Facets of Medicine (1)

The color of white coats

By William Wetherall

A Japanese version of this article appeared in
Kokutai, 16(3), April 1995, pages 158-159

Since I was in my teens nearly 40 years ago, I have questioned the dominance of white as the symbol of cleanliness. I owe this facet of my skepticism to a very idiosyncratic family doctor. His protests against socialized medicine also raised questions in my youthful mind about the meaning of the Hippocratic Oath and the quality of medical care in modern society.

White continues to be the dominant color of medicine. Surgical gowns have come in a variety of light greens and blues for many years, but in clinics and on bed rounds doctors still prefer starched white. Pastel pinks and blues have come into vogue as colors for uniforms worn by nurses, especially in pediatric clinics and geriatric homes. Yet most nurses still wear white, from their caps right down to (for many nurses) their shoes and, presumably, their underwear. Lab and X-ray techs, and all manner of other support staff, are also likely to work in hospital whites: tunics and pants, short or long coats.

Few hospital exteriors today are white, yet hospital ships, and of course ambulances, continue to be very white. Until rather recently, hospital interiors, such as ceilings and walls, even floors, tended to be white or at least whitish. Tiles in surgeries and morgues were white. Before the days of stainless steel and discardable plastic, clinic and lab sinks, and kidney basins, were usually white porcelain.

Why white and not, say, black, green, or some other color? White supposedly signifies cleanliness and purity, the assumption being that dirt is any other color but white. Look at all those detergent ads, which both nurture and play upon obsessions to get the collars of shirts and blouses, the toes, soles, and heels of socks, and the armpits and crotches of underwear clean-meaning as white as possible.

Our brains have been washed to believe that a freshly laundered and pressed white coat is ipso facto cleaner than a wrinkled one with a few yellow, brown, or red stains on it. And the medical industry spends fortunes on bleaches and starches to feed such fantasies about whiteness as the principle signifier of cleanliness.

When I was growing up, I expected my doctor to wear white. Only delivery van drivers and some butchers wore brown. Doctors, dentists, optometrists, and of course bakers and cooks, wore white. Butchers, too, were beginning to wear white, but my image of a butcher was brown.

Then one day after my family had moved from San Francisco to a small town in the mountains of northern California, my mother took me to a doctor to get some medicine for my hay fever, which I continue to battle every spring and other times of the year. We were called into the doctor's office by a balding man who was wearing an unstarched tan coat of the kind I had seen some butchers wear. I wondered who he was, but he had a stethoscope around his neck, and he reached for a tongue depressor while asking me to sit on the stool by his desk and take off my shirt. So I concluded that he was the doctor. And indeed he was.

Dr. Ballou was his name, and he'd come to his small town practice via the jungles of Burma during World War II. He did surgery as well as treat common colds, and he was assisted by his wife, who had been a nurse.

I immediately took a liking to Dr. Ballou. He talked straight. He explained things. He gave me some free medicine for my hay fever. He told my mother and I that he'd gotten it from a pharmaceutical company that was experimenting with new treatments. Those were the days when it was possible to conduct field tests without a lot of government permits and signed papers from patients who agreed to be guinea pigs-before the advent of law suits and malpractice insurance.

In 1959, when I was a senior in high school, Dr. Ballou operated on me to repair a right inguinal hernia I had developed in middle school. I was prepped the day before surgery, by Dr. Ballou, who shaved me himself after school, in his office, after explaining the procedure to me. That evening, in the hospital, a nurse gave me an enema.

The next morning, dressed in only a gown, I was rolled into the operating room and knocked out with sodium pentothal. Later I learned that Dr. Ballou, upon opening me up, discovered a hydrocele, and so the anesthesiologist slapped an ether mask on my face to keep me out another hour or so.

I came to in the afternoon, in the same private room I had slept in the night before. The next day, however, I was transferred to the ambulatory ward, where I stayed for another two or three days, until I was able to walk to the toilet and back by myself.

The total bill-from Dr. Ballou, his backup, the anesthesiologist, and the hospital-was only a few hundred dollars-a couple of months wages. Practically no one in those days had health insurance. Today, because a few days stay in the hospital would cost one or two years of average pay, such routine hernia corrections are done on an outpatient basis, as happened a few years ago with my father and younger brother.

During the 1950s and 1960s, far before the Clinton Administration took on the politically difficult task of instituting a national health insurance system in the United States, one of the big issues in the progressive State of California was socialized medicine. Dr. Ballou, proud of his philosophy of letting the standard fees he collected from his financially solvent patients cover the fees of the few patients who were unable to pay, erected a genuine grave stone on the small lawn in front of his one-story, cinder-block office, on which he had had a mason engrave the words "Here Lies Free Medicine".

Dr. Ballou was objecting to the growth of the medical bureaucracy, which he viewed as a tumor on the spirit of medical practice in a town where professionals-physicians like Dr. Ballou, and lawyers like my father-took care of people who couldn't afford their services, without being told to do so by an intrusive bureaucracy. He shared the concerns of other opponents of socialized medicine, that if medical care became over regulated by state or federal government, or by health insurance companies, not only would the costs of treatment increase, but the provision of care would become depersonalized, thus destroying the intimacy of the traditional doctor-patient bond.

It is reasonable to argue that increasing urbanization and social mobility requires a degree of socialized medicine, to compensate for the decline in the spirit of mutual assistance that comes with the breakdown of community and family. Yet Dr. Ballou's reluctance to endorse a medical care system that would deprive doctor and patient their dignity as neighbors as it were, and treat them as cogs and ciphers in some incorporated clinic in which everything is decided by machines and numbers, seems laudable when I witness how doctors and patients alike are affected by bureaucratized medicine in Japan.

Dr. Ballou is no longer alive. But whenever I go to the toilet or take a bath, and see my hernia scar, I think of him learning in Burma how much a well-trained, innovating, conscientious physician can do under the most adverse conditions, without all the trappings of a self-interested medical technocracy. I say to myself, now there was a doctor; and if I were to be one, I'd want to be like him.