Blog | Thursday, August 6, 2015

The white coat debate continues on and on and on and on


I couldn't resist blogging in response to Eli Perencevich, MD's recent post regarding doctors' attire. I guess this debate continues on with some new warriors from the University of Michigan. They plan to do a bigger, worldwide study of patient preference for physician attire. We really do need another meaningless study on this topic, don't you think? While they're at it, I think they should ask patients their favorite color, favorite flower, and favorite season of the year, because it would have the same impact.

I have blogged on this topic many times (see here, here, here, here, and here) and I won't rehash all the arguments in this post. But these are the most important ones, I believe:

I think we need to act consistently about the role of clothing in infection control. That is, if you believe that contaminated clothing plays no role in transmission of infection, then be consistent and eliminate contact precautions. If you do believe that clothing may transmit pathogens, ditch the white coat and employ bare below the elbows or contact precautions, or some combination of the 2. Or if you believe that the white coat magically resists contamination by pathogens, disclose that as well and those of us who believe in the germ theory and other scientific concepts like global warming can move on.

If you think that we need more data about patient preference then put the issue of physician attire into context in your survey or test your hypothesis with a clinical trial. Both types of studies have been done. And the results are clear: when placed into context, patients find physician attire to not be very important (not really surprising—most patients would rather have a kind physician who listens well and wears scrubs than a mannequin in a white coat) and when formally tested in clinical trials, attire had no impact on patient satisfaction with their care (see here and here).

The white coat is all about the doctor, more specifically the doctor's ego. It's truly about professionalism in the most negative sense of that concept (physicians judging other physicians to “protect the profession”).

In my current job as Chief Quality Officer at an academic medical center, I am able to separate my time fairly cleanly into clinical time and administrative time. When I am seeing patients, I wear scrubs, have done so for the past 6 years, and have never had a complaint. Interestingly, when my CEO sees me in scrubs, he always points to the scrubs and comments, “That's a good look!” I also don't consistently introduce myself as “Doctor,” particularly in situations where I am likely to follow a patient over a long period of time, and in cases where the patient's status is tenuous and they need to be able to reach me quickly, I give them my cell phone number. Call my crazy, but this approach to patient care works well for me. When I'm working in my administrative role, I frequently wear a tie, though not always, rarely wear a sports jacket, and almost never a suit. Most physicians have enough common sense to dress appropriately for work, so very few need to be told how to dress. And I respect the fact that each of us has our own style. How you dress is a personal decision, a reflection of who you are. By the same token, there are some patients who prefer their doctor to dress more casually. There is no one size fits all.

So to our colleagues in Michigan, a challenge: in your new survey ask patients the following question: which is more important to you, that your physician be dressed in a white coat or that your physician gives you his/her cell phone number? I can't wait to see the results.

Michael B. Edmond, MD, FACP, is the Chief Quality Officer at the University of Iowa Hospitals and Clinics. This post originally appeared at the blog Controversies in Hospital Infection Prevention.