A recent article in a major newspaper asked why physicians still wear white coats. The theme echoed many recent stories about bacterial contamination of clothing and other inanimate objects.
It also brought to mind a controversial rule instituted by the UK’s National Health Service in 2008 that medical and nursing staff could not wear ties or white coats and had to have arms “bare below the elbow.”
Despite published papers reporting the existence of bacteria on white coats and ties, the UK policy was not based on any evidence linking coats, ties or long sleeves to transmission of infection to patients.
The subject has been debated for years. Yes, the white coat may be contaminated with bacteria. But whatever one wears may also be contaminated. What is the difference between wearing a white coat for few days and wearing a suit jacket or a pair of pants for a few days?
I wear a white coat for the following reasons: It has a lot of pockets; It protects my clothes from blood, vomit, pus and poop; It is easy to clean; It is laundered by my hospital.
I change it at regular intervals, usually amounting to fewer than 5 days.
Thankfully, I don’t get blood, vomit, pus or poop on me every day. When I do, I change coats immediately. I don’t wear the coat when I’m operating or doing a procedure like inserting a central line on the floor. Some days I might only have it on for an hour or two. Some days I’m in an office or doing paperwork and the coat is hanging up. The actual time of exposure of the coat to pathogens is not very long on any given day.
I doubt very much that doctors who don’t wear white coats have their suits, sport coats or pants dry cleaned that frequently.
Taking advantage of the adverse publicity about ties, I have stopped wearing them because it’s more comfortable rather than for an unsupported notion of an infection risk for patients.
More importantly, I wash my hands or use an antibacterial gel quite often.
Do you wear a white coat? Why or why not?
Skeptical Scalpel is a practicing 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 two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 315,000 page views, and he has more than 4,000 followers on Twitter.