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Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. 1-12 By contrast, the medical literature has paid almost no attention to the patient gown. Two studies on patient privacy and dignity mention in several short sentences that patients, but not nurses, include the gown as a factor contributing to indignity. 13 14 Two qualitative Scandinavian studies based on interviews of a small number of patients conclude that patient clothing while convenient, also depersonalises and marginalises the wearer. Both studies acknowledge a striking paucity of research on the impact of patient clothing on patient and provider attitudes. 15 16 This is somewhat puzzling, as the relative undress enforced by the patient gown exacerbates the status differential between doctor and patient, and may affect patients' experience of the medical encounter more deeply than their response to what their doctors are wearing. Especially at their most vulnerable-during the physical exam and in the hospital-patients lose the right to any trappings of individuality when donning a hospital gown.
In this article, we argue that in order to understand the full implications of the white coat in the doctor-patient relationship, we must also take into account how patients dress. 17 In particular, we use visual art as an interpretive source. In order to explore how certain artworks depicting medical clothing represent common attitudes and ambivalence towards medical status and hierarchy, we have identified a number of artistic representations of physicians' and patients' clothing. Some of these, such as 'The Cloaking,' or 'Leapfrog,' foreground the actual garments, while others use the clothing as one of several visual indices to make more general statements about physician and patient roles. Our selection process has involved finding appropriately representative images, particularly contemporary ones, through internet searches, inquiry among professional organisations and personal knowledge of artistic works. Additionally, we have selected images for which copyright permission could be readily obtained. The broader goal of this analysis is to show how the visual arts can contribute to our understanding of medical self-representation: the visual arts purposefully portray the medical hierarchy manifest in everyday practice and bring its hidden assumptions to conscious awareness. Paintings and photographs,...