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September 27, 2018

Is it time to abolish the white coat?

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Aug. 21, 2019.

    A doctor's white lab coat serves as a sign of status, education, and cleanliness—but some physicians are bucking the trend in favor of scrubs and business attire.

    5 myths physicians believe about patient experience

    The white coat's perception fixing origins 

    While medicine is widely viewed as a science today and the public generally holds doctors in high esteem, that wasn't always the case.

    According to an article in the AMA Journal of Ethics, up until the last third of the 1800s, "virtually all of 'medicine' entailed many worthless cures and much quackery." Doctors during that time period often wore "black, formal garb, similar to a tuxedo," Elaine Howley reports for U.S. News & World Report.

    But in the 1900s, as medicine and the profession improved, doctors ditched the black attire in an effort to change the public's perception. As Michael Edmond, an infectious disease specialist at the University of Iowa Hospitals and Clinics, explained, "[T]he concept was doctors would wear white coats because it reinforced the notion that they were scientists." He added, "Initially the white coats were worn only in the operating room. Then in the early 1900s, physicians started wearing them outside the operating room because at that point in time, medicine wasn't considered to be scientific."

    Some say it's time for a white coat update

    While the lab coat can make medicine look more scientific, some health systems have moved away from long-sleeved white coats for safety.  

    For example, the United Kingdom's National Health Service in 2008 implemented a "bare below the elbow policy" that advised physicians and health staff to wear scrubs to reduce the chance that the doctor's clothing would come in contact with patients' skin during visits, Howley reports. According to Howley, some doctors also have opted for a business professional look.  

    According to Edmond, there's some experimental research that has shown bacteria and infectious agents can live on clothing. "We know that all people have bacteria on their skin, and in the hospital setting in particular, these could be multi-drug resistant organisms," he explained. "We have good evidence that clothing of health care workers becomes contaminated as they work."

    However, Vineet Chopra, chief of the division of hospital medicine and associate professor of medicine at the University of Michigan Hospitals, said the perceived risk might be overblown. "What is most important to prevent infection is the basics of safe practice," he said. "A little bit of hygiene is all that it takes."

    White coat remains the patient favorite

    While some health systems and individual providers may be moving away from the white lab coat, Chopra pointed to a study she led that showed patients overwhelmingly favored the white lab coat when compared with other types of physician attire. Scrubs with a white coat took second place and formal attire with no white coat ranked third.

    According to Chopra, uniforms give people "a sense that this person is somehow appointed to be able to do what they do," Chopra said. "They've got the right training, background, skills and certifications."

    However, Edmond noted that "most patients are sophisticated enough that they see through [appearances] pretty quickly." He added, "If you pay attention [to your patients], I think most of this other superficial stuff really melts away" (Howley, U.S. News & World Report, 9/19; Rege, Becker's Hospital Review, 9/21).

    5 myths physicians believe about patient experience

    5 myths physicians believe about patient experience

    Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

    Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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