White coats? Go figure

Symbols. They’re important shortcuts. An example? White coats. When I was a fourth year medical student beginning hospital learning, I was chuffed to wear a short (i.e. waist length) white coat around the wards. Because it showed I was a senior medical student. Immediately after graduation I was even chuffeder to wear a longer white coat – knee length or slightly lower – because it signified I was a doctor. That was over 40 years ago. In recent years medical white coats around hospitals have become scarcer than hens’ teeth. I’ve previously written about contamination and infection issues [1]. Last Monday a salon.com article amplified the topic [2]. Titled ‘What happened to the doctor’s white coat?’ it confirms the white coat’s disappearance from hospitals (in the US at least) over the past generation. The author, US paediatrician Dr Rahul Parikh, proposes several reasons for the white coat’s demise: diminished doctors’ omnipotence and omniscience due to the rise of incurable chronic non-infectious diseases, diminished doctors’ power at the expense of nurses and allied health workers (and patients themselves), and of course the (so far unproved) infection risk. So doctors’ white coats are disappearing fast from hospitals. And in some hospitals they’ve gone already. If that’s what society wants, then that’s what it’ll get. Is it a change for the better? I don’t know. Time will tell. But Dr Parikh ends his article by quoting research concluding young children, far from finding white coats threatening, prefer doctors to wear them [3]. Go figure.

farmdoc's blog post number 495

Today’s post is the second of three about this mad world we live in. The American Medical Association’s Council on Science and Public Health is studying the role clothing plays in transmitting bacteria and other bugs. In its sights are white lab coats, stethoscopes, and even ties (dangly ones, I assume, and not bow ones). MRSA and other hospital infections cause nearly 100,000 deaths in US hospitals each year. And a 2004 study found that 48% of ties worn by hospital workers carried at least one infectious microbe. Big bloody whoopy do! Until bugs on clothing and stethoscopes can be shown to cause infections, there’s no need to intervene. Not to be outdone, two years ago the UK’s NHS adopted a policy prohibiting lab coats, ties, below-elbow sleeves, watches, and even long fingernails. The medical conservatives – I expect of an older demographic – are resisting the change. Professor Richard Cohen of Cornell University said: ‘When a patient shares intimacies with you and you examine them in a manner that no one else does, you’d better look like a physician – not a guy who works at Starbuck’s’. In the popular imagination, a white lab coat is as much a part of a doctor’s persona as a cowboy’s 10-gallon hat…’ Okay, but I think the diehards will lose. Why? Because they’re sheep people in cattle country; and it’s a MMMMW.