Even more than the stethoscope or the black bag, perhaps nothing symbolizes the medical profession more than the white coat. Medical students enter the profession with a “white coat ceremony,” and patients see a doctor in a white coat as a trusted authority.
Historically, doctors wore white coats to act as a barrier against disease and infection. However, that assumption has been contradicted recently, by numerous studies showing that doctors’ coats harbor germs and promote the spread of dangerous bacteria.
A study at the University of Maryland found that only 65 percent of medical personnel had changed their coat in the last week, and a shocking 15 percent admitted they hadn’t changed coats in a month.
The bugs that promote drug-resistant Staphylococcus infections can survive on clothing for 56 days.
Studies show that hospital-acquired infections decrease when hospitals handle the staff laundry. In hospitals in the United Kingdom, physicians have been banned from wearing white coats in order to decrease the risk of infection.
Is it time for all doctors to abandon tradition, and say good-bye to their white coats?
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{ 19 comments }
“…patients see a doctor in a white coat as a trusted authority.”
Not anymore.
Ok, let’s say we ban white coats. Then someone will do a research project where they swab my paisley tie and my desultory light blue button down and it will show that all those bugs growing on my white coat are now growing on my clothing. So then what? Make rounds with my shirt and tie like a Dr Tarzan? A HazMat suit?
Hospitals should provide staff with white coats and laundry services. Do people think they burn the bedsheets between patients? They can’t be any cleaner.
Clean laundry and replacement coats. Simple solution to a simple problem. Oh yeah, and handwashing, too.
You should probably buy a new coat after six months anyway, even if you do launder regularly.
I go through at least six per year, even though I use them mainly in the office: you need at least one to wear, one to wash and a backup.
I see nothing wrong with the white coats (or blue as some of the physicians I work for choose to wear). But they do need to be washed. Seriously, for a couple of our docs I do not think the coats have ever been washed. To quote my daughter “EEEEEEWWWWWWWWW GROSSSSSS!”
Besides without the coat how are you going to carry everything you need from room to room? The RX pads (for the scripts requiring a signed RX), the PDA, the pens, schedule, the stethoscope and everything else that makes the pockets look like they are going to burst.
Hang up the white coat?
I’d settle for launder it.
SarahW 2:12PM wins the commonsense award for today.
I guess it dates me to say I remember when that was one thing the hospitals did, and did well.
It’s definitely worth studying. If you can culture all sorts of nasty bugs off a white coat, then there’s a reasonable possibility that the coats are spreading infections. Let’s get a few hospitals to try it and track the infection rates. If banning white coats actually reduces rates of nosocomial infections and reduces morbidity and mortality, then I think it would be reasonable to ban white coats.
Ban the nursing caps! They don’t lauder that easily!
“Historically, doctors wore white coats to act as a barrier against disease and infection. However, that assumption has been contradicted recently”
I beg to idffer Kevin. My lab coat during residency did protect me… from a lot of blood spatter, urine, vomit, etc etc. Also, betadine stains don’t come out easily on my white shirt and tie.
The hospital where I trained had a laundry where they supplied a fresh starched white coast 24/7 to any resident who dropped by. We were admonished to do so often and the attendings would remind anyone with a limp coat to go get a fresh one.
Being in the humid south, that was often twice a day.
I bet it saved lives.
The office is a problem though.
I talked to some European med students. They told me that they dont have their own white coats. Everytime they go to hospital, they grab a new one from the changing room that has been washed everyday. Their white coats have short sleeves so that sleeves dont get touched by wounds and infection easily.
No, they don’t need to ban the white coat, they just need to wash it every day. Just like scrubs.
Seriously? People are wearing the same white coat into icky hospitals for weeks on end without washing it?
I guess there’s no common sense class in med school?
The reason coats get so dirty is that they’re basically briefcases. Coats don’t get washed because people (me included) don’t want to take out and possibly lose one of the 68 pieces of paper in the pockets or the book in the other pocket or the 4 pens in the coat pocket and the pager clipped to the inside pocket.
As a med student in the UK, white coats are a thing of the past. When the decision affects all hospitals and practices across the entire country, patients get used to the changes very quickly, and the authoritative connotations that come with the white coat are admonished. I’d like to see some data proving/disproving that the white coat ban in the UK has been effective. Does anyone know of any current studies?
Oh, and to answer “The Clerk’s” comment, yes, you end up with everything hanging from your neck when you don’t have pockets to fill. Female physicians often carry small purses around with them, which I’m sure get laundered A LOT LESS than white coats would be laundered.
And for “Buckeye Surgeon,” they’ve also implemented a “bare below the elbow” policy across the UK, and many areas are starting to enforce a no-neck tie policy, too. Who knows what’s next?
As a medical student I always detested the white coat. In a tropical country, a white coat is a burden.
But I fell in love with this garment. One does not see bacteria but blood, vomitus, urine, pus, spill from injections or IV fluids are the few of many things that my coat has protected me.
The study in discussion points that dirty coats harbor bacteria. If somebody does not change his coat for month, I think they need more education and reinforcement.
Its the habit that needs to be addressed and not the garment.
The solution is to get laundered coats at the hospital.
Many housestaff have lockers where they dump their coats (including the white coat–you don’t want to bring than thing home.) Instead of putting it back in the locker, the coat ought to go in the laundry hamper, just like scrubs. The locker room is the logical place for that: clean coat pickup and dirty coat drop-off.
It is true that coats become walking file cabinets. Don’t know the answer to all that.
I think it will do to hang up the dirty white coats, wearing a clean one is OK.
The hospital is the correct facility for making this happen. Industrial laundry.
As for ties, and while they may look neat, they are merely decoration and are better disposed of in a health care setting where fomites ought to be discouraged.
Physicians started wearing white coats to prevent transferring infection between patients.
Over the years, it became associated with being a physician…the good old days, when hospitals would actually do laundry. There was even a hierarchy: Short coats for students, long coats for residents, and long coats with cloth buttons(frogs) for attendings…
In the last 20 or so years, however, everyone started wearing white coats. Nurses, techs, people who actually (gasp!) worked in labs, janitors, porters, etc. And hospitals went from providing them daily, crisp and fresh, to providing the residents with a couple (to last their entire residency), to not providing them at all – and no laundry, either.
Now, if physicians are going to walk around in grimy, filthy, coats (and many do, unfortunately) in the hospital or in their office, there’s not much that can be done for them. They’re beyond caring about professional appearances, and so are probably beyond professional behavior. After all, how hard is it to wash a coat when doing the laundry (a skill that most young physicians seem to have not learned, either – both sexes, too). The ‘modern’ polyester blend coat can be laundered (soap, bleach, hot water, just like your underwear) and hung to dry, it will never look good but at least it won’t look bad. And the stains do come out.
As far as not wearing them at all, if that is the case then we must do away with all other fomites: STARTING WITH THE NECKTIE. A sexist piece of stupidity, symbolizing how men (since women are excused from wearing them in the hospital) tie a ceremonial noose around their necks daily. It may be silk (or some god-awful synthetic) but it’s still a noose, and usually affixed after ritualistically slashing ones throat in a process called ’shaving’. Not willing to submit to the ’system’, I grew a beard: Take that, you mindless drones!
But, lets not stop there: ID badges (especially those on lanyards), stethoscopes, pagers, and all the rest of hospital impedimenta must be sterilized and sanitized, in the name of protecting our patients. Carrying too much stuff? Too bad, learn to do without. If you have a little piece of paper in a pocket that can be lost, it WILL be lost – so don’t have them at all. Can’t remember a drug dose? Then why are you doing prescribing it? Two Tylenol for everyone!
Or, perhaps hospitals can just start providing and laundering the coats. I think somehow I’ll be able to remember my name, degree and specialty without seeing it on my coat, and I doubt that my patients care except as it helps them get better. With a coat on my necktie stays in place, my impedimenta is hidden, and my patients, and my family, are safe.
And I don’t really care if my buttons are cloth or not.
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