Why does everybody want to wear a white coat? At work these days, I feel like it’s all the rage. I see the phlebotomist, the radiology tech, and the nursing manager… Everyone’s kind of running around like a modern medical ghostie! And I just don’t get it. Here are a few reasons why nobody should want to wear a white coat:
First, white coats are gross. There have been a lot of studies looking into white coat cross-contamination and it turns out 100% of them are contaminated with staph aureus. Some studies show that up to 32% of white coats are contaminated with MRSA. That means that in addition to a healing hand and a listening ear, you’re bringing your next patient a side order of MRSA 32% of the time. Some studies show that you can minimize the cross-contamination by laundering your coats daily, but who does that? Not me.
Second, white coats are unhealthy. I tried to find data about “white coat hypertension” and I found one thousand eight hundred and twenty-three studies. Now, as it turns out, white coat hypertension is pretty much pre-hypertension, but do you want to be giving your patient a quasi-cardiovascular risk factor just by walking into the room? I don’t think so!
Third, white coats are dirty. We’ve already covered the bacterial grossness, but that was on a micro level. Let’s get macro-gross: It only takes one patient encounter to convert your pristine, diamond-toned white coat into a questionable Jackson Pollack interpretation (and let’s be honest, who likes Jackson Pollack, really?). It’s difficult to clean a white coat well and even if you’re one of those “laundering daily” unicorns, industrial bleach can only do so much. In this way, your white coat is a testament to all of your previous patient encounters. Stool, blood, gastric contents, wayward pens–it’s like a breadcrumb trail of your clinical history.
Finally, and most importantly, the white coat is mine, so hands off! It is what I wear, and it is what patients think I wear. Children identify their doctors by the presence of a white coat 69% of the time. The parents of those pediatric patients have similar identification abilities—that is to say, it is harder for both parents and children to identify providers as physicians if they don’t wear a white coat. According to this same study, groomed mustaches and beards are also “rated favorably,” but I’m pretty out of luck in terms of growing a groomed mustache and/or beard.
White coats improve patient satisfaction. There is another study that shows that patient trust and confidence directly relates to their doctor’s professional dress. And what do patients identify as professional dress? 76.3% of the time, it’s a white coat. 10% of the time it’s surgical scrubs, and the other casual/business attire milieu make up the remainder. This is important because patients are more likely to share personal history like drug history and sexual history, with someone who they trust. I see this sometimes with residents—I come back from the patient’s room and say something like “did he tell you about his penile discharge?” and the resident is taken aback, rightly so, because they asked and the patient denied it. I’d like to attribute this difference in disclosure to my sage countenance and insightful questioning, but I think it’s probably because of the white coat.
Not only do white coats improve physician identification, patient satisfaction, and patient trust, but they also hold clinical tools. My white coat holds my pen light and my Snellen card (when was the last time you got a good visual acuity without waiting for several hours?), it holds my stool guaiac, my stool guaiac cards, and it holds my teeny tiny measuring tape for measuring abscesses, lacerations, and patient height for the calculation of lung protective ventilation. It holds my sharpie, my post-its, and my pen. It holds my smooshed granola bar (don’t tell Joint Commision), and most importantly, it holds my paper-brain, which is where I make tiny cuneiform notations about the patients I’ve seen over the shift so I can do my charting the next day, or the next day, or the next. I can never finish my charts in real time these days.
On a more personal note, my white coat diverts distraction. The same study that showed white coats increase patients’ trust also showed that it mattered more if that physician was a female. Reading this study, I was immediately reminded of the old riddle: “a father and his son get into a car crash. The father is killed immediately. The son, in critical condition, is rushed to the hospital, where the head surgeon says, aghast, ‘I can’t operate on this patient! He’s my son!’ How can this be?” To put it differently, if a woman is not wearing a white coat, it’s fairly easy to imagine that she’s someone else in the care-provider team.
This study, and others, prompted me to perform my own randomized, controlled, not double-blinded study in which I alternated whether or not I wore my white coat during clinical shifts. It may come as no great surprise to you that I was interrupted a lot less when wearing the coat. I had to bring less blankets, less water, unhook less monitors. If I was sitting on my computer charting I was less likely to be asked for directions or for assistance in using the phone. This is not a rigorous (or frankly, publishable) study, and I can’t prove causation, but I can say that when I wore a white coat, I was interrupted half as frequently. This, in turn, made me a better physician. I could think about complex problems more thoroughly. I was less likely to forget that repeat dose of morphine, the consultant waiting on the line, or the family sitting in the waiting room eager to hear about a loved ones’ events in our department. My care improved.
I understand that this is a conflicting message. I have reduced the white coat to a walking comorbidity and also extolled its virtues as a symbol of our training and a talisman of respect. I guess what I’m saying is that the decision to wear a white coat is a difficult one, and it should be physicians’ decision to make. Like all dangerous clinical decisions, we should carefully weigh the pros and cons and accept risks as necessary for benefits that enrich our clinical practice, or decide that the risks are too profound and we can manage our “soft skills” in a different way. This is our garb and our profession, and our decision to make.
1) Uneke CJ, Ijeoma PA. The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. World Health Popul. 2010;11(3):44-54.
2) Kollias A, Ntineri A, Stergiou GS. Is white-coat hypertension a harbinger of increased risk? Hypertens Res. 2014 Sep;37(9):791-5.
3) Matsui D, Co M, Rieder MJ. Physicians’ attire as perceived by young children and their parents: the myth of the white coat syndrome. Pediatr Emerg Care. 1998 Jun;14(3):198-201.
4) Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med. 2005 Nov;118(11):1279-86.