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EDITORIAL
Year : 2018  |  Volume : 11  |  Issue : 4  |  Page : 285-286  

To wear or not to wear: Is it time to return the borrowed white coat?


Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication2-Aug-2018

Correspondence Address:
Amitav Banerjee
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_93_18

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How to cite this article:
Banerjee A. To wear or not to wear: Is it time to return the borrowed white coat?. Med J DY Patil Vidyapeeth 2018;11:285-6

How to cite this URL:
Banerjee A. To wear or not to wear: Is it time to return the borrowed white coat?. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Jul 17];11:285-6. Available from: http://www.mjdrdypv.org/text.asp?2018/11/4/285/238181



Prior to the 19th century, doctors dressed in black clothes in keeping with the formal and serious nature of medical encounters.[1] The patient's referral to the doctor was an act of desperation as medicine was primitive, most treatments were worthless, and the visit was often a precursor to death. In such solemn somber situations, black was appropriate for both physicians and priests.

In the 19th century, scientists working in lab coats commanded more trust and respect. The doctor was distrusted as a quack as modern medicine was yet to find its bearings.[2] In an attempt to gain respectability, doctors borrowed the lab scientist's coat, which came to be known as the “apron.” Over the next century, miraculous advances in modern medicine elevated the physician from the pit to the pedestal next to God. The white coat halo around the healers became firmly established. The apron also had a strong placebo effect instilling cheer and confidence among both patients and doctors.

The era of antiseptic surgery fostered by Joseph Lister's contribution further elevated medicine from home remedies to bioscience with better survival outcomes. White garments of doctors and nurses became the new symbol of cleanliness and hygiene, replacing the dull black of an earlier era.[3]

Rapid medical advances in the 20th century firmly established the doctor–patient relationship as a favorable interaction and the physician in a white coat became a symbol of modern medicine.[4]

In the era of evidence-based medicine, what is the level of evidence of doctor's attire on the doctor–patient relationship? No randomized controlled studies have been done. Observational studies show that most patients prefer physicians to dress in formal attire rather than casually, for example, in jeans.[5] Good dress sense has also shown to increase confidence in the doctor's competence.[6],[7] On the other hand, too much formal attire on the doctor's part may increase the doctor–patient communication gap as patients may perceive the doctor to be less approachable.[6]

The white apron of the doctor offers the middle path to reconcile this contradiction.[5] The doctor's white coat serves to instill confidence and perceived competence and at the same time not too formal to distance the doctor from the patient.[5]

However, in recent times, the worldwide tradition of doctors wearing white coat has become a subject of debate. Ironically, the doctor's white coat which after Lord Lister's era of antiseptic surgery symbolized cleanliness and hygiene has been attributed to contribute to nosocomial infections on the basis of studies demonstrating microbial growth in apron sleeves and pockets.[8]

This concern is aggravated by the fact that aprons are laundered infrequently and can be a potential vehicle for spread of hospital infections.[9] Studies have confirmed that many microorganisms detected on doctors' white coat are antibiotic resistant including the dreaded methicillin-resistant Staphylococcus aureus. Such reports have led some countries to ban the doctor's white coat. The British Department of Health banned the white coat from hospitals in England, changing the dress code for doctors to “Noncoat bare-below-the-elbow policy, which facilitates thorough handwashing.[8] The Ministry of Health of the United Arab Emirates has issued a notice decreeing that doctors should not wear their white coats outside the sterile medical facilities to cut the risk of nosocomial infections.[10]

Besides the risk of hospital infections, aprons are losing prestige for aspiring doctors. Doctors who were raised from the pit to the pedestal during the heady days of medical discoveries appear to be falling from their haloed position. Progress is slowing, and medicine appears to have reached the limits of its potential. Much hyped new technologies such as the human genome project have only yielded modest results to date.[11] Death is no longer accepted as the natural history of end of life in spite of the reality that all must die. Modern medicine tries to intervene on people during their last 6 months of life with poor outcomes and exorbitant cost.[12] Many patients feel frustrated as realities do not match the high expectations fuelled by the media's coverage of “medical breakthroughs” which fail to deliver in the long run. These and other factors are eroding the doctor–patient relationship. Litigation and violence against doctors have become rather too common.[13]

In these difficult times, medicos who were once proud of wearing their aprons on and off campus hesitate to wear them off campus. One medical student approached the author for guidance on a survey on whether “Medicos feel safe to wear aprons outside the hospital campus”?

For doctors, the wheel has come full circle. We borrowed the apron from the scientist in the lab to gain respectability which we got with advances in treatment and outcomes. Now, the progress has slowed down and doctors are losing the pride of place earned over the years. Most of the progresses are in medical instrumentation driven by advances in engineering and computer sciences, further marginalizing the doctor. Younger generations of doctors are rapidly losing history taking and clinical skills perfected by clinicians of an earlier era. Due to this, they are also losing the rapport with the patient (with or without apron).

Is it time to return the borrowed white coat?



 
  References Top

1.
Hochberg MS. The doctor's white coat – An historical perspective. Virtual Mentor 2007;9:310-4.  Back to cited text no. 1
    
2.
Jones VA. The white coat: Why not follow suit? JAMA 1999;281:478.  Back to cited text no. 2
    
3.
Blumhagen DW. The doctor's white coat. The image of the physician in modern America. Ann Intern Med 1979;91:111-6.  Back to cited text no. 3
    
4.
Anvik T. Doctors in a white coat – What do patients think and what do doctors do? Scand J Prim Health Care 1990;8:91-4.  Back to cited text no. 4
    
5.
Brase JL, Richmond J. The white-coat effect: Physician attire and perceived authority, friendliness, and attractiveness. J Appl Soc Psychol 2004;34:12:2469-81.  Back to cited text no. 5
    
6.
Gledhill JA, Warner JP, King M. Psychiatrists and their patients: Views on forms of dress and address. Br J Psychiatry 1997;171:228-32.  Back to cited text no. 6
    
7.
Hennessy N, Harrison DA, Aitkenhead AR. The effect of the anaesthetist's attire on patient attitudes. The influence of dress on patient perception of the anaesthetist's prestige. Anaesthesia 1993;48:219-22.  Back to cited text no. 7
    
8.
Shelley BP. Doctors' White coat and the evidence boondoggle: Microbiology, desiderata, symbolism, or professionalism decorum? Arch Med Health Sci 2016;4:161-5.  Back to cited text no. 8
  [Full text]  
9.
Wiener-Well Y, Galuty M, Rudensky B, Schlesinger Y, Attias D, Yinnon AM, et al. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011;39:555-9.  Back to cited text no. 9
    
10.
Amir S. A Doctors and Pharmacists Told not to Wear Their White Coats Outside of Medical Facilities. The National; 14 October, 2017. Available from: https://www.thenational.ae/uae/doctors-and-pharmacists-told-not-to-wear-their-white-coats-outside-of-medical-facilities-1.667075. [Last accessed on 2018 Jun 10].  Back to cited text no. 10
    
11.
Braithwaite J. The medical miracles delusion. J R Soc Med 2014;107:92-3.  Back to cited text no. 11
    
12.
Le Fanu J. The Rise and Fall of Modern Medicine. 2nd ed. New York: Basic Books; 2012.  Back to cited text no. 12
    
13.
Banerjee A. Perspectives on violence against doctors. Perspect Med Res 2018;6:6-13.  Back to cited text no. 13
    




 

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