White Coats: habit vs Habit

Any act or process performed often enough with the same frequency or timing become ritual. The type of clothing and their association with different jobs are not limited to only health care but for the purpose of this thought exercise we will focus on pharmacy and its ritual dress similarities.

We, in pharmacy, experience the same position specific clothing day after day, either willingly or mandated by employment or circumstance. The distinction does not particularly matter as the process itself lends a specific ritualized preparation in the wearer. The significance is individual but more often it is to steel their resolve to begin the day, and also contains an undercurrent of enshrining ourselves in the responsibility of the work we do.

What I find more interesting is the effect that the White Coat has on pharmacists as a whole. In essence it is the symbol to the public of who we are when in the traditional environment (see retail pharmacy). In more mixed environments such as hospitals it does denote an air of health care provider but so many other specialties also wear the coat that it becomes much more important to read the nametag before taking advise to heart. In traditional retail pharmacy work, when you wear the White Coat you are on duty and serve the public. This in turn leads to many pharmacists who have regular employment to leave their white coats at the job itself, to themselves they say it is so they do not forget it but in truth its also to help separate they themselves from the responsibility and obligation of duty. We are not ourselves when we wear the Coat but conduits of care towards the patients, just with very fancy degrees and sore feet.

Currently we are essentially conditioned to associate the White Coat with our profession from school,  as soon as we enter into the professional phase of the degree many pharmacy universities have a White Coat ceremony were the student is presented with their own shortened white coat that they are expected to wear during all pre-graduation work experiences as well as internal professional days. They seep the students in the cultural expectations of what it means to put on the coat and get them comfortable with the appearance of duty. The true realization doesn’t quite set in until you have your first solo shift unfortunately. Like the progression in medical school, student wear the shortest coat and fully credentialed pharmacists wear the mid-thigh length full white coats, one may expect that a wizened apothacist would wear a white robe that drags on the floor. Interesting enough that the White Coat as a professional symbol is inverse of the belt colors in eastern martial arts, where some accidental coffee or dirt may off color the coat when first starting but the expectation of a pure white coat denotes a higher ranked perfection.

What I find interesting is the what the individual attire of the pharmacist and their ritualistic wearing and dressing patterns intersect with religious vestments and garb. Insofar as a Catholic priest may wear a Chauble and Stole when performing mass, so too does the pharmacist don their “vestments” when providing service to the public. The layering of the items is also significant, mostly for personal reasoning in the pharmacist case. As a priest would layer an Alb overtop the Cassock then the Stole, the pharmacist may have their base professional layer, covered by their white coat or alternative, many others going so far as to don the identification badge or neck-based lanyard. Each piece complimenting the previous but with intention behind the ordering, similar to why you don’t put your tie around your white coat.

Objects of significance differ but in the case of pharmacy are most often located directly on the pharmacist. From the pens they derive so much power from to; phones, pagers, badges, keys, books, paper, glasses, hairnets, laptops. The tools of the trade are important but varied for intention and action, significant and hallowed none the less. To be prepared is to be effective and for that they must have a reproducible routine of items gathered and work so they may “minister” to the public.

Not limiting to that, they rest of the pharmacist defined outfit is honed for optimal use and effective comfort. Shoes are often not what they appear when not distinctly for comfort, the hidden insoles and small adjustment towards flats rather than heels is as important as switching to hybrid dress shoes with leather uppers but soft cushion below. As the retail uniform relaxes ala scrubs so does the need the enforce historical appearances vs optimization. Although some scrub clad pharmacist may wear the white coat, it can often be eschewed in favor for warmer personal coats or other longer scrub tops. These occupy the same niche area of organization and coverage without relying on the visual assistance of the White Coat. The shoes change, the shirts change, the pants change, even the socks may change based on your standing needs but the intention and ritual is still there. Same enough for a shift at CVS as one in a sterile compounding room.

Finally, there is a peaked difference, our lack of headwear. Most organized region and cultures have hats, coverings, and objects that are based on the head. These lack a presence in the pharmacy world. We have no Kippah, no Keffiyeh, no Hijab, and no Mitre. Some things may approach this territory but are found lacking in comparison. We now have the surgical mask of a post-covid world, Bluetooth headsets of a busy phone world, but the closest we can get is just the simple arrangement of long hair so not to impair compounding or work duties. Crossing over the medical barrier to physicians, they historically had a forehead-based headlamp that although now not effective outside of niche applications would be better suited for this comparison. Sadly, the physicians get all the cool things.

 Editorial By

Ultan McGlone, PharmD