters with physicians rarely benefitted the patients, since most of the therapies were worthless and more of quackery or palliative in nature. People consulted medical practitioners more as a ritual without any benefit. Doctors/medical practitioners were often identified with black dress indicating their ultimate role in soothing a process that could not be reversed. Dr. Samuel D. Gross and his assistants were shown amputating a young man’s leg in a black dress in a painting created by Thomas Eakins at Jefferson Medical College in Philadelphia. This picture was labeled as “The Gross Clinic”. It is not clear whether the patient survived or not. Over the years, medical knowledge has tremendously improved beyond counselling, giving some hope to terminally ill patients [1]. Dr. Joseph Lister described anti-sepsis in the year 1889. The painting, “Agnew Clinic” by Thomas Eakins at the University of Pennsylvania shows the anatomist and surgeon, Dr. David Hayes Agnew in a White coat. The spread of malaria by mosquitoes was known in 1892. Medicine became more scientific in the late 19th century. The concept of illness and management of patients gradually changed. Doctors and nurses started wearing “White dress” to indicate the purity of the profession and some hope for the sick patients [2]. The White coat originated in the year 1989 at the Pritzker School of Medicine, University of Chicago, Illinois, United States of America (USA). The credit of conducting the first White coat ceremony goes to Dr. Arnold P. Gold, who was a Professor of Clinical Neurology and Paediatrics, College of Physicians and Surgeons, Columbia University, New York, USA. It was conducted in the year 1993 and was seen as a great event for students getting initiated into the medical profession. Deans, Presidents of colleges and other distinguished professionals participate in this induction function. The White coat indicates a projection of love for self, one’s coat, friends and family and above all patients. Usually, an oath is administered during this ceremony highlighting doctors’ role in abiding to the universal principles of ethics while discharging their duty. Some 90% of American and nearly 50% of British medical students swore some kind of oath either on entry to medical school or at graduation during the year 2001 [3]. This makes them give a lifelong commitment to the profession, individual patients and society at large. In the present-day scenario, the White coat ceremony marks the welcoming of medical students into the profession. White coat is placed on the student’s shoulder and a stethoscope around their neck during the program. The students are addressed by a notable person in the field along with institute authorities like the Director, Dean etc. Students’ family members and friends may also join the function. Students should be initiated into the profession and should be guided through universal principles of ethics. Autonomy, beneficence, non-maleficence along with equality and justice form the universal principles of ethics. One should weigh the benefits versus risk while advising treatment and patients’ autonomy should always be respected. A doctor can counsel and advise but should not make the final decision on the course of treatment without a patient’s consent. Every patient should receive quality care irrespective of race, religion or socio-economic status. It is also necessary that confidentiality is always maintained with regard to information provided by the patient. White colour indicates goodness and purity. It makes the medical students feel a sense of honour, inclusiveness, and respect [4]. White coat wearing is not compulsory in England and Denmark but is part of the uniform in Sweden, Finland and Norway. The White coat gives the doctor an identity, confidence, and respect. Simultaneously, it gives challenges and responsibilities. The medical profession demands a lot of work, but the financial returns may not be always good. It is a noble profession which requires hard work, dedication, commitment, compassion, and empathy. “Medical schooling is a marathon” and the student has to keep pace with the time [4,5]. The Medical college of Kolkata was the first Medical College to function in India in the year 1835. But the first White coat ceremony was conducted in the year 2017 at Guru Gobind Singh Medical College, a constituent college of Baba Farid university of Health Sciences at Faridkot. Professor Russell D’souza, head of Asia Pacific division, United Nations Educational, Scientific and Cultural Organization (UNESCO) chair of Bioethics was the chief guest. During the next year, many medical colleges across the country initiated this program. A White coat ceremony was usually conducted when the student entered the clinical departments, i.e., after completing the pre-clinical subjects. The National Medical Council has introduced early clinical exposure in the first year now and the White coat ceremony being conducted now during the first year itself. It is essential to make the medical students affirm their position as they enter the medical school and not after graduation. Feedback from students, parents and the medical fraternity are also highly positive towards this initial induction programme [1]. It has been observed that 72% of doctors wear a White coat during 75% of their working time. Usually, paediatricians and psychiatrists do not wear a White coat. They often like to be seen by their patients in casual dress. A White coat not only helps in recognising the doctor by colleagues, co-workers and patients, but also protects their dress from getting dirty. It also helps in carrying examination items in large pockets. However, White coat usage is not restricted to doctors now. It is also used by nurses, physiotherapists, technicians and others. All professionals dealing with illness of human beings wear White overcoats. A laboratory coat or wear coat is typically worn by healthcare professionals who work in laboratory settings or who handle chemicals or other hazardous materials. It is designed to protect the wearer and their clothing from spills and splashes. While a laboratory coat may not be as closely associated with the medical profession as a White coat, it is still an important piece of protective clothing for healthcare professionals in certain settings. Wearing a White coat not only makes the medical professional more easily identifiable but also provides hope for sick patients and their relatives. The Hippocratic Oath and universal principles of ethics should guide the professional in the right direction for betterment of the society.
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