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 and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.