Saturday, June 4, 2011

Should Doctors Wear White Coats?

The Doctor's white coat has been a symbol of the profession for decades.  In the 1800's and up through the early 20th Century, doctors wore street clothes while performing surgery...rolling up their sleeves and plunging dirty hands into patient's bodies.  They often were dressed in formal black, like the clergy to reflect the solemn nature of their role.  (And seeing a doctor was solemn indeed as it often led to death)

A 1989 photograph from the Mass General Hospital shows surgeons in short sleeved white coats over their street clothes and in the early 20th Century the concept of cleanliness and antisepsis was starting to take hold in American medicine.  Both doctors and nurses started donning white garb as a symbol of purity.  The white coat took on more and more symbolic meaning and the "White Coat Ceremony", where medical students are allowed to don the formal long white coat,  has even been a right of passage with graduation from Medical School.

For the past few years, the American Medical Association and other medical societies have debated if it is time for the white coat to be retired.  A study of New York City doctors in 2004 showed their ties were a source of infectious microorganisms.  The NIH in Britain barred ties, lab coats, jewelry on the hands and wrists and long fingernails because of infection.  Researchers from Virginia Commonwealth University showed bacteria from a white cotton lab coat can cause infection just minutes after touching skin.  Another study reported that the majority of medical personnel change their lab coats less than once a week.

At this time there are no recommendations for doctors regarding wearing lab coats.  I've not seen a good comparative study on the hazards (or benefits) of wearing the white coat.  Are street clothes any more sanitary?  Isn't the real issue hand washing and good hygiene from caregivers?

A number of surveys of patients show they "overwhelmingly" prefer their physicians to wear white coats.  Patients seem to have more trust in and comfort with physicians who wear the coat.  For many patients it is still a symbol of professionalism and good care and it helps them identify the physician.

I must admit I like my white coat.  It has pockets that are filled with my needed paraphernalia and tools.  It protects my clothes and when I don it, I take on a professional personae...I'm no longer a wife, mother, insecure female,  or worried about (fill in the blank)...I am a doctor.  It helps me shift into a professional role with focus and clarity.  I know it is psychologic,  but for me it works.

So what do you think?  Do you like your doctor in a white coat?  Would you prefer regular street clothes?  Physicians, do you still wear the white coat?

17 comments:

Raymond Bouchayer said...

Yes I think so , why not , Pilots wear a Uniform as well as Policemen, Military personnel and on and on ....

Anonymous said...

Yes, keep the white coat. Just please wash it regularly! ;)

medrecgal said...

I like the white coat because it is so strongly identified with the profession of physician that you always know who they are when they are wearing it. I know there are some physicians who don't wear them, but I've never met one as a patient. I think subconsciously the white coat engenders a level of trust that's not there when a physician shows up in their street clothes; as such it functions like the police uniform or the judge's robe. (Scrubs, for surgeons, have a similar role in a hospital setting in my experience.) The trick, like anonymous suggested, is to keep it white and clean.

wedding photographers bristol said...

I think physicians should wear white coats for several reasons. the white coat helps patients have confidence in a doctor. the white coat has been the iconic symbol of doctors.

Cary said...

I'm with the rest: the white coat = doctor. I've had hippie docs who wore no coat and it was weird (well, that and the sandals and gnarly hairy toes). But I wonder... how long before doctors have to start wearing biohazard suits? To protect themselves, I mean.

Kate said...

When at work I faithfully wear my white coat. Not only does it have deep pockets for my stethoscope, telephone, penlight, writing pen, cash, and important papers (like my list of hospital patients), it makes me feel more professional. And, and, and....when I walk down the hall I don't feel like people are looking at my butt. Let's be honest here and identify all the benefits! It's all good.

Great question.

Anne said...

The white coat helps to define medical professionals as exactly that. It can sometimes by a pain to have to wear it, but where else would I put all my "stuff"?

Toni Brayer, MD said...

Great comments folks.
Kate: right on!
Anne: my pockets are full of stuff and I use it all. Tools of the trade.
Cary: sandals on doctors...ewwww! I always like the clogs and scrubs look however. And I do wear peep high heels but I have painted toenails. Is that OK?
Anon and medrecgal: Yes, cleanliness is essential
Raymond: And prisoners...

ThatStudent said...

I am a medical student working on a trauma service right now. Let me tell you, those coats are junk magnets. And there's no back-up coat that the attendings, residents or students have. They stay dirty, and I see the same stains day in and day out. Which tells you what's going on. So while I do love the professional aura and extra carrying capacity that even my flimsy little white coat gives me, I am displeased by the grime that accumulates simply overnight.
As for sandals and such, my mother came back one day after seeing a young specialist and said "I am never going back, he was this young boy wearing sandals, and walking around chewing gum."
So there you have it.

Michael Kirsch, M.D. said...

Haven't worn one in decades. My mom said she wouldn't see me as a patient as I don't don the white coat. I'm not sure I'd want to be her doctor anyway.

OldSquid said...

It does add a degree of professionalism; however, it is no doubt a germ, bacteria, virus magnet like the stethoscope that is used often an a number of patients without cleaning. I once read a number of years ago you should never sign anything with a doctor's pen because it is often used for a number of tasks.

In short, wear it and wash it. Have a spare on hand.

PS the only time scrubs should be worn is if you are going to, are in, or just game out of the OR. Unless you work in the ED. Scrubs otherwise are not a professional look.

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Unknown said...
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Steven Reidbord MD said...

We psychiatrists almost always avoid wearing white coats. Most of us don't need them to carry equipment or fend off bodily fluids. But more important, the image of "men in white coats" taking someone away to an asylum has tainted the white coat in the mental health field. Psychiatric nurses and techs rarely wear white uniforms either, in my experience.

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