Prior to beginning medical school, all physicians must matriculate through “The White Coat Ceremony,” in which they are donned white coats by their school’s leadership. The white coat isn’t like any other garment; it symbolizes the professionalism and authority that the field has gained throughout history. Before the late 19th century, doctors actually wore black but switched to white laboratory attire to signify that medicine was science. However, recent discussions between doctors have revolved around whether the white coat might actually be harmful to patients by spreading infectious diseases.
Dr. Philip Lederer, an infectious disease fellow at HMS, is against wearing white coats in this debate. He believes that the white coat is a “germ magnet,” one that is teeming with deadly microbes that are being picked up in and transferred between patient rooms. He states, “There is no harm in avoiding white coats, but there could be danger in wearing one.” Dr. Lederer prefers wearing something like the picture below on the right: a short-sleeved shirt with a vest for warmth or a dress shirt with the sleeves rolled up–the “bare below the elbows” style.
Dr. Michael Edmond, then chief of infectious diseases at VCU School of medicine, stands with Dr. Lederer. He cites that, in 2008, physicians in the UK were required to follow the “bare elbows” attire to prevent the spread of infectious diseases. There must have been good reasons for the Brits to authorize this rule.
The physicians took a closer look at the cleanliness of white coats. In fact, “lab coats are infrequently laundered.” A survey of 183 physicians and medical students conducted at Edmond’s Virginia hospital found that only 1% wash the coat every day, 2% every other day, 39% once a week, and 40% once a month. And, get this: 17% said they had never washed their coats. Gross much?
However, there has not been a study to show that white coats are actually agents of germs. But Dr. Edmond believes that it’s not worth the risk–why not get rid of white coats and eliminate the risk factor altogether? Dr. Edmond and Dr. Lederer have parted ways with the white coat, and Dr. Lederer estimates that approximately 20% of his colleagues at Brigham and at MGH have adopted the “bare below the elbows” style.
Of course, there are physicians who prefer wearing the white coat. It is a large part of their clinical identity, and provides a mutual comfort to both patients and doctors. In fact, studies have shown that microbe contamination on white coats compared with other garments or even the skin did not find a difference. Those who favor white coats say that it “engenders trust” while those who do not say that it creates a barrier between the patient and doctor as it diminishes the egalitarian relationship.
In a survey summarized by Dr. Paul Sax of Brigham and Women’s Hospital, an even split of 49% respondents of the general public said to keep the coat, and 51% said to get rid of it.
So where do you stand in this debate? Should doctors keep wearing their white coats, or should doctors give them up all together? Personally, I agree with Dr. Edmond: “If you’re nice to your patients, if you communicate well, you’re empathetic, you give them access to you, they [patients] don’t care how you’re dressed.” No coat? No problem.
Articles: A Doctor Wrestles With Whether To Keep Wearing His White Coat & Doctors debate safety of their white coats