Most patients prefer that their doctors wear white coats. It’s traditional, it makes it easier to tell who the physicians are, and the white coat signifies purity, cleanliness, and other virtues. Many doctors still wear them.
I never wear a white coat, mainly because they’re hot and uncomfortable. The white coat is almost always ornamental and is rarely worn for function or comfort. More important are the cultural and class roles symbolized by the white coat. Along with the rest of our health care system, these roles have completely changed. The physician now serves at the beck and call of a corporation or government bureaucracy. These businesses and bureaucracies have a variety of agendas which are often opposed to the best interests of the individual patient.
Would it be accurate to say that the medical profession has been proletarianized? Are physicians “1) the lowest social or economic class of a community, or 2) industrial workers who lack their own means of production and hence sell their labor to live?” No to the first definition, absolutely yes to the second. The physician and his treatment of the patient are now largely controlled by insurance companies and the government. That the delivery of decent care is usually not obstructed is irrelevant. If there is a conflict between the patient and the bureaucracy, bureaucratic diktat almost always wins out.
Medicine is a decidedly middle class pursuit. Do you ever read about the society weddings in the Sunday New York Times Style Section? In the 1960s and 1970s, the couples were almost all WASPS. Now the couples are ethnically and religiously diverse, but the common denominators are still elite schools, big jobs, and big money. Careers are almost always in business and law. Very few doctors.
In fact, the physician’s white coat has always had some blue collar overtones. For one thing, as you ascend the occupational scale in the direction of increasing income and status, the uniform is almost always business attire. After all, butchers and Xerox repairmen wear white coats. Most physicians don’t have a problem with these class, status, and income considerations and decided long ago that being a physician was more fun than a job on Wall Street. I also think that most physicians could do well in a Wall Street career, but the reverse isn’t necessarily true.
Formerly, doctors were independent professionals. They were respected and affluent, to be sure, but were deeply committed to the individual patient. The independence is no more, and the status and income are declining along with the commitment.
I share an office with a physician from Hungary. He has taught me much about life under Soviet Communism. He believes that our health care system is becoming increasingly like the Soviet system. Physicians are proletarians in that system, but it’s a “dictatorship of the proletariat,” so it’s OK, right?
In the Soviet health care system, it was necessary to tip health care workers and physicians in order to get decent care. If physicians and health care workers in the US aren’t underpaid and overextended now, they will be soon. I predict that Americans will soon find themselves greasing palms in an effort to get decent health care. It’s probably a good idea to start doing so now.