Thursday, January 23, 2014

A white coat is a sacred trust

As we consider the growing discussion involving the capture of the University of Illinois' reputation to market the wares of a particular medical device manufacturer, we should pause and reflect how, in doing so, the manufacturer also denigrated the standing of clinicians.

As doctors will tell you, the day they are granted their first white coat is a meaningful, indeed sacred, occasion.  It is symbolic of their taking on a lifelong commitment to alleviate human suffering caused by disease.  Other medical professions, too, wear the coat as a symbol of their commitment to the public good.  The public, in turn, views that symbol as emblematic of that sacred trust.  We look up to and respect people wearing the white coats.  We know they have devoted themselves to our well-being and have engaged in extensive training for our good.

When a non-clinician appears in a white coat in an advertisement designed to hawk the wares of medical device company, it is a violation of that sacred trust.  Such was the case in the University of Illinois-daVinci advertisement in the New York Times.  Here's the ad:

As pointed out by one of the commenters in yesterday's blog post:

According to the university web page, one of the 'team' members is the "Media and Administrative Contact."

I confirmed this by viewing the site.

I imagine this non-clinician was put in the advertisement in that garb to enhance the gender mix presented to the public.  This is particularly important given the company's desire to expand the use of its surgical robot into the OB/GYN field, something that has received adverse publicity.  Indeed, some uses of the daVinci robot in this field have been decried by the head of the American Congress of Obstetricians and Gynecologists.

In mentioning this advertising technique, I mean to impose no blame on the person involved.  After all, we don't even know if she knew how this picture would be used by Intuitive Surgical.

Clearly, some senior clinical leader the University of Illinois was responsible for this ad.  The idea that any such person would add to his or her other Code of Conduct violations by permitting a degradation of the sacred trust inherent in the wearing of a white coat--especially in support of a commercial enterprise--is a sad statement about that person's moral code.


Unknown said...

Very well said and it needed to be said. Perhaps we can remember the reasons for our codes and trusts... These are the real value add for physicians. This kind of media work is just shilling and we are all made less for even being exposed to it.

Brad F said...

I dont know about you, but the halo floating above white coats disappeared more than a decade ago.

At least in NYC, any spa you solicit has reams of staff in white lab coats; receptionists at large group practices--all in long whites. Some ancillary personnel on the front lines. Same.

The beef should be with defining (societally) the white coat and any restrictions donning it, not, in this case, a non doc "pulling a fast one."

The mystique and exclusivity of the lab coat disappeared long ago, at least in my neck of the woods. The reveal by the commenter strikes me less than newsworthy (although I appreciate the digging).


Paul Levy said...

NYC is different, I'd suggest.

60s doc said...

Anyone can and does put on a white coat and hospital CEOs talk about their delivering medical care, but are long gone and hard to find when the real work of caring for patients in the trenches occurs. It all sounds a bit to me like the present generation of "we are pregnant" folks---the co-opting of something better described as pretending to be. In the hospital of 2014, the person in scrubs might be the nurse or the person coming to empty the trash. The person in a white coat a physician or someone picking up stool specimens for the lab. The "suits" in packs roaming the halls are well known to be of little use---no white coat confusion arises around them except among them. While doctors and nurses busied themselves with delivering actual care, the business folks and their metrics have been busy driving the whole shebang into the ditch.

Maria said...

While practicing to be a nurse practitioner in several family clinics that had both FNPs and physicians, I noticed that the physicians that have been practicing longer religiously wear the white coat while the physicians with less than 10 years of experience did not. I asked about this and the younger physicians told me they skip the coat to decrease "white coat syndrome" as some patients feel that it's purposefully elevating yourself above others. I don't have an opinion about the coat as long as the providers are professional in conduct. And since it seems to have lost some of its meaning, it's not quite the ordeal it's made out to be when other professions/occupations borrow it.

Paul Levy said...

I disagree, Maria, when it is used by a commercial firm to make an advertisement appear to be full of clinicians in support of their product.

If you think the white coat has no meaning in that setting, why didn't the firm just show this person wearing regular business clothes? I believe they knew exactly what result they were trying to achieve in the public eye.

Anonymous said...

Actually the poster is right: the "halo" around doctors has been dropped for years. With access now to medical databases, the "care" I'm getting by some, not all doctors (and previous ones), leaves a lot to be desired. It is this, combined with the inability to judge the patient and not the labs, to complain that they don't make enough money but want 9-5 jobs, how bad patients are, the lack of true policing in the medical profession of their own, all these things and a few more have combined to give people a very different picture of doctors. This is quite true when patients are blamed for outcomes and when we're given "mental" diagnoses when the problem was the doctor didn't get the physical one right or even ran the right tests for it. When we are treated as ones not to be trusted, always suspecting the patient will lie to you, out to sue you, you can't expect "paranoia" (as you would label us) not to be returned.

Paul Levy said...

Boy, are you all missing the point. The use of the white coat in this setting is an attempt to manipulate the viewer.

YOU might not regard the white coat in the "old-fashioned" way, but lots of people still associate it with clinical expertise.

Do you really think it is an accident or coincidence that the MBA media person in the picture is wearing one?

Anonymous said...

The last time I checked, folks with MBAs didn't need white coats to avoid getting their clothes dirty. I'm with you on the manipulation and the perception of clinical expertise.

Anonymous said...

Paul is right. Think of this: A Doc like me took a long time to "earn the right to wear it". Anybody can "wear" a coat, a few of us "earned" the right to wear it as a doc. Therefore, it follows that "wearing" in that setting may even suggest breaking the law for false representation of one's profession. Paul, check with your lawer

Paul Levy said...

Dear Anon,

I edited your comment to remove your personal attacks. Here's the redacted version:

UIC is pretty dirty probably starting from the top. Medicare frauds, personal wars to colleagues, abuse of power, breaking the rules, favoring people and a lot more...all pretty dirty. Too many should be fired there.

Anonymous said...

Paul good morning. You have to live here and see and feel to understand how some things and behaviors at UIC can instigate even normal and sane people to write outrageously all these things in your blog. I have been following this blog for over 2 years and I believe the comments to your last 3 posts had been the most "violent" so far. Anon, we feel what you do and we can imagine well what you wrote. Paul, don't fool yourself. You are not getting traction because everybody swims in the same sewer.

Anonymous said...

Mr. Levy is correct in pointing out that the primary issue is UIC's attempt to mislead the public. The secondary issue is that several medical professionals appear to have elected to violate the "sacred trust" of the white coat by participating in the ad.

So, again, the root cause of this undermining of the medical profession by misusing the (remaining) trust the public has in it, is the fact that corporate medicine has gained the power to impose corporate ethics on the medical profession, to the detriment of whatever remains of medical ethics.

To the government, and to business, medicine is a business, and that's all it is. It is a dollars and cents analysis of the appropriate way to provide goods and services to consumers.

Mr. Levy expects the medical community (the doctors) to act according to their sense of medical ethics, but ignores the fact that for them to do so risks professional suicide.

Corporate control of medicine is the problem, and fretting about whether UIC is practicing sufficient medical ethics is, at best, a waste of time and, at worst, an exercise in cynical hypocrisy. UIC, and every other hospital corporation in America, has no intention of allowing medical ethics to get in the way of corporate profits - which is precisely why the corporate practice of medicine is itself the central problem.

Anonymous said...

You may be right but you are neglecting those honest ones who are proud of what they do ethically everyday

Paul Levy said...

I totally agree with Anon, 4:34. I have never met more committed and ethically upright people than the many doctors and nurses who have devoted their lives to alleviating human suffering caused by disease. When I see a white coat, THAT's what I think of--and that impression is overwhelmingly reinforced by their actions and deeds every day.

Anonymous said...

I find it interesting that a hospital CEO/business type cares whatsoever about a white coat.

White coats were first used by lab technicians who had zero patient contact to keep their clothes clean from harsh chemicals. At that time, there was nothing "prestigious" or "professional" about the white coat. It was simply functional attire only.

Only later did doctors start to wear it as part of their "professional" attire.

A few years later, after the "prestige" of the white coat had been established by doctors, everybody else in the healthcare field started copying off doctors, hoping they could replicate some of hte "prestige" of the doctor title.

Thats why nurses, phlebotomists, respiratory techs, NPs, PAs, and just about everybody else including the janitor wears a white coat.

Interesting anecdote: Parkland Hospital in Dallas tried to institute a "color scrub" code whereas doctors would wear gray coats, nurses and everybody else would wear different colors. In the span of 1 month that plan had to be scrapped because of complaints by nurses and nurse practitioners that they were being "disrespected" by not being allowed to wear the gray coat.

That anecdote shows you what this white coat BS is all about. Pretenders trying to copy the prestige of doctors.

Take a stroll through your former hospital Mr Levy and do a spot count on the number of people wearing white coats. I would estimate conservatively that less than 10% are doctors.

Whatever prestige the white coat used to have disappeared a long time ago. Now it means absolutely nothing, because the people who wear it have nothing in common.

BTW, any public response from Univ of Illinois about this ad?

Paul Levy said...

Please read again. I never said that it is only doctors. Indeed, I explicitly included other medical professionals.

Whatever you might think about the power of white coats, I'd argue that most non-hospital people view them as a sign of some aspect of medical professionalism. Hence, when an advertiser puts a white coat on a non-medically trained administrative person--as in this ad--it is meant to manipulate the public's perception.

In that regard, that is why "a hospital CEO/business type" cares about a white coat. [Now, by the way, maybe you can explain by what you mean by a "type!"]

Here's more on the U of I:

Anonymous said...

Mr Levy, I am one of the many victims of the da Vinci device and the marketing hype of device manufacturer, hospital, and doctor. I was naive about the deceitful marketing of hospitals when I was diagnosed with cancer and sought what I believed to be the top ranked urology department in the country. The FDA cited ISRG for not reporting adverse events including deaths. ISRG, revealed in court cases, has used heavy handed marketing to attempt to put a da Vinci in every "Greenfield" hospital in this country and pressured hospitals to reduce the credentialing requirements of physicians. This effort has been so effective that Cleveland Clinic Foundation Urology department was cited by CMS for having NO credentialing requirements for use of the da Vinci. But equally egregious, the Urology Director for the Center for Robotic and Image Guided Surgery, a lecturer, consultant, and proctor for Intuitive, was not board certified, misrepresented credentials and outcomes, and like U of Illinois staff, did not reveal his conflict of interest to patients. JAMA and the Cleveland Clinic represented 98% preservation of continence and 90% (or better at Cleveland Clinic) for
preservation of sexual function from prostatectomies; patient outcomes at the Cleveland Clinic and CMS substantiated complaints suggest otherwise with the
Cleveland Clinic director above quoted as saying that “only one third” of da Vinci prostatectomy patients at Cleveland Clinic recover potency. patients will continue to pay for the da Vinci hospital investment with devastating negative surgical outcomes. Thank you exposing the unethical relationships between hospitals/doctors and the device manufacturers.

Anonymous said...

CMS Documents citing Cleveland Clinic for having no credentialing requirements or certification in the urology department can be found here:

Anonymous said...

The physicians are very clearly differentiated from the other "white coats" in the photo with embroidered names and credentials. There is something aesthetically pleasing about the dominating use of white in the image, from an artistic perspective. If this one person (the non-clinical staff) were not wearing the coat, the image would suffer. None of the non-MD staff have embroidered names, perhaps they all borrowed those coats for the photo. The ad does convey the staff as a unified front, across disciplines, in caring for their patients. Advertising is art too. Those physicians couldn't function without the presence and dedication of ancillary staff. #alldisciplinescount. #iwenttoschooltoo