Hospitals are places of long-standing hierarchies where some people are made to feel important and others … not so much. A long time ago, I was told nurses used to stand when a white coat walked into a room. (Imagine that now. Laugh. Snort. Choke. Cough.) In those days, in the patient care setting, white coats were synonymous with importance.
These days, non-clinical hospital administrators, various technicians, and Clinique make-up counter experts are donning long white coats for work. Despite their ubiquity, they have not lost their significance as an iconic symbol of our profession. I attribute this, at least in part, to the fact that in traditional medicine, a long white coat is still earned. MD/DO students are still forced to wear short, funny-looking things. While other people of various levels of training float around in coats of enviable length (mid-thigh or longer) — med students are stuck tugging on their too short sleeves and too short hems until the day they graduate from medical school.
Although no one stands when one walks into a room, a white coat still holds some of its original power. If I wore a white coat, I suspect I’d be asked for soft drinks less often in the hallway. I would get fewer squinting gazes directed at the small print on my hospital badge in the doctors’ lounge. And I would have fewer patients call me their nurse.
Despite the potential perks (and research that has shown patients prefer them), I will not wear a white coat for these two reasons:
1. It’s impractical. Honestly, when was the last time you saw a perfectly tailored white coat un-besmirched by hair, makeup, coffee or ink? I have only seen them this way hanging in thin plastic bags from the dry cleaner — oh, and sometimes on emeritus faculty and guest lecturers — the kind with gelled hair and an air of untouchability.
But people who touch patients? Their coats are filthy. Even if they look clean, they’re not.
Research has shown that 8 hours of routine patient contact leaves white coats teeming with infectious microbes. Whether or not this actually leads to transmission of infection is still up for debate, but that hasn’t kept institutions like the National Health Service in the UK from implementing a dress code that includes a “bare below the elbows” policy for all clinicians who come into contact with patients.
Emergency medicine is hands-on work. It’s fresh wounds, open sores, and soiled undergarments. It’s scabies and vomit and bloody noses. I can wash my arms and hands, but I can’t wash a white coat during a shift. So I show up to work — ready to do the work — bare below the elbow.
2. I don’t believe in them anymore. A white coat is worn to set the wearer apart. It says, “I have a unique/special role here.” There’s a lot of lip service paid to medicine being a team sport, but we have yet to embrace looking like a team. It’s not uncommon for hospitals to require different colored scrubs for doctors and nurses.
Can you imagine a quarterback of a team demanding a different color uniform? He may make more money and be a more valued asset from a management perspective, but he still wears the same uniform as his teammates. He may be the MVP and the jersey with his name may sell the most, but it looks like the ones his teammates wear when they win or lose as a team. I realize it is a strategic advantage to blend in football, and perhaps a strategic advantage to stand out in medicine. But either you believe in a team mentality, or you don’t.
Wearing “special” garments to stand out is a symptom of a culture that elevates some and diminishes others. It’s bad for morale. Imagine working for a boss who walked around wearing a hat emblazoned with “CEO.” Not cool.
Whether or not a wealthy person wears a diamond encrusted Rolex or not, he’s still wealthy. Whether I wear a white coat or not, I’m still a physician. My role is not defined by what I wear — it’s defined by my training and education. And coat or no coat, that doesn’t change.
So what should we be wearing?
The same scrubs.
The loudest dissent will be that this will increase confusion. I mean — we’d actually have to introduce ourselves and explain our roles. Which would mean at least ten extra words sometimes. Gosh. Painful!
In one of my first articles I described “specialism” and compared the halls of the hospital to the halls of a high school. If we all wore the same thing, I think it would help us remember that we’re all on the same team. It would help us see one another as people first. I don’t think everyone has to look identical — like elementary kids playing twins — but it’s time to hang up the white coats and start looking like a team.
Is there something everyone can wear that offers some of the practical aspects of a white coat without its drawbacks?
Fresh from the long polished “runways” of your nearby academic center of excellence — I present the latest in hospital fashion: a black, water-repellent vest.
Embroidered emblems/logos make them look ‘official’ and names and titles stand out against the dark background. They repel coffee, ink, hair, and fuzz. The pockets provide ample room for essentials. Bonded lining holds warmth. And they’re sleeveless.
White coats are so 1990s grunge by comparison. I think long white coats will soon go the way of Doc Martens and white dresses for nurses. It’s time for a new era. It’s time to recognize the importance of every team member by putting on the same team uniform. And if black water-repellent vests really do become the new long white coat — remember, you heard it here first.
Kristin Prentiss Ott is an emergency physician who blogs at her self-titled site, Kristin Prentiss Ott.
Image credit: Kristin Prentiss Ott