Has the White Coat Lost Its Meaning in the Hospitals?

Are doctors going to dump the white coat in favor of business suits? What does infection have to do with white coats?

A freshly laundered white coat bearing the first name, last name, MD – isn’t this what we expect our health care provider to wear when we walk into a hospital or clinic? But soon the white coat may become a thing of the past.

The Society for Healthcare Epidemiology of America (SHEA), one of the topmost organizations for preventing and controlling infections in the medical workplace, has issued guidelines on health care provider (HCP) attire, except for the attire in the operating room. Why?

In their paper published in the journal Infection Control and Hospital Epidemiology, researchers evaluated various studies and they gave reasons and recommendations for the same.

Studies evaluated by the researchers indicated that doctor’s white coat and nursing uniforms may serve as potential sources of contamination by pathogens such as Staphylococcus aureus, Acinetobacter species, Enterobacteriaceae, and Pseudomonas species. The worst areas of the white coat are the sleeves, collars and pockets.

A study found that in India, the white coats of medical students and staff in rural dental clinics were contaminated with Staphylococcus and Pseudomonas species.

SHEA thus recommended the following two solutions among others, albeit voluntary -

• Wearing short sleeves (bare below the elbows), no wrist watch, no necktie, and no jewelry during clinical practice.

Clinical approach to a child with fever
A good clinical history and a thorough physical examination should form the basis of making a provisional diagnosis. Laboratory tests should be supportive.

• Possessing two or more white coats and having access to economical and convenient means to launder white coats.

Incidentally, the National Health Service in UK had also adopted the ‘bare below the elbows’ attire policy to reduce infections. They also required the doctors to leave their uniforms at the work place where they were laundered.

White Coat Syndrome Common Among Hypertensive Patients
More than a third of hypertension patients actually suffer from “white coat syndrome”, a condition where their blood pressure increases whenever they visit a doctor

Although studies evaluated are divided on the patient’s preference for white coat, surveys show that patients felt most comfortable when their physicians wore scrubs followed by business suits and last, the white coat.

SHEA does not recommend either wearing white coat or not wearing one, they did come out with following data:

• Patients’ preferences for attire had a limited overall impact on patient satisfaction and confidence in physicians.

• When made aware of the potential risks associated with white coat, patients appear willing to change their preference for physician’s attire.

• 93 percent of the doctors and nurses and 83 percent of the patients thought physician appearance was important for patient care.

Interestingly, a study published in the Journal of Experimental Social Psychology suggested a phenomenon called ‘enclothed cognition’ to describe the influence the clothes have on the people’s psychological processes. And the effects depend on two conditions:

1. The symbolic meaning of the clothing

2. The actual wearing of the clothing

It gives the doctors acquired heightened attention and focus. It gives medical professionals the confidence to not only heal the patient but also to understand that the life of patients is in their hands.

However, many medical organizations are not in favor of the white coat. For example, Mayo Clinic believes that the white coat builds a barrier between the practitioner and the patient, and makes patients more anxious.

Many physicians disagree.

‘I find it amusing if not disturbing the idea of wearing, say, street clothes, instead. Personally, the donning of a white coat establishes a necessary professional boundary, well understood by patients and physicians alike, a decorum that is not only physical but psychological as well,’ says Manfred Marcus, a retired physician.

What does the white coat mean to the interns? At the 13^th Annual White Coat Ceremony, Andrew Gibb, a second-year dental student at University of Alberta, said ‘Well, first of all, it’s white. The Latin word for white is ‘candidus,’ which is also the origin of the English word ‘candor,’ meaning openness and honesty in expression, unstained purity, and freedom from bias, or impartiality. Our white coats represent what we must be as clinicians: kind, honest and sincere. Our dedication to our patients will drive us to learn, to develop and improve our skills’.

So, are the medical professionals going to ditch the more than 100-year-old tradition of white coats? Time will tell.

References:

1. http://www.jstor.org/stable/full/10.1086/675066

Source-Medindia