Hospital heirarchy--the need to differentiate

[guest1234567]

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It's annoying. You walk into a hospital and you have no idea who is who. Today, everyone wears a long white coat--the phlebotomists, the OR-Techs, the orderlies, the premed volunteers (I'm not even kidding about this), the nurses, the cafeteria workers, janitors, etc.

The problem is, we can't even tell who the attendings are from the residents or from the orderlies. Neither can the patients. Imagine how frustrating that is--going into the hospital and having no idea that you are seeing a PA instead of an attending. I propose the following solution:

1. nurses wear only pink scrubs, no white coats
2. med students wear only green scrubs and short coats
3. PA's wear green scrubs, no white coats
4. residents wear only blue scrubs and long white coats
5. attendings wear only grey scrubs and long white coats
6. All support staff wears green scrubs, without white coats

Problem solved, everyone knows who is who and the patients wouldn't have to squint to read a name badge to figure out who they are actually talking to. This would cut down on patient frustration as they wouldn't be so confused by a heirarchy that they don't understand.

 

[renox9]

hehe..i bet the male nurses will love that system

 

[DrMom]

Hmmm. On most of our rotations we have to dress up.

 

[Winged Scapula]

hehe..i bet the male nurses will love that system

I think the Trauma team (including male nurses and residents) at Baltimore Shock trauma look cute in their pink scrubs. Its a matter of pride to wear the pink - you're a member of the team.

I suppose it was started because people don't want to steal pink scrubs and wear them out in public.

 

[amy2003uva]

I think the Trauma team (including male nurses and residents) at Baltimore Shock trauma look cute in their pink scrubs. Its a matter of pride to wear the pink - you're a member of the team.

I suppose it was started because people don't want to steal pink scrubs and wear them out in public.

hi kimberli -
sorry for the off-topic post, but you piqued my interest when you mentioned baltimore shock trauma. did you do an away rotation there during med school or spend any time there? though still early in the game and i'm just starting med school this fall, i'm from the baltimore/dc area and am interested in possibly pursuing a residency at shock trauma. what have your experiences (if any!) been like there?
thanks for the input! 🙂

 

[ItsGavinC]

Yes, problem solved indeed.

 

[trudub]

I completely agree. I have said for a long time that a system needs to be in place that is standardized nationally with different colors of scrubs for different members of the team. It would just clarify so much. It is a really good idea!!

 

[sacrament]

At my hospital it goes like this:

med students: short white coats
every employee of the hospital, including but not limited to residents, attendings, lab techs, phlebotimists, candy stripers, janitors and cafeteria workers: long white coats

 

[Crake]

Haha, I do research with this really arrogant jerk. he was wearing a long white-coat over scrubs, had a stethoscope in his pocket, and a namebadge just like the residents. So I asked if he was a resident. This didn't go over well, as he's in his second application cycle now, still with no acceptances. I guess if you can't get into medschool, at least you can dress like a resident and look down your noses at the other premeds!

 

[Winged Scapula]

hi kimberli -
sorry for the off-topic post, but you piqued my interest when you mentioned baltimore shock trauma. did you do an away rotation there during med school or spend any time there? though still early in the game and i'm just starting med school this fall, i'm from the baltimore/dc area and am interested in possibly pursuing a residency at shock trauma. what have your experiences (if any!) been like there?
thanks for the input! 🙂

I've never rotated there. My BF is a fellow there so I am familiar with some aspects of the system.

 

[mrezai]

1. nurses wear only pink scrubs, no white coats
2. med students wear only green scrubs and short coats
3. PA's wear green scrubs, no white coats
4. residents wear only blue scrubs and long white coats
5. attendings wear only grey scrubs and long white coats
6. All support staff wears green scrubs, without white coats

How do you tell the support staff from the PAs?

 

[amy2003uva]

Hospital Color Codes Staffers to Help Patients

By Peggy Peck, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
April 01, 2005

Review
CLEVELAND-Patients at the Cleveland Clinic starting on Monday won't see red. Instead, they'll see white, black, royal blue, hunter green, and purple. The hospital has color-coded its staffers so that patients, in principle, will know who is who.


Patients will be issued color charts to help them differentiate nurses from respiratory therapists and attending physicians from residents and fellows.


The administration of the 1,000-bed institution says the initiative is in response to patient-satisfaction surveys. A frequent complaint was that patients didn't know the status of staffers who entered their rooms.


During a typical hospital stay, the average patient is visited by dozens of Cleveland Clinic staffers, said Claire Young, RN.. MBA, the chief nursing officer. She sys that most identify themselves to patients, but it can get confusing.


For instance, a transporter-the clinic term for aides that spend their days pushing hospital carts and wheel chairs--may be mistaken for a nurse. "A transporter could come into a room and a patient may ask for help-help that the transporter is not capable of giving," she said. "Later that patient may complain to that 'a nurse' didn't help when asked to do so."


Now all a patient has to do is consult the color chart and see that the purple-clad person is a transporter, not a nurse at all.


In fact, the chart will allow patients to identify the specific job of anyone who enters a room-including the doctors. It will now be possible, says Young, to "instantly identify the personnel in the room-attending physicians, residents, nurse and techs-in emergency situations." This can help staffers as well as patients, says Young.


Traditionally, Cleveland Clinic physicians wear unadulterated white lab coats. Now all 1,200 attendings will be wearing lab coats that are embroidered with black thread. On the right front side of the coat, the Cleveland Clinic logo will be embroidered as will the clinic department. On the opposite side the doctor's name will be embroidered in black script.


All 900 physicians-in-training-from first year residents to post doctoral fellows--will wear lab coats embroidered with royal blue thread. Their names will be in block letter style.


Nurses, meanwhile, will have a retro look, and all will wear white. All 1,800 nurses have been supplied with six new, white uniform pieces-with dresses counting as two pieces just as scrubs (top and bottom) are two pieces.


The Clinic's four hundred "patient care technicians," a group that includes a wide variety of nursing aides and techs, will all wear distinctive hunter green.


The new uniforms cost $150,000. The clinic bought its own embroidery machine.

 

[mufaddal]

Glad to see Cleveland Clinic going in the right direction. Its better for both patients and the house staff to know who is who.

But I guess its better than the oppostive, my preceptor NEVER wears his white coat in the clinic. Maybe its just personal, I don't know, but I felt awkward when I'm wearing my short white one next to him. But I got used to it. 🙂

 

[hospitalistpac]

I know this is late, but I don't know what was more offensive, the fact that you stripped PAs of coats or the fact that your propose we wear scrubs. I wear professional dress on days and scrub pants on over nights. I do not know of any PA or attending physician in non-surgical specialties who would walk around the hospital in green scrubs. Especially since that is the same color you propose the "support staff" wear. So you would like PAs confused with the dietary aids and housekeeping.
I am not sure that you are aware of this but state laws governing the practice of PAs requires that PAs identify themselves as such. My state, PA, requires the title "Physician Assistant" in 14 point letters to be on the lapel of your coat.

Sorry for the rant.

 

[docmorgan]

I know this is late, but I don't know what was more offensive, the fact that you stripped PAs of coats or the fact that your propose we wear scrubs. I wear professional dress on days and scrub pants on over nights. I do not know of any PA or attending physician in non-surgical specialties who would walk around the hospital in green scrubs. Especially since that is the same color you propose the "support staff" wear. So you would like PAs confused with the dietary aids and housekeeping.
I am not sure that you are aware of this but state laws governing the practice of PAs requires that PAs identify themselves as such. My state, PA, requires the title "Physician Assistant" in 14 point letters to be on the lapel of your coat.

I agree. Having everyone being color-coded is unrealistic (and a little too much like Communism). Name tags or badges with your title on them work just as well, without making men wear pink.

 

[athena21]

i think there needs to be a way to distinguish between medical students, besides how dirty our white coats are. A first year knows so much less than a 3rd year, yet we're all wearing the same coat and people think we're at the same level. The way residents tell what year i am is by how white my coat is and the fact that i don't carry much in it! Patients don't see that, though and think i know just as much as the 4th year who's been treating them.

 

[UCSBMed1]

i think there needs to be a way to distinguish between medical students, besides how dirty our white coats are. A first year knows so much less than a 3rd year, yet we're all wearing the same coat and people think we're at the same level. The way residents tell what year i am is by how white my coat is and the fact that i don't carry much in it! Patients don't see that, though and think i know just as much as the 4th year who's been treating them.

There is a way to differentiate them: its called a name badge.

If we're going to start IDing students by year, whats next, residents? Interns wear red, PGY 2-X where white, Chief/Senior residents blue? Come on. That isn't realistic, and besides, even if a 4th year knows infinite amounts regarding patient care than a first year straight out of college, all 4 are medical students, and should have a common identifier--just like residents and attendings alike all wear long white coats to signify them as MDs.

 

[tupac_don]

It's annoying. You walk into a hospital and you have no idea who is who. Today, everyone wears a long white coat--the phlebotomists, the OR-Techs, the orderlies, the premed volunteers (I'm not even kidding about this), the nurses, the cafeteria workers, janitors, etc.

The problem is, we can't even tell who the attendings are from the residents or from the orderlies. Neither can the patients. Imagine how frustrating that is--going into the hospital and having no idea that you are seeing a PA instead of an attending. I propose the following solution:

1. nurses wear only pink scrubs, no white coats
2. med students wear only green scrubs and short coats
3. PA's wear green scrubs, no white coats
4. residents wear only blue scrubs and long white coats
5. attendings wear only grey scrubs and long white coats
6. All support staff wears green scrubs, without white coats

Problem solved, everyone knows who is who and the patients wouldn't have to squint to read a name badge to figure out who they are actually talking to. This would cut down on patient frustration as they wouldn't be so confused by a heirarchy that they don't understand.

So you propose that pts get a manual when they check into the hospital, with who wears what scrubs, so when someone with green scrubs walks in they will say hold up let me look at my little book, oh yes you must be a PA. COme on give me a break. If a pt really wants to find out whether someone is a doctor or not, just ask. Also I think that most of the time health professionals can tell who is who, by the way people carry themselves. I certainly wont mistake a janitor for a doctor. Now mind you some PA's maybe, but then you just converse with them and you can quickly tell whether they are doctor or not. Also coats always tell you the designation, if the coat doesn't than the badge does. I don't see a problem here.

 

[Crake]

The PA's I work with wear blue surgical scrubs and long white coats. I didn't even know they weren't residents (or attendings for that matter) until one of them left their whitecoat in the office and I saw the namebadge. It's written so small and the badges all look the same. Heck, I have the same badge as the medical students only mine says "visiting student" instead of "medical student." How can a patient be expected to know the difference? How would they even know to look? Why is the burden on the patient to find out who is treating them?

Before I was premed, I honestly thought that only doctors wore whitecoats; I'm honestly suprised that nurses, PAs, techs and even premeds and volunteers do as well. I think the patient has a right to know whether the person discussing their treatment with them is a PA or a surgical attending.

The Cleveland Clinic is taking a step in the right directing, IMHO.

 

[ecoscuba]

well obviously, if it worked for star trek it should work in cleveland as well.

Actually I think it's a good idea.
Patient satisfaction and all.

 

[hospitalistpac]

The PA's I work with wear blue surgical scrubs and long white coats. I didn't even know they weren't residents (or attendings for that matter) until one of them left their whitecoat in the office and I saw the namebadge. It's written so small and the badges all look the same. Heck, I have the same badge as the medical students only mine says "visiting student" instead of "medical student." How can a patient be expected to know the difference? How would they even know to look? Why is the burden on the patient to find out who is treating them?

Before I was premed, I honestly thought that only doctors wore whitecoats; I'm honestly suprised that nurses, PAs, techs and even premeds and volunteers do as well. I think the patient has a right to know whether the person discussing their treatment with them is a PA or a surgical attending.

The Cleveland Clinic is taking a step in the right directing, IMHO.

First of all, law dictates that PAs introduce themselves as such before interviewing or examining a patient. It is illegal for a PA to 'pretend' to be a physician. Now, that doesn't mean patients listen though. I can go through a whole shmeal about who I am and what I do and still get call a Doctor or a Nurse but that is another story.
As for the whole white coat thing, I agree that too many people where them. But you forget that white coats serve a purpose above a status symbol: they protect your clothes and give you a place to carry your reference material, formulary, exam equipment.
I know it aggravates you now that these PAs are wearing la onger coat than you but once you are an attending and maybe work with PAs it won't bother you anymore. The lab techs and janitors that wear white coats probably will though but you won't notice it as much.

 

[chameleonknight]

Hmm.

I always make it a point to look at name badges, and I VERY distinctly remember the white coat wearing PA who walked into the clinic to see me (as a patient; minor leg injury) did not even introduce himself, much less as a PA not a doc.

You may think it's obvious what your role is, uh, because you're you, but the patient may not always pick up on the subtle differences in the hospital.

 

[Ross434]

First of all, law dictates that PAs introduce themselves as such before interviewing or examining a patient. It is illegal for a PA to 'pretend' to be a physician. Now, that doesn't mean patients listen though. I can go through a whole shmeal about who I am and what I do and still get call a Doctor or a Nurse but that is another story.
As for the whole white coat thing, I agree that too many people where them. But you forget that white coats serve a purpose above a status symbol: they protect your clothes and give you a place to carry your reference material, formulary, exam equipment.
I know it aggravates you now that these PAs are wearing la onger coat than you but once you are an attending and maybe work with PAs it won't bother you anymore. The lab techs and janitors that wear white coats probably will though but you won't notice it as much.

Why does a janitor wear a white coat. That doesnt seem right. He's scrubbing dirt!! WHITE COAT?! !? ?! ?!

 

[backrow]

Quite interesting that this topic comes up as I was just discussing this w/ my fiancee. My theory was long coats for MD/DO/PA/DDS/OD, short coat for students and something else for everyone else.

 

[Crake]

First of all, law dictates that PAs introduce themselves as such before interviewing or examining a patient. It is illegal for a PA to 'pretend' to be a physician. Now, that doesn't mean patients listen though. I can go through a whole shmeal about who I am and what I do and still get call a Doctor or a Nurse but that is another story.
As for the whole white coat thing, I agree that too many people where them. But you forget that white coats serve a purpose above a status symbol: they protect your clothes and give you a place to carry your reference material, formulary, exam equipment.
I know it aggravates you now that these PAs are wearing la onger coat than you but once you are an attending and maybe work with PAs it won't bother you anymore. The lab techs and janitors that wear white coats probably will though but you won't notice it as much.

So nurses need white coats too then? Afterall, they have thing they need to carry around as well. Even if it is just for the pockets, do PA's really require a LONG white coat? They need it to protect their scrubs? Come on.

The white coat isn't just a status symbol, it's an identifier, a far more recognizable one than the namebadge. Only MDs and DOs should wear long white coats--then the patient will have no trouble telling the doctor from the phlebotomist. The burden shouldn't be on the patient to find out who's treating them, that's ridiculous. Especially when they have to do it just to protect the egos of allied heathcare workers. A color-coded system just makes sense, especially in a situation where everyone has different levels of training. It's not Communism to be open about who is a doctor and who is a lab technician, it's just fair to the patient, if not as desirable to the staff. Again, I have to agree with what the Cleveland Clinic is doing.

 

[hospitalistpac]

So nurses need white coats too then? Afterall, they have thing they need to carry around as well. Even if it is just for the pockets, do PA's really require a LONG white coat? They need it to protect their scrubs? Come on.

The white coat isn't just a status symbol, it's an identifier, a far more recognizable one than the namebadge. Only MDs and DOs should wear long white coats--then the patient will have no trouble telling the doctor from the phlebotomist. The burden shouldn't be on the patient to find out who's treating them, that's ridiculous. Especially when they have to do it just to protect the egos of allied heathcare workers. A color-coded system just makes sense, especially in a situation where everyone has different levels of training. It's not Communism to be open about who is a doctor and who is a lab technician, it's just fair to the patient, if not as desirable to the staff. Again, I have to agree with what the Cleveland Clinic is doing.

The burden should not be on the patient! It should be on the clinician!
I wear professional dress so I'm not going to start wearing scrubs to satisfy med students egos. I think different allied health departments in hospitals do color code and that is great. For example PT/OT wear green in my hospital. As far as lab techs go, I never see them wearing long white coats or white coats in general. They walk around with a cart of phlebotomy material and go into pts room and daw their blood, if the pt thinks that is their doctor that is their problem.
In response to your question, do PAs really need long white coats. The answer is no, no one needs LONG white coats. I could wear a short one and it would carry my materials but then how would staff differentiate me from the PA students? I dunno but we PAs have been wearing them for 30 years. Again, once you are an attending you will not mind.

 

[Crake]

The burden should not be on the patient! It should be on the clinician!

. . .if the pt thinks that is their doctor that is their problem.

Wait, so is it the patient's fault for not knowing who is treating them? You say that the burden is on the clinician, and then turn around and say it's too bad if the patient can't tell the phlebotomist from the attending.

Is it really too much to ask that all the allied healthcare workers in a hospital wear scrubs? Sure they may not want to; they may prefer to wear long white coats and surgical caps--but honestly, it's not an ego thing, it is about the patient and the patient alone.

Sure when I'm an attending (should that ever happen) I won't care about the ego boost I get from my long white coat, and won't care that everyone else wears the same. But it's not about that, attendings that feel that way are doing their patients a disservice by making the system so confusing. There is no way that someone should have to ask for an introduction or squint at a namebadge to find out if they're being seen by the chief of surgery or a phlebotomist. That's ridiculous, especially when such an obvious means for differentiation (colored scrubs) is appropriate and available.

 

[hospitalistpac]

Wait, so is it the patient's fault for not knowing who is treating them? You say that the burden is on the clinician, and then turn around and say it's too bad if the patient can't tell the phlebotomist from the attending.

Is it really too much to ask that all the allied healthcare workers in a hospital wear scrubs? Sure they may not want to; they may prefer to wear long white coats and surgical caps--but honestly, it's not an ego thing, it is about the patient and the patient alone.

Sure when I'm an attending (should that ever happen) I won't care about the ego boost I get from my long white coat, and won't care that everyone else wears the same. But it's not about that, attendings that feel that way are doing their patients a disservice by making the system so confusing. There is no way that someone should have to ask for an introduction or squint at a namebadge to find out if they're being seen by the chief of surgery or a phlebotomist. That's ridiculous, especially when such an obvious means for differentiation (colored scrubs) is appropriate and available.

I did not mean to imply that is approriate for phlebotomists to wear anything other that scrubs. I do not think just anyone should wear white coats either. Just today I saw someone handing out lunch trays in one and I thought of all theses posts and I thought that was wrong. I also did not mean to imply that "allied health workers" should not wear suitable professional attire which in many cases are scrubs.
And no it is not the patient's fault for not knowing who is treating them. I think I made it clear that clinicians have a responsibilty to introduce themselves whether they are color coded or not.
You suggested that we color code allied health. That is fine with me as PAs are not allied health. All I said was that I wear professional dress. I think housekeeping, lab staff, transporters, etc, should by all means wear scrubs.
I'm sorry if that was not clear in my earlier posts. I