Infection control versus psychology: To white coat or not

There’s a piece in the Atlantic entitled “The Psychology of Lululemon.” I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out — that in some way, clothes have power over the wearer.

Of course, I began to think about the implications of the white coat for doctors, particularly because I remembered a survey we did a few years ago where some physicians mentioned that wearing a white coat made them feel more confident. I must admit that at the time I thought that was fairly absurd.

The article cites a study from the Journal of Experimental Social Psychology, which I reviewed. Turns out, a colleague blogged on this paper last year, so I won’t belabor all the details. In a nutshell, investigators at Northwestern University set up a series of experiments in which subjects performed cognitive tasks that measured selective or sustained attention. In one trial some subjects wore white coats and some didn’t; interestingly, those who did performed better by a factor of 2. In another experiment, all the subjects wore white coats but some were told they were wearing a doctor’s coat, while others were told they were wearing a painter’s coat. The doctor’s coat group scored significantly better. The results led the investigators to coin the term enclothed cognition, which they defined as the systematic influence that clothes have on the wearer’s psychological processes.

Rehashing this paper made me stop and wonder whether after being white coat free for the past five years I should put that dirty old thing back on. It is true that I know some very smart physicians who are never to be seen without their white coats. On the other hand, I also know some white-coated doctors, probably just as many, that I hope to never meet on the other end of a stethoscope. Maybe I’m just too grounded in reality. As much as I wish that if I ensconced myself in Under Armour my athletic abilities would surge, there’s not enough magical thinking on earth to tear me from the bitter reality that my skinny, scrawny body would not perform any differently.

While I’ll have to bow to science and come to grips with the concept of enclothed cognition, I still believe that keeping patients from contact with contaminated coat sleeves trumps whatever small intellectual edge the white coat might provide. As the psychologists have shown, it’s all in your head.

So here’s my recommendation: as you enter your next patient’s room, bare below the elbows in your freshly laundered scrubs, stop for a split second and imagine yourself sporting a shiny white coat in all of its radiant splendor with a Superman logo blazing above the chest pocket. Then strut confidently into that room, and bedazzle the patient with your diagnostic brilliance.

Michael Edmond is a professor of internal medicine and chair, division of infectious diseases, VCU Medical Center.  He blogs at Controversies in Hospital Infection Prevention.

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  • EmilyAnon

    I can’t address the topic of contaminated coat sleeves, but from a patient’s POV (mine anyway) I feel the white lab coat is a dignified reminder of who is in front of me in the exam room. Scrubs would make me think the doctor was coming from some messy procedure and didn’t have time to change. Obviously confidence in your doctor should trump their attire, but hopefully whatever they wear is “freshly laundered”.

  • Dr. Drake Ramoray

    In the inpatient setting, say hospitalists, it would be interesting to see if the long sleeve shirt at the end of a shift is that much different. We could always go short sleeves and ties for the guys but then we might get confused with the guy that’s there to fix the copier.

    http://blogs.citypages.com/blotter/Homer.jpg

    I know. Wife beaters for inpatient medicine. The doctor will see you now.

    http://www.givememyremote.com/remote/wp-content/uploads/2006/05/k-fed.jpg

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