This is my somewhat random question for the day. I will be doing an away clinical rotation in England and was wondering if students wear a short or long coat there by tradition.

Thanks.

No, there is no long-coat short-coat thing here :). Just wear one. Or, with some consultants/rotations, you don't even wear one. They're just spreaders of disease serving no purpose except providing pockets.

We don't generally wear white coats here in the UK. They are seen as outdated, unnecessary and vectors of infection spread.

yes, but the pockets, think of the pockets! :)

Pardon my naivety on this, but what is it about white lab coats that make them infection spreaders?

you see lots of patients in them and their little critters get all over it, you touch it with your hands before you touch your patient and spread buggies. They say the same thing about mens ties. :eek:

I just came home and did a rotation this summer in Canada. I bought lots of new white lab coats and no one wore them in the hospital! I just threw on a pair of scrubs for ER shifts. On the wards it was suprisingly casual.

you see lots of patients in them and their little critters get all over it


I'm sorry. Critters? What are you talking about? The patients' critters? Or something else. Please define critters. I thought critters = wildlife animals.

LOLOL well, critters is a rather non-specific term for small things that run around. You could refer to something like a chipmunk as a woodland critter, but critters normally mean "bugs." White coats are just asking for spread of infection, because the long sleeves can brush off a patient you're attending to, and then you go see another patient who you may also inadvertently touch with your white coat. Even if you're wearing gloves and have washed your hands. It's the same principle as why male doctors have to roll up their sleeves before handling a patient. Also, we ourselves are constantly contaminating our white coats by taking things in and out of the pockets, etc.

When you go see a patient in isolation because of MRSA or something, you're actually required to take the white coat off before you enter the room...so the white coat is pretty useless except for the pockets.

LOLOL well, critters is a rather non-specific term for small things that run around. You could refer to something like a chipmunk as a woodland critter, but critters normally mean "bugs." White coats are just asking for spread of infection, because the long sleeves can brush off a patient you're attending to, and then you go see another patient who you may also inadvertently touch with your white coat. Even if you're wearing gloves and have washed your hands. It's the same principle as why male doctors have to roll up their sleeves before handling a patient. Also, we ourselves are constantly contaminating our white coats by taking things in and out of the pockets, etc.

When you go see a patient in isolation because of MRSA or something, you're actually required to take the white coat off before you enter the room...so the white coat is pretty useless except for the pockets.



Forgive me if I'm sounding like the devil's advocate here, but isn't all this talk of the chances of a coat causing infection a bit foolish. Yes, obviously a coat could come in contact with a sick patient and then later in the day spread some germs to another patient, but then again so can regular clothes. So, I just don't see what the big deal is. Maybe, we should just all wear scrubs and after seeing each patient, we should take a shower and put on new scrubs. Rinse, lather, repeat. So, why not just say that we should just wear space suits or something instead of normal clothes?

You could see it like that, but a lot of teams won't use white coats just to curb one more aspect of infection control. The normal clothes you wear on your body are easier to handle because for the most part, work clothes are rather tight fitting and shirts are tucked in. Some men will tuck in their ties as well. A white coat is harder to handle because it's quite a flowy garment. It may seem stupid to you, but it's not in places where MRSA is a problem and people are doing all possible to make sure it doesn't get worse. Critters are scary things. The same principle applies to the necessity of cleaning the stethoscope bell after each use. Here are some research artcles (pubmed) about the topic:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1773186&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12825118&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11123387&query_hl=1

if clean white coats were as readily available as scrubs, then they may not be so much of an issue with regard to the spread of infection (i.e. enter hospital, get a clean white coat, wear during day, change if dirty, remove end of day, place in hospital laundry. start next day with fresh white coat).
however, the case in the uk (at least at my med school), you buy your white coat, wear it during ward teaching when a consultant requires it, stick it in your bag/locker, wear it again at next teaching session. otherwise you're in a your normal everyday clothes.
so, you could argue, the white coat is not so much the problem, but how often its washed.
i do like the pockets though!

you see lots of patients in them and their little critters get all over it, you touch it with your hands before you touch your patient and spread buggies. They say the same thing about mens ties. :eek:

So what do they wear, if they don't wear white coats??? According to what you are saying, anything you wear, you will spread disease, b/c you will touch whatever you are wearing. That argument makes no sense.

> According to what you are saying, anything you wear, you will spread
> disease, b/c you will touch whatever you are wearing.

Potentially yes. But a long sleeved white coat which typically doesn't get laundered daily is just more of a vector than a short-sleeved scrub-top for example. Anything with long sleeves is bad, because it limits your ability to effectively wash (or sanitize) your hands and wrists between patient contacts.

Reminds me of an article I read last year:


http://bmj.bmjjournals.com/cgi/content/full/328/7430/57?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=coat&andorexactfulltext=and&searchid=1127951509411_21703&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4

And a pretty funny response in the letters section:


http://bmj.bmjjournals.com/cgi/eletters/328/7430/57#56305

As the chief medical resident (senior registrar) at a university hospital 45 years ago, my height and long arms precluded my wearing one of the white coats supplied by the institution. And everyone admired my well-tailored buttondown shirts and stylish ties. That is until the arrival of a new medical director. An insecure man with a whining, high-pitched nasal voice he found fault with anyone he considered a rival to his authority.

At a weekly medical grand rounds presentation, shortly after his arrival, and as I began to tell the physician audience the reason for presenting this particular case, he abrupty jumped up and demanded to know why I was not wearing a white coat. Sitting in the audience and obviously annoyed by the puerile deprecation, the chief of medicine, a man of great physical and academic stature, issued an unforgettable rebuke. Staring down at my antagonist, his deep baritone voice reverberating in the auditorium, he said, "Dr. ____, some of us must wear white coats so patients will know we are doctors and then there are those of us who patients immediately recognize as a physician." The utter silence of the audience that followed this stunning rebuke is oddly one of the most memorable events in my medical half-century. During my years of private practice, I continued to wear those well-tailored shirts, stylish ties but no white coat.

> According to what you are saying, anything you wear, you will spread
> disease, b/c you will touch whatever you are wearing.

Potentially yes. But a long sleeved white coat which typically doesn't get laundered daily is just more of a vector than a short-sleeved scrub-top for example. Anything with long sleeves is bad, because it limits your ability to effectively wash (or sanitize) your hands and wrists between patient contacts.

Reminds me of an article I read last year:


http://bmj.bmjjournals.com/cgi/content/full/328/7430/57?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=coat&andorexactfulltext=and&searchid=1127951509411_21703&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1,2,3,4

And a pretty funny response in the letters section:


http://bmj.bmjjournals.com/cgi/eletters/328/7430/57#56305

As the chief medical resident (senior registrar) at a university hospital 45 years ago, my height and long arms precluded my wearing one of the white coats supplied by the institution. And everyone admired my well-tailored buttondown shirts and stylish ties. That is until the arrival of a new medical director. An insecure man with a whining, high-pitched nasal voice he found fault with anyone he considered a rival to his authority.

At a weekly medical grand rounds presentation, shortly after his arrival, and as I began to tell the physician audience the reason for presenting this particular case, he abrupty jumped up and demanded to know why I was not wearing a white coat. Sitting in the audience and obviously annoyed by the puerile deprecation, the chief of medicine, a man of great physical and academic stature, issued an unforgettable rebuke. Staring down at my antagonist, his deep baritone voice reverberating in the auditorium, he said, "Dr. ____, some of us must wear white coats so patients will know we are doctors and then there are those of us who patients immediately recognize as a physician." The utter silence of the audience that followed this stunning rebuke is oddly one of the most memorable events in my medical half-century. During my years of private practice, I continued to wear those well-tailored shirts, stylish ties but no white coat.

the need to wear a white coat = insecurity.

So what do they wear, if they don't wear white coats??? According to what you are saying, anything you wear, you will spread disease, b/c you will touch whatever you are wearing. That argument makes no sense.

It could. But they just wear a shirt and tie. When they lean over the patient, they tuck their ties into their shirts so that the tie won't accidentally hang over or brush the patient's body. They roll up their sleeves to nearly their elbows so that the cuffs can't brush off anything either. Then they wear gloves and make sure that they touch the affected area(s) with the glove-covered part, and not the bare skin of their forearms. Pretty much, every article of clothing is kept as tightly to the physician as possible.

With a white coat, you can't do these. You can't really roll up the sleeves of a white coat, you can't prevent the tail end of a white coat from billowing out. Jetpropilot, that's a cool story!

As the chief medical resident (senior registrar) at a university hospital 45 years ago, my height and long arms precluded my wearing one of the white coats supplied by the institution. And everyone admired my well-tailored buttondown shirts and stylish ties. That is until the arrival of a new medical director. An insecure man with a whining, high-pitched nasal voice he found fault with anyone he considered a rival to his authority.

At a weekly medical grand rounds presentation, shortly after his arrival, and as I began to tell the physician audience the reason for presenting this particular case, he abrupty jumped up and demanded to know why I was not wearing a white coat. Sitting in the audience and obviously annoyed by the puerile deprecation, the chief of medicine, a man of great physical and academic stature, issued an unforgettable rebuke. Staring down at my antagonist, his deep baritone voice reverberating in the auditorium, he said, "Dr. ____, some of us must wear white coats so patients will know we are doctors and then there are those of us who patients immediately recognize as a physician." The utter silence of the audience that followed this stunning rebuke is oddly one of the most memorable events in my medical half-century. During my years of private practice, I continued to wear those well-tailored shirts, stylish ties but no white coat.

Classic! :laugh:

I just want to point out that this is not MY story but rather a letter to the editor of the BMJ from a practicing physician in CT in reply to an article about the white coat cult.

just to update any international students doing electives in the UK, white coats are now banned in most hospitals here. The recommended dress is for everyone to be bare below the elbows with no watches or rings apart from a wedding ring, and men to wear open shirts without ties unless secured by a tie pin. This is all for infection control reasons although everyone acknowledges there is little evidence behind it.

this has just come in so it very patchily adhered to, and consultants certainly don't obey it. But the white coat is a real no no in the UK.

this has just come in so it very patchily adhered to, and consultants certainly don't obey it. But the white coat is a real no no in the UK.

I would say it's pretty strictly adhered to! Most places you would be screamed at for even suggesting wearing long sleeves or a watch let alone a white coat or a tie.

that's why i say patchy - wherever you are it's obviously strictly adhered to, but where i am it's just words, no one cares whether you're in short sleeves etc...

that's why i say patchy - wherever you are it's obviously strictly adhered to, but where i am it's just words, no one cares whether you're in short sleeves etc...

Where the hell are you? Some dodgy backstreet clinic?

the top medical school in the country according to the Guardian University Guide 2008, if you'd like to call that a dodgy backstreet clinic :)

In the Hospital i work in my job is a maintenance assistant and recently thanks to Gordon brown's new deep clean plan,scrubs and white lab coats have been banned on docotor's but other types of professions like paitient porters and surgeons they wear them. The only people who seem to wear white lab coats are the people who work in microbiology.

Although i see no difference in wear as casual clothing still would have thousands of germs like MRSA and C.DIFF, The only real way would be to wear fresh scrubs on the entrance to a ward and then remove on exit but thats ALOT of washing and very inconvenient and time consuming or you could put high intesity ultraviolet lights on the entry to kill the germs.


Sorry if off topic i just saw you talking about critters and such.

just to update any international students doing electives in the UK, white coats are now banned in most hospitals here. The recommended dress is for everyone to be bare below the elbows with no watches or rings apart from a wedding ring, and men to wear open shirts without ties unless secured by a tie pin. This is all for infection control reasons although everyone acknowledges there is little evidence behind it.

this has just come in so it very patchily adhered to, and consultants certainly don't obey it. But the white coat is a real no no in the UK.
I think it's curious that white coats are not OK because they spread infection, but stethoscopes (which actually touch patients' bare skin) are still flung around a medic's neck and carried from room to room.

They usually use alcahol wipes on things like a stethoscopes inbetween patients.