February 25, 2020

Is it time to rethink the hospital gown?

Daily Briefing

    Patients are almost always instructed to put on a one-size-fits-all, open-back gown when they're in the hospital, but in many cases, the gown doesn't afford any benefits and can strip patients of dignity, raising questions about whether it's truly necessary, Ersilia DeFilippis, a physician, writes for the New York Times.

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    'Exposed' and 'vulnerable': How patients feel in the hospital gown

    As a physician, DeFilippis is familiar with how what people wear in the hospital can influence how they feel about themselves. For doctors, "the white coat is a symbol of … status," DeFilippis writes. "We are meant to undergo a kind of identity transformation when we put it on for the first time."

    But Patients also undergo an identity change when they put on their gowns, "step[ping] into the 'sick role,'" DeFelippis writes. "In this role, they are exposed, vulnerable and deidentified, contrary to the authority and protection conferred by the white coat."

    That's not to say hospital gowns don't serve a purpose, DeFilippis writes. The openings provide physicians easy access to intravenous lines to infuse medications and also make physical exams more efficient. They are also the best type of coverage for patients who have urinary catheters or are incontinent, DeFilippis notes.

    However, the gowns also leave other parts of the body "unnecessarily" exposed, DeFilippis writes, leading some to question: "Would care really be impeded if … patients wore their own clothes?"

    One Canadian study of five teaching hospitals found that only 14 out of 127 patients were wearing anything more than underwear underneath their hospital gowns. However, physicians said more than 50% of the patients could have worn more than just their underwear. Meanwhile, many patients in the study said they would have preferred to wear clothes on their lower bodies if allowed.

    In some cases, keeping their own clothes on can actually help patients, DeFilippis writes. According to other research, allowing patients to wear their own clothes can increase their self-esteem and help those with cognitive decline remain oriented in new locations.

    Meet the patients who passed on the conventional gown

    While most patients accept that wearing the gown is part of their hospital stay, others become their "own advocates" and find ways to personalize their hospital attire—or skip it entirely.

    For instance, DeFilippis recalls a patient who spent weeks in the hospital waiting for a heart transplant. One day when the patient was holding the back of her gown closed, she told DeFilippis the hospital should "do something about these hospital gowns." Days later, the woman came in with a leopard print gown she'd ordered online.

    "Her personality became even more vibrant," DeFilippis writes. "She walked around the unit with her family, her hand now free to wave at her doctors and the staff members."

    DeFilippis' own mother also bucked the trend during a hospitalization, opting to wear her own clothes.

    "Before we had left for the [ED] suspecting she would be admitted to the hospital for at least a few days, she had meticulously instructed me on what clothing to pack: comfortably fitted but loose T-shirts, sweatpants and patterned pajama bottoms," DeFilippis writes.

    "For my mother, her non-hospital clothing provided moments of comfort and individuality." She adds, "Although she had little control over when she took her medications and when her blood was drawn, she retained dignity and self-expression in choosing what to wear in the morning."

    Redesigning the hospital gown

    Some designers have caught wind of the desire for more dignified gowns and are designing more stylistic and less revealing attire for hospitals.

    For instance, designer Diane von Furstenberg designed "chic" hospital gowns that featured a closed back for Cleveland Clinic, and designer Cynthia Rowley made some changes to the hospital gowns at Hackensack University Medical Center. One group of students at Parsons School of Design even created hospital gowns that open in the front instead of the back. 

    Some companies are selling customized hospital gowns online, embroidered with phrases like "the beat goes on."

    But DeFilippis believes it may be time to abandon the hospital gown altogether. "We could empower patients and family members to bring in their own clothes, in the same way that we encourage them to bring in pictures or other mementos," she writes. "This small act can go a long way with respect to physical and emotional healing" (DeFilippis, New York Times, 2/18).

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