Friday, July 20, 2012

Why I wear a white coat


A recent article in a major newspaper asked why physicians still wear white coats. The theme echoed many recent stories of bacterial contamination of clothing and other inanimate objects. [For more on this subject, click on the "Infection" label on the right next to this post.] 

It also brought to mind a controversial rule instituted by the UK’s National Health Service in 2008 that all medical and nursing staff could not wear ties or white coats and had to have arms “bare below the elbow.”

Despite published papers reporting the existence of bacteria on white coats and ties, the UK policy was not based on any evidence linking coats, ties or long sleeves to transmission of infection to patients.

The subject has been debated for years. Yes, the white coat may be contaminated with bacteria. But whatever one wears may also be contaminated. What is the difference between wearing a white coat for few days and wearing a suit jacket or a pair of pants for a few days?

I wear a white coat for the following reasons:

  • It has a lot of pockets
  • It protects my clothes from blood, vomit, pus and poop.
  • It is easy to clean.
  • It is laundered by my hospital.
I change it at regular intervals, usually amounting to fewer than 5 days. I doubt very much that doctors who don’t wear white coats have their suits, sport coats or pants dry cleaned that frequently.

Taking advantage of the adverse publicity about ties, I have stopped wearing them because it’s more comfortable rather than for an unsupported notion of an infection risk for patients.

More importantly, I wash my hands or use a gel quite often.

Do you wear a white coat? Why or why not?

A version of this was posted on Sermo yesterday. A majority of those few who commented say they do still wear white coats.

17 comments:

Chris Porter said...

I usually wear a white coat (self-laundered), for the same reasons you mention. Also, I wear it for identity in the broad sense. The coat (or scrubs) says "I work in this hospital, and not in admin."

A few months ago I was wearing jeans and a scrub top on weekend call. Collecting a pizza at the main hospital door, I was detained, scolded, and fined $50 by hospital security for inadvertently pushing open a locked door. Convincing the officer I was a doctor (awaiting an ABG and xray on a deteriorating patient) was a lost battle. I think a white coat (or my misplaced nametag) may have made the difference.

Carolyn Thomas said...

I had to go have a little lie-down when I read that you launder your white coat "at regular intervals, usually amounting to fewer than 5 days".

USUALLY fewer than FIVE DAYS?! Why on God's green earth would somebody who has an even passing exposure to the aforementioned "blood, vomit, pus and poop" not be tossing that white coat into the laundry hamper every single night before leaving the building?

Yikes....

Skeptical Scalpel said...

Chris, good story. Have you appealed the fine? I think a pizza is a good enough reason to open a locked door.

Carolyn, I hope you are back on your feet. May I explain that 1) I don't get blood, vomit, pus or poop on me every day, thankfully. When I do I change coats immediately. 2) I don't wear the coat when I'm operating or doing a procedure like inserting a central line on the floor. Some days I might only have it on for an hour or two. Some days I'm in an office doing paperwork and the coat is hanging up. The actual time of exposure of the coat to pathogens is not very long on any given day.

Anonymous said...

As a consumer who was the victim of being "examined" by a "non-medical person" in a hospital when I was much younger, I much prefer that medical personnel wear uniforms that are in line with their position. Is that person in scrubs a doctor; a nurse -- and if so, what level; an orderly; or a visitor? Name tags should also be large and easy to read, plainly stating the name and title of the person, and ALWAYS worn. And, yes(!), the coat or uniform should be changed and laundered daily, sooner if soiled. I put on clean clothing every day, why shouldn't you? Charlotte D.

Dr Skeptic said...

I always wore a white coat during my residency, mainly to carry stuff and to identify myself as a doctor, even though by that time most doctors did not wear them. In the USA on fellowship, we all wore them. When I got back home I continued to wear them, but ended up giving it away as I started to look like a freak, being the only doctor left in an Australian hospital who wore one (there may be exceptions).
I don't think they were banned, they just went out of fashion.
Maybe I should bring them back into fashion?

Skeptical Scalpel said...

Charlotte, I agree with your comment about name tags. Coats should be clean. I didn't mention this but the way doctors and nurses dress these days is deplorable. Jeans and midriffs showing don't work for me.

Dr. Skeptic, maybe you should start a trend down there. Bring back the white coat.

Anonymous said...

Certainly, I despise wearing my awkwardly abrupt, short white coat...On days that I don't wear it due to the casual culture of a field (peds, psych), people think I'm already a doctor!

Nevertheless, I agree with the bit about ties. I cannot tell you how many times my tie dipped into something foul. I now wear tie clips, as they both look dapper and protect me from VRE.

Skeptical Scalpel said...

Anon, thank you for commenting. Pediatricians are famous for wearing bow ties which don't dip into things.

Neal Lippman said...

I suspect that white coat or no white coat has a lot to do with the local hospital culture. I was a medical student, resident, fellow, and attending all at one place. During that time: medical students always wore short white coats. I think this is largely to a) identify us and b) because we carried so much darn stuff around all the time, so we needed the pockets. Some residents worse short white coats, but I always work a shirt and tie, hospital issue white pants, and no coat. This was the norm on the medical service, but on the surgical service, white coat and white pants, shirt and tie (all fresh, clean and and pressed) were an absolutely requirement on rounds. As a fellow, we all worse long white coats - largely, I think, to distinguish us from residents. Attendings all changed into long white coats in the hospital, even if they wore suits in the office.

In my current practice, nearly all private practitioners wear suit coats in the office and in the hospital; few wear white coats. Residents and fellows all wear long coats, pretty much all the time. I wear my long white coat uniformly now, but that's mostly because I wear scrubs nearly all the time, and outside the procedure suit I cover it with the coat.

Seems that it is largely a cultural situation in different environments.

rnraquel said...

Bare midriffs?!?!

Skeptical Scalpel said...

Neal, makes sense and works for you. We agree.

M, yes, I've seen it in the hospital, usually a "muffin top" too.

Carolyn Thomas said...

"the way doctors and nurses dress these days is deplorable" - you likely would NOT approve of the way my cardiologist dresses. The first time I met him (I was in mid-heart attack in the E.R. at the time), he came up to my bed, his long shiny dark curls flying behind him, wearing a wildly colourful Hawaiian print shirt. I'd never seen a doctor wearing quite that outfit (and I'd worked in that same hospital for eight years!)

I very quickly learned, however, during the course of our ongoing relationship since that day in 2008, that despite his decidedly non-doctorly garb, this was a remarkably gifted physician, a skilled diagnostician, a brilliant communicator, a kind and caring person.

I also learned, unfortunately, that not all of us were so open to accepting his unorthodox appearance. One of his patients even wrote a letter to the editor of our daily paper complaining about his wardrobe. More on this at: "My cardiologist: the devil himself" - http://myheartsisters.org/2009/07/01/devil/

Skeptical Scalpel said...

Carolyn, good comment and I liked your blog post too. Just as I'm sure there are very competent doctors who can't spell, there are competent doctors who dress bizarrely.

However if I could choose, I would rather take my chances with a doctor who can spell [suggesting he pays attention to detail] and who dresses in a conventional manner [suggesting he's someone I can relate to].

mrjiggles007 said...

Its a hard balance that I've pondered many times. A professional culture that is a little casual may permit more "bonding" or more "trust" in the physician, at least here in the U.S., as people like to speak to someone on 'their level'. Hence, consult psychiatrists for instance at my hospital do not wear white coats, alluding to the communicative emphasis of the field. However they are usually still dressed to the nines, and LOOK like doctors. We are taught in medical school to sit below a patient's eye level, etc etc. In my parent's culture however (they are from India), a doctor who doesn't wear a tie and white coat would be seen as a quack, and in Japan doctors have a far more paternalistic role in the doctor-patient relationship than we would entertain here, undoubtedly they wear white coats.

I feel that a doctor should look like a Doctor, and to give that up is to lose the special privilege (perhaps), and role we have in society, and would hasten the demise of society's respect for us as we shift from being professionals to being employees. If I walk into a room where someone is going south, I can say, "I am a doctor", and suddenly the culture of the environment changes. Sometimes we can't be a "friend" to the patient and doctor at the same time, so I think that the white coat should remain as a slight barrier against both colloquialism and snot.

Skeptical Scalpel said...

mrjiggles, thanks for the very thoughtful comments. You have described different points of view very well.

Anonymous said...

I am a patient, not a medical doctor. My doctors wear white coats and nice clothes under them, be it Bohemian or more formal. I like to know who the doctor is. Just like the person with the keys is in charge

Skeptical Scalpel said...

Anon, Some studies have confirmed your point of view. Patients seem to prefer that their doctors look like . . . doctors.

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