On a warm August 2004 day in Philadelphia, I joined 150 first-year medical students on stage at the University of Pennsylvania to celebrate the start of our medical careers. The dean called our names and, one by one, draped short white coats around our shoulders.
During my four years of medical school, I wore that short white coat on the hospital wards. After graduation, I moved to California and traded in the short white coat for a long one. Residency was exhausting. I was on call for 30 hours every few nights, my coat became sullied, and it was difficult to keep it pristine. Once, after rounds in the intensive care unit, the attending physician took me aside. “Do a better job washing that coat,” he admonished me. “Patients and their families shouldn’t see you like that.”
Several years later, I am an infectious diseases fellow at Massachusetts General Hospital and Brigham and Women’s Hospital and help teach the Harvard Medical School students when they do their infectious diseases clinical rotations. When I came here, I was given new white coats. But I have never worn them.
Patients rarely perceive that white coats can be covered with bacteria.
And now, with a few years of experience, I have come to believe that we should get rid of white coats.
You wouldn’t want to be cared for by a doctor who doesn’t wash his or her hands. Why would you want to be treated by a doctor wearing a white coat that hasn’t been washed in a week? Many white coats are covered in bacteria. And it’s time to hang them up for good.
According to the Society of Healthcare Epidemiology guidelines, health care personnel apparel can hypothetically serve as a vector for pathogen cross-transmission in health care settings. Eli Perencevich and Mike Edmond, physicians at the University of Iowa, have studied this issue in depth. They admit that while transmission to patients hasn’t been definitely proven, there is strong circumstantial evidence that it could occur.
Physicians haven’t always worn white coats. Until the late 19th century, surgeons operated wearing black coats.
Although Edinburgh, Scotland, physician Dr. Joseph Lister had discovered that being free of microorganisms reduced the risk of hospital-acquired infections, it took years for doctors to get rid of their black coats.
A few pioneering Germans seized on the idea of the surgeon as a scientist. They traded in their black coats for pristine laboratory whites.
And it’s not just tradition that keeps physicians in white coats. Doctors give a variety of reasons for wearing them – to carry papers, hospitals are cold, or for a confidence boost when facing a stressful situation.
Yet the situation is notably different in many countries in Europe. In the United Kingdom, for example, physicians simply don’t wear white coats when seeing patients because they have adopted a “bare below the elbows” policy.
A few months ago, Dr. Vineet Chopra and Dr. Sanjay Saint wrote an article arguing that patients prefer white coats.
I disagree. At least one study from Scotland suggested that patients feel that their doctors’ appearance was not as important as compassion, politeness and knowledge.
And patients felt an impression of cleanliness and good personal hygiene were more important. In fact, patients preferred a “smart casual” style of dress, which conformed with a “bare below the elbows” dress code policy.
In any event, patient preferences are primarily shaped by cultural norms rather than medical evidence. Patients rarely perceive that white coats can be covered with bacteria, that coats are infrequently washed, that white coats can make a health care worker’s hands dirtier, and that coats could lead to serious infections.
Dr. Philip Lederer is an infectious disease physician in Boston. Distributed by The Associated Press.
