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Should Doctors Wear White Coats? The Debate Continues

Should Doctors Wear White Coats? The Debate Continues
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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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An infectious disease fellow at the Harvard Medical School is convinced that white coats are covered in bacteria and cause infections. But in a post on a website called The Conversation, he admits that there is no conclusive evidence proving the latter.

Evidence—who needs evidence? In the piece, Dr. Philip Lederer quotes ID epidemiologists Drs. Eli Perencevich and Mike Edmond, who said, “we don’t need a randomized trial to prove that parachutes save lives, we also don’t need a trial of white coats.”

The parachute reference is to a 2003 paper in the annual humorous Christmas edition of the BMJ, which pointed out that parachutes have never been subjected to a randomized trial. It concluded, “We think that everyone might benefit if the most radical protagonists of evidence-based medicine organized and participated in a double-blind, randomized, placebo controlled, crossover trial of the parachute.” The parachute paper has been cited 145 times in the peer-reviewed literature and is constantly brought up to rebuff those calling for evidence.

It happens so often that the deputy editor-in-chief of the Canadian Journal of Anesthesiology, Dr. Greg Bryson recently tweeted, “The parachute argument. A signpost indicating that bull[*!@] lies ahead.”

Lederer goes on to recommend that physicians in the US adopt the 2008 UK rule called “bare below the elbows” which mandates all physicians must wear shirts with sleeves above the elbows, no ties, and no watches or rings.

If this policy has decreased the rate of hospital-acquired infections in the UK, wouldn’t someone have done a before-and-after study documenting this breakthrough by now?

A recent post by Dr. John Henning Schumann echoed what I have written before. He said, “I’d give up my white coat instantly if I knew it was spreading harmful bacteria. But colonization with bacteria is different from transmitting them to another person. Bacteria live on all of us, so are white coats necessarily worse than our other garments or even our own skin?”

My sentiments exactly. Whatever you wear is possibly going to be contaminated at some point. Most people are not going to dry clean their pants after every wearing or scrub their arms up to the elbow after seeing each patient.

Even though I practiced general surgery and critical care, I was rarely swimming in pus. People who complain about white coats seem to think we brush up against infected patients and dirty beds all day long.

After a debate on this topic during a session at this year’s Infectious Disease Week, a straw poll found 58% of the audience voted against going “bare below the elbows.” If ID docs at the largest annual meeting the specialty has can’t be convinced, who can?

Let’s focus on hand washing and more judicious use of antibiotics, both of which are prime areas for improvement.

Schumann ended his piece by promising to wash his white coat more often. That works for me.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

 

4 Comments

  1. Hum..Harvard ID guy. Likely overly obsessive in his specialty & with way too much time on his hands (..as well as numerous bacteria). I practice in a busy ED accommodating lots of MRSA carrying patients & I try to practice the usual contact precautions (hand washing etc.). More likely health providers are the recipients of likely colonization, not the culprits. Why pick on the white coat? I’m gonna bet this fellow practices in a very “sterile” atmosphere; changes his own white coat daily.. and has not developed “herd immunity” like those of us in a more rowdy clinical (yet “bacterial ridden”) environment.

    Reply
  2. Sorry for the delayed response. I just saw your comment. If you wore a coat with long sleeves, why would you need to wash your arms above your wrists? As I said in the post, you have to wear some clothes. Whatever you wear could become contaminated.

    Wash the white coats more often. Problem solved.

    Reply
    • Lab coats look more professional. Agree, wash them more often. Those wearing filthy lab coats, I guarantee you will wear filthy clothing and wash their hands less frequently.

      Reply
  3. Back when I was interning I cut the sleeves off the white coats because I could only wash up to my wrist which is the way almost all lab coats are made today. Talk about unsanitary, I run away from lab coats as they are filthy. How can you wash other than your fingers ? I personally see doctors wearing lab coats to their home and to stores. I know it is not generally done but they don’t wash their hands between patients and if they do with long sleeves think of the microbes that grow on them. Doctors are not the only ones at fault. Nurses and technicians who wear scrubs are included. White coats used to be in the hospital (and scrubs). for practical use of some cleanliness. Finally, this is not a new concept of cleanliness, remember Lister, carbolic acid germ theory? My comments come from combined experience of 90 years of practice.(my father had the 60 years.)

    Reply

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