Monday, September 19, 2016

A white coat is more than just a symbol

The raging controversy over whether doctors should wear white coats has been based on the theoretical problem of possibly infecting patients with organisms that can be cultured from white coats vs. the lack of an apparent benefit from wearing a white coat.

A 2012 paper by investigators from Northwestern University in the Journal of Experimental Social Psychology sheds some new light on the latter issue.

Rather than summarizing the study myself, I will quote the excellent New York Times article about the three experiments that were done [emphasis added by me]:

In the first experiment, 58 undergraduates were randomly assigned to wear a white lab coat or street clothes. Then they were given a test for selective attention based on their ability to notice incongruities, as when the word “red” appears in the color green. Those who wore the white lab coats made about half as many errors on incongruent trials as those who wore regular clothes.
In the second, 74 students were randomly assigned to one of three options: wearing a doctor’s coat, wearing an [artistic] painter’s coat or seeing a doctor’s coat. Then they were given a test for sustained attention. They had to look at two very similar pictures side by side on a screen and spot four minor differences, writing them down as quickly as possible.

Those who wore the doctor’s coat, which was identical to the painter’s coat, found more differences. They had acquired heightened attention. Those who wore the painter’s coat or were primed with merely seeing the doctor’s coat found fewer differences between the images.

The third experiment explored this priming effect more thoroughly. Does simply seeing a physical item, like the coat, affect behavior? Students either wore a doctor’s coat or a painter’s coat, or were told to notice a doctor’s lab coat displayed on the desk in front of them for a long period of time. All three groups wrote essays about their thoughts on the coats. Then they were tested for sustained attention. Again, the group that wore the doctor’s coat showed the greatest improvement in attention.
If you wear a white coat that you believe belongs to a doctor, your ability to pay attention increases sharply. But if you wear the same white coat believing it belongs to a painter, you will show no such improvement.

That was the lede in the Times piece which included a discussion of some previous papers on the subject of embodied cognition [defined by the Stanford Encyclopedia of Philosophy as "when aspects of the agent's body beyond the brain play a significant causal or physically constitutive role in cognitive processing."]

The Times article mentioned another example of embodied cognition relevant to those who work in hospitals—people who carry heavy clipboards feel more important.

So embodied cognition is not always a good thing.

However a white coat is not a clipboard. This research tells us that simply wearing a white coat may help us focus and sustain our attention.


Cutter said...

Imagine how much performance on detail oriented and fine motor tasks would improve if subjects were allowed to wear a scrub cap designated from a surgeon's (historical) wardrobe, as opposed to a boufont cap which belonged to a fast food employee...

artiger said...

I wear a white coat every day, which (at my own expense) I have professionally laundered no less than every 10 days, sooner if soiled at all. I don't have to wear it, but now I'm afraid my history taking skills will suffer if I don't wear it.

You know, judges and clergy don't have to wear robes to do their jobs, but I don't see any movement leaning on them to give them up; I wonder how a similar study with their garb would turn out?

Old FoolRN said...

There must be something significant about the white coats as some nursing schools have abandoned the capping ritual and now substitute a white coat ceremony. Imitation is the highest form of flattery.

William Reichert said...

What about the docs who now wear blue coats.? Is it the color that matters or is it the fact that your brain remembers you solving problems from past experiences wearing a white coat? I think it primes you to pay attention. Same with sports. When you put on that uniform your brain remembers all the times you were forced to put forth a maximum effort in previous games so your brain takes you there again to the same highly motivated place place. Memories can focus your attention to the thing you were doing at the time the memory was formed. This is why Tiger Woods always wore red on the final day of a tournament. He had done it before and got his head into the shots needed to win because the red color reminded him of how it felt to concentrate
enough to win. And this is why a woman's perfume can drive a man crazy. Just saying.

Skeptical Scalpel said...

Cutter, we need a study saying the traditional cap helps us focus better than the bouffant.

Artiger, judges and clergy usually don't get accused of transmitting infectious diseases.

Old, when the nursing students get their white coats, is a heavy clipboard included?

William, good points. But I guess Tiger lost all his red outfits. Maybe Elin got them as part of the divorce settlement.

artiger said...

Scalpel, true (about judges and clergy), but criminals and sinners probably host a few germs.

William Reichert said...


Tiger did not lose all his red outfits. Remember: you have to make the cut after the second round to be able to wear your red outfit
on day 4.
Unfortunately. not even white coats can save doctors from the
curse that has been put upon them by the demand to worship the EMR.

Skeptical Scalpel said...

Maybe Tiger needs to wear red for rounds 1 and 2.

Ariel said...

Full disclosure: I do work for a scrubs and lab coats company.

That being said, I've heard the argument about lab coats transmitting bacterial infections. I'd like to point out that data collected from hospitals where lab coats are banned (for this reason) have no significant decrease in hospital-borne infections.

What's more, every study I've seen shows that patients prefer their docs in white coats, for whatever subconscious reason may be. Anecdotally, a friend of mine saw his pt satisfaction scores go up when he wore his white coat for 6 months, and when he went 3 months not wearing it his pt sat scores went back to baseline.

Skeptical Scalpel said...

Ariel, thanks for commenting. Interesting story about patient satisfaction and white coats. Someone should study that.

Do you have a link or citation for your point about before and after data for hospitals that have banned white coats? I would love to see a paper that has looked at that.

Ariel said...

Skeptical, it looks like I actually did mis-word that - there haven't been before/after analyses of white coats spreading infections. There are, however, many studies that have concluded there "is there is no higher infection risk from daily-washed, white coats, than any other clinical attire."

Admittedly there is limited data in general on this subject. More studies should be done on actual pt outcomes rather than just coat contamination (even those studies are limited).

A lot of these sources can be found here:

Skeptical Scalpel said...

Thanks for commenting again and for the link. It's a nice discussion of the topic.

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