White Coat Psychology


Psychiatric practitioners, as a rule, tend not to wear white coats as much as in other medical disciplines. I’m not sure why. Maybe it’s because of the old Napoleon XIV song, with its maniacal “They’re coming to take me away, ha ha!”

Our team was recently discussing some of the problems of practicing psychiatry in the midst of a sea of medical practitioners, however, and for a variety of reasons, we decided to start wearing white coats, among them that it helps to make our role clearer to patients, and doctors who walk in when we’re doing an interview are less likely to assume we’re a visitor or someone from admissions or something and hijack our interview right in the middle of a sensitive discussion. There were more reasons, but you get the idea.

Yesterday, I experienced an unexpected result of the move to white coats. In our hospital, as in many others, a “code gray” is called to alert staff and security of a behavioral incident–someone’s behavior has escalated to the point where it is disruptive to the other patients, or there is a concern for the safety of patients and/or staff. Our team responds to codes gray, if at all possible. There are only 2 or 3 of us in the hospital at any given time, and we’re only there during the day, and depending on what we’re involved in, we can’t always get there. But we do respond, the majority of the time, to daytime codes gray.

Yesterday there were a LOT of codes gray. And a funny thing was happening when I showed up.  Every single time, without exception, I was greeted with exclamations of surprise and gratitude; “Oh! You guys are responding to codes now?” “Wow, so it’s just like a rapid response or something now, you guys come too, huh?”

This was really puzzling to me. Why were they so surprised? We show up for codes a lot; sometimes more than one of us. But since I was preoccupied with finding out what was going on and trying to help resolve the situation, which in yesterday’s codes was consistently “angry demented but surprisingly fit elderly man wants to beat up everyone between him and the exit,” I didn’t really have time to stand there being puzzled, so each time I shook off my puzzlement and jumped into the fray instead.

Weird as it was, It might still have escaped my notice, if one of the codes hadn’t been on the unit that tends to get most of our more difficult psychiatric patients. And if ANYBODY should know we show up for codes gray, it should be them. Plus, the comment wasn’t just from some float nurse who wasn’t used to how things work there. It was the charge nurse. I’ve *personally* dealt directly with her numerous times when assisting with codes gray.

It was all rather disconcerting, but it was such a busy day that I really just didn’t have time to think about it. Until now. And it finally dawned on me what the difference was. I’ve been there two years, and have nearly always showed up when there was a code gray during my shift. My teammates have all been there much longer, and have also been responding to codes, for YEARS.


We never showed up in white coats before.

I’ve known for a long time that white coats are powerful. I think I first learned it from my brother Jon, who graduated from medical school at an age where most people are just getting started, and who got laughed at by cops when he stopped to help at car accidents, until he started carrying a white coat and stethoscope in his trunk to wear at accident scenes, because then no one ever questioned him.

I had no idea how invisible we were, even all the times we single-handedly de-escalated difficult patients or had an instrumental part in helping to resolve a situation, until the very same people who we helped out all those times before were surprised yesterday when I showed up.

Wow. I might just start wearing my white coat everywhere I go.

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