Blog Author: George Szasz, CM, MDPosted: Tuesday, January 3, 2017 - 12:17
While doing a bit of research for my previous blog post on sterilization of surgical instruments (“Cleanliness is next to . . .”) I came upon an interesting debate about how physicians and health care workers may or may not be significant spreaders of germs in our hospital settings. Potential vehicles for spreading germs could include virtually anything that a doctor carries from room to room and patient to patient. Of course his or her own hands may be the biggest bug carriers, but how about the stethoscope, the clothing, and the iconic white coat?
The white coat has quite a history. In the late 1800s doctors, like clergy, dressed in black to reflect the somber nature or their work. By the late 19th century antiseptics revolutionized inhospital care and doctors strove to be more scientific in their practises and their dress. The white coat became the symbol of science, but also the symbol of hope and the symbol of the healer. Many patients like the white coat because it helps them to identify who is who. Medical students wear short white coats, doctors wear long ones. Nurses, lab technicians, and other hospital staff members tend to wear scrubs.
But does a doctor’s coat carry germs from patient to patient? Apparently bacteria tend to harbor around the coat’s cuffs. Also, for whatever reason, lab coats are thought to be an impediment to doctors washing their hands regularly. A few years ago in the United Kingdom the National Health Service adopted the “bare below the elbow” policy—calling for short-sleeved lab coats, no wrist watches, and no jewelry. In spite of such restrictions there seems to be no proof that getting rid of the sleeves or the coat itself reduces infection rates in hospitals. Nonetheless, fewer and fewer doctors wear the white lab coat in the UK and the US—I imagine that figures are the same for Canada.
Many pediatricians and psychiatrists give up this uniform because it is seen as scary by their patients. Other formerly white-coated physicians now take their coats off to avoid causing “white coat hypertension” in their patients. Yet others abandon the coat because they feel more part of the team when they wear scrubs. In my 40-plus years of medical practice and teaching I always wore a white coat. What “bugged” me was that the hospital did not want to launder the coats free of charge.
—George Szasz, CM, MD
Reese S. Do you wash your white coat often enough? Medscape. Modified 21 November 2016. www.medscape.com/viewarticle/869813_2.
Picard A. Globe and Mail. Modified 2 July 2012. www.theglobeandmail.com/life/health-and-fitness/health/why-do-physicians...
This posting has not been peer reviewed by the BCMJ Editorial Board.