Blog | Monday, June 27, 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 rite of passage upon 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 British health service 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, nor am I 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 psychological, 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?

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.