Why I Wear a White Coat | Guest Blog

The topic of bacteria on white coats has been debated for years. I'm keeping mine. How about you?


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.

  • Stephen says:

    I wear my short white coat. Still same number of pockets but way more mobility with the lower body exposed. Maybe I will continue post med school. Those long white coats must be hot too!!

  • Aka Gvakharia says:

    I do. I also wear scrubs. Most of the time. Never a tie.

  • Gary Kiefer MD says:

    Looked at another way, bacteria, etc. on a white coat mean the coat is doing one of its job: protecting the wearer. The media, regulatory boards and many patients don’t seem to grasp the fact that we practice in a dirty, nonsterile world. I agree with ‘Skeptical Scalpel’: wash hands between patients AND let your patients SEE you do it! The coat at least identifies you as part of the healthcare team (often better than just a nametag).
    As to the coat being hot: I have no problem wearing a white coat on rounds here in Arizona; I just don’t wear it outside in the summer.

  • Carmen Gutierrez says:

    I see the white coat as a sort of unecessary costume.

    I want people to know that I am a doctor by my knowledge of medicine and not by the clothes I wear.

    I also think white coats make our patients really uncomfortable/nervous (White Coat Syndrome) and distances us from our patients so that we are less personable and more pretentious.

    • SkepticalScalpel says:

      Carmen, thanks for commenting. I hear what you are saying, but obviously, we don’t agree.

      My post was directed at the hysteria over bacteria on white coats and not the symbolism or relationship to patients issues.

      As Gary mentions, better the bacteria are on your white coat than your silk jacket.

      Maybe you are in a specialty that does not result in you becoming contaminated.

      Personally even though everyone knows I’m a doctor, I still like the white coat’s distinctive look.

  • Jackie says:

    I would just like people to consider what we expect from PPE and what nurses have been doing for years. My thoughts are:
    Wear a clean uniform everyday (in this case a white coat) and change when becoming soiled. Don’t wear it outside the clinical area and don’t wear it home. Launder it at a high temperature either at work or at home but separate from other laundery. That to me protects the patient and the employee and the general public

  • EmilyT says:

    I’m very late with this reply, and won’t challenge the bacteria issue, but as a patient I think the white coat unconsciously commands respect. If the doctor dressed in street clothes during my exams, I might be tempted to call them by their first name, and maybe even drop the Dr. title. I guess I’m old fashioned, but I want a visual reminder that I am seeing a doctor.

    Emily

    • SkepticalScalpel says:

      Emily, a lot of people feel the way you do. Others say if the doc calls me by my first name, I feel I can do the same. The issue is not settled.

  • Ben Gold says:

    I actually disagree with many of the comments above. I work in the Emergency Department and feel that even a minimally increased infection risk for the children, immunocompromised, and at risk individuals that we treat is not outweighed by the “personal satisfaction” of wearing a white coat. May site the professional appearance aspect of wearing a white coat, but informal studies have actually shown no patient preference for a white coat over either formal dress or scrubs. I personally feel that wearing a white coat for the sole purpose of appearing distinguished does not hold up if there is even the slightest increased infection risk.

    • SkepticalScalpel says:

      Thanks for reading and commenting. My question to you is, “What do you wear to work and how do you know it is not transmitting infection?”

      • Ben Gold says:

        I wear full scrubs which are changed daily. I admit, if one wants to wash their white coat daily, it likely would cause there to be a negligible increased infection risk, but few do. Additionally, the studies surrounding white coats and bacterial contamination show that the highest bacterial counts are on the cuffs and sleaves which are not present on scrubs. Yes, most of this is somewhat conjecture rather than pure science, but I think it makes sense enough to avoid a white coat.

        • SkepticalScalpel says:

          Ben, thanks again for the comments. If you want to carry the argument to it’s logical conclusion, I submit that the last few patients you see every day are exposed to all of the bacteria you picked up on your scrubs earlier. Maybe you should change them every hour.
          ***
          Are they supplied and laundered by the hospital or are they your own scrubs that you wash at home? If the latter, you are probably not getting them clean enough and you are contaminating your own house.
          ***
          Despite the studies that show bacteria on lab coats, ties, phones, keyboards, money, etc, no one has every proven that a disease has been transmitted from those sources.
          ***
          England has had a “no long sleeves” rule for about 5 years. Is there any data showing that there are fewer nosocomial infections now than in 2007?

  •  

     

     

    Physician's Weekly for Current Medical News, Events & Issues