White Coats - Function, Fashion or Neither?

Way back in antiquity, physicians wore black to denote their profession. Their garb was a visual cue for laymen and carried prominent cultural signifiers of importance and distinction. Over time, the traditional black attire shifted to white, symbolizing purity, cleanliness, and the (then) novel concept that medicine was to be treated as one of the sciences. We still use the white coat as a visual symbol for the physician, an essential ingredient of the uniform we’ve come to expect. For many medical students, a prestigious, calf-length white coat will be a confirmation of a long and arduous achievement; a wearable rite of passage. 

Having been a staple of traditional healthcare since the late nineteenth century, the long white coat holds a prominent level of prestige. It’s classic and easily-identifiable, and in many cases helps dictate the constituent hierarchies of a particular hospital or health care system. Despite its long history, the white coat is an oft-debated facet of modern health care with both critics and proponents decrying and advocating its use. With steadily changing attitudes towards function and pathology, as well as a more nuanced grasp of physician-patient relationships, many are rethinking the role of the white coat in the healthcare model. 

White Coats are Symbolic, Germs Are Not

Though the white coat’s nominal hue denotes symbolic power and specialization, what’s actually contained within those fibers is a little more tangible...and ghastly. Most white coats aren’t washed regularly and are perpetually left at the office at the end of one’s shift. Surveying 183 physicians and medical students at a Virginia hospital revealed that a scant 1 percent washed their coat every day. 2 percent washed their every other day, with 39 percent performing laundry duties once a week, 40 percent monthly and an alarming 17 percent claiming that they never washed their white coats (Freyer, Doctors Debate Safety of Their White Coats). It shouldn’t come as any surprise that even the most routine 8 hour day of patient contact will leave a white coat a veritable petri dish, teeming with microscopic germs and bacteria, undetectable to human eyes.

But physicians aren’t powerless here. To combat the perceived spread of infectious germs and diseases from physician clothing, Britain’s National Health Service instituted a measure that required all physicians to go “bare below the elbows” in their work. A select few health care systems in the United States have also followed suit, including Virginia Commonwealth University School of Medicine in Richmond. Generally however, “bare below the elbows” initiatives aren’t a widespread development. 

The Data is Unclear

The problem with a hardline “bare below the elbows” approach is this: concrete study linking the spread of disease and hospital-borne infection to white coats simply doesn’t exist. Furthermore, there’s little logical reason to suspect that the long white coat is any more germ-riddled than another article of infrequently-laundered clothing a physician may wear, like a necktie. So, while it’s perfectly logical to assume that reducing contamination in one’s attire would eliminate hospital-borne infections, many physicians cling to guidelines from the Society of Healthcare Epidemiology of America which claim an “unclear connection” between the two. Furthermore, “white coat apologists” prioritize patient data suggesting that patients are more at ease and comfortable when they’re physicians are dressed “as professionals.” (i.e. business attire with a white coat to match). 

In this regard, traditionalists see no need to jimmy with the unseen dynamics of the doctor patient relationship. They understand that in order for physicians to be the most effective for their patients, their work must be couched in a spirit of reassurance, ease and competence...virtues the white coat seemingly embodies. Removing such a striking visual element, they contend, theoretically diminishes a patient’s confidence in their physician and erodes the subsequent pathways of communication.    

Just Speculation?

It’s all essentially just speculation though, as such abstract concepts like a patient’s level compliance, forthrightness and ease are difficult to truly measure and analyze with hard data. In fact, critics of the white coat claim the exact opposite of the aforementioned. They claim the white coat presents a social barrier to communication, one which psychologically separates the physician from the patient and hampers honest dialog. In a modern world that’s that’s continually democratizing knowledge and information in unprecedented ways, arbitrary distinctions like “traditional attire” and social identifiers only impede the creation of new, more efficient models of health care and the delivery model. Theoretically at least. 

What’s worth noting is the resistance many physicians feel at the prospect of wearing “just” scrubs, like a nurse, nurse practitioner or physician’s assistant. Maybe they feel that without their identifying feature, their white coat, they’re creating confusion for patients who can’t make heads or tails of the bevy of scrubs-clad professionals bustling around about them. Of course, ego factors in as well, and the very culture of the “white coat elitism” comes into question.

If No White Coat, What?

In her article, This is What I’m Wearing Instead of a White Coat, Kristen Prentiss, OTT, MD speaks of modernizing the traditional physician attire. Neoprene vests with easy to read logos and identifiers, featuring one’s name and health care organization present one solution with the added benefit of keeping physicians “bare below the elbows” by default.  Couple them with space age stain resistant fabrics and we’re talking about serious physician utility here. 

Maybe hard data linking long white coats to hospital-borne infections will be the catalyst for a universal policy change. Of course, ubiquitous adoption of such a measure remains a mystery. Technical study is lacking and for now, the psychological benefits of the white coat outweigh the health and safety benefits that many can only theorize.

 

References

Prentis, Kristin, OTT, MD. "This Is What I'm Wearing Instead of a White Coat." 

KevinMD.com. KevinMD, 16 Feb. 2016. Web. 20 Feb. 2016.

 

Freyer, Felice J. "Doctors Debate Hanging up the White Coat." 

BostonGlobe.com. Boston Globe, 19 Nov. 2015. Web. 20 Feb. 2016.