The White Coat Ceremony: Turning Trust Into Entitlement

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Abstract
To examine the symbolism of the white coat and the nature of authority as employed in the White Coat Ceremony for incoming first-year medical students. Little has been written concerning the rapid spread, bioethical implications or theoretical underpinnings of this ceremony despite adoption by over 100 medical schools in the United States, international recognition by medical schools in Israel and as the subject of recent editorial opinion in the United Kingdom. The short white coat can be a highly useful tool allowing patients to identify practitioners in a liminal state. However, by officially sanctioning the white coat as a sign of the psychological contract of professionalism and empathy, the medical establishment may be responding to abrogations of its own authority and is teaching students that they are respected for their sartorial behavior separate from their behavior as individuals. The White Coat Ceremony fosters a sense of entitlement whereby authority based on title and uniform, and authority based on trust, are poorly distinguished.

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