White Coat

[Reg]

Advertisement - Members don't see this ad

Do you guys/gals wear a white coat while working in the ED? Are you concerned about the increased infection transmission risk from wearing the coat everyday?

I don't wear a coat in the ED. I find that I seem to overfill the pockets (which constantly spill out my very important contents), and the jacket is then too heavy which begins causing neck and body pain. I find it impossible to do procedures or really "get my hand's dirty."

Oh, and I posted a tread in 'general' regarding everyone's thoughts on physicians wearing a blue coat, to distinguish ourselves from everyone else (which is what the white coat was for, initially, but now that we're in an era of diminished hierachy and not wanting to hurt anyone's feelings, we allow everyone to wear a white coat to help boost their self-esteem) IMO

 

[11-44]

I find wearing a solid dark RED coat works well. As a physician, this colorful attire is sure to give me the notice I have worked so hard for. My procedural competence is no longer determined by the profoundness of the blood sprays and I avoid the approned 'Butcher' appearance the old white coat carried with it.

 

[Reg]

Although a red coat may disguise your incompetence in perfoming procedures...most of us wouldn't have that concern...

So, for the *rest* of us....

....I think it's important for people to be able to identify the nurse, the doctor, and "the others." Especially in the hosptial. You see this same problem in the nursing profession, where CNAs are mistaken as RNs, and this causes lots of frustration for all parties involved. Likewise, now that many more women are going into medicine, how easy is it to confuse an MD for an RN or RT, etc. - especially if everyone is wearing the same 'uniform.' Patient's need to be able to identify the doctor, period, for very obvious reasons.

 

[Apollyon]

Sorry to inject a little science, but, even IF a white coat is totally colonized, you need to show that it is the source of infection. There was a similar study last year about ties and how they were hugely infected, but, so what? Another thing that is overloaded with bacteria is the kitchen faucet - yet, millions of Americans had their cuts washed out by mom under that same faucet, and how many people can EVER remember a kid they knew with a wound infection - ever?

As far as the red coat...reminds me of a joke... (read the whole thing - it's worth it)

"Long ago, when sailing ships ruled the waves, a captain and his crew were in danger of being boarded by a pirate ship. As the crew became frantic, the captain bellowed to his First Mate, "Bring me my red shirt!" The First Mate quickly retrieved the captain's red shirt, which the captain put on and led the crew to battle the pirate boarding party. Although some casualties occurred among the crew, the pirates were repelled. Later that day, the lookout screamed that there were two pirate vessels sending boarding parties. The crew cowered in fear, but the captain, calm as ever bellowed, "Bring me my red shirt!" And once again the battle was on, however, the Captain and his crew repelled both boarding parties, although this time more casualties occurred. Weary from the battles, the men sat around on deck that night recounting the day's occurrences when an ensign looked to the Captain and asked, "Sir, why did you call for your red shirt before the battle?" The Captain, giving the ensign a look that only a captain can give, exhorted, "If I am wounded in battle, the red shirt does not show the wound and thus, you men will continue to fight unafraid." The men sat in silence marveling at the courage of such a man. As dawn came the next morning, the lookout screamed that there were pirate ships, 10 of them, all with boarding parties on their way. The men became silent and looked to the Captain, their leader, for his usual command. The Captain, calm as ever, bellowed, "Bring me my brown pants!"

courtesy: http://miljokes.com/a/nov99/151199.htm

 

[12R34Y]

University of Illinois at Peoria the EM residents/attendings do wear blue coats. it looks kind of weird, but they do.

later

 

[SoCuteMD]

I kind of plan on ditching the whole coat thing ASAP if possible. I mean, I figure the name tag and the "don't screw with me" walk should be enough for people to decide who/what I am. If they want to look up close at the name tag then they can. The white coat just seems so...white. And it covers up my fabulous butt (j/k).

 

[spyderdoc]

I wear a scrub top and cargo pants. I won't wear a white coat for several reasons:

1) Everybody and their mother wears one, so does it really distingish the docs? I think not.

2) They are VERY uncomfortable and constricting.

3) When I sit on an exam stool, the wheels run over the bottom of the coat and almost causes me to fall when I try to stand up.

4) When I sit down, all the crap in the pockets fall out.

5) I put a lot of crap in the pockets that I wouldn't otherwise carry around. I only carry my Palm Pilot, a pen, my stethescope, and some blank scripts. When I was wearing the white coat I put all kinds of junk in there that I never used.

 

[SoCuteMD]

3) When I sit on an exam stool, the wheels run over the bottom of the coat and almost causes me to fall when I try to stand up.

I really would be the one who rolled the wheels over the coat so hard that she fell OFF the stool.

 

[roja]

I do often wear my coat, but not consistently:

when I am wearing pants that don't have pockets (the only thing I carry in my pockets are a scalpel and a 14g angiocath). - I tend to only wear scrubs when I work overnight weekends or when I am out of work clothes- or most often when I am wearing scrubs (distinguishes you a tiny bit from the nurses, techs, etc that are all wearing green scrubs) or I am cold.

 

[peksi]

By the way from a patient standoint this was actually studied by someone.

Patients felt that the "most professional looking doctor" donned scrubs, a white coat, and check this out..."had a healthy tan!"

Paul

 

[11-44]

Although a white coat may disguise one as a CNA...the rest of us wouldn't have that concern...

So, for the *rest* of us....

....I think it's important for people to be able to identify that for the most part *the rest of us* are not threatened if someone mistakes us for a tech, nurse, or a janitor. *Most* of us have security from within to know what we are and that a badge, uniform, stethoscope, or a *gold star* does not define us. To most, everyone in the hospital looks like a doctor or a nurse, except those of course who wear gold stars on their foreheads...

 

[docB]

I wear a scrub top and EMS pants. A white coat gets too hot and gets in my way. For identification my scrub tops have my name on them and I always wear my hospital ID tag hanging from the v of my scrub top. That keeps admin happy. I bring a white coat to work every day and I hang it by my desk. I keep a calculator, Sanford, my schedule, extra pens, business cards, preg wheel and so on in it. I really only ever put it on if I'm cold which is rare or if I have to deliver bad news. That leads to a great truth of EM: You never want to make the ER doctor take off or put on a white coat.

 

[Jeff698]

I always wear my coat in to work in the ED. As soon as I get there, I promptly hang it on the back of my chair and use it as a storage bag for all my crap.

On my off-service rotations, though, I almost always wear my white coat. I do this because I don't have a 'home base' to hang my wearable storage bag.

I'm not sure I actually need all that crap but that's another story.

Take care,
Jeff

 

[Apollyon]

By the way from a patient standoint this was actually studied by someone.

Patients felt that the "most professional looking doctor" donned scrubs, a white coat, and check this out..."had a healthy tan!"

Paul

Wait a minute - there was a study (be ready for some vagueness) that was published in July or August, in Annals I think, that was done at either Jacobi or Lincoln (hey, I saw it in Journal Watch), that showed no difference between scrubs and shirt and tie. Is that the one you speak of?

As for me, my white coat is my "purse" (we are required to wear it, so I make sure I use it) - stethoscope, scissors, reflex hammer, hemostats, Tarascon, Sanford, and the mostly useless EMRA books, and spare change. Gum when I have it (the change and gum make it a purse).

 

[peksi]

Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department

Henri G ColtMD *, Jerald A SolotDO †
Received 9 February 1988; received in revised form 9 May 1988 and 11 August 1988; accepted 29 August 1988

To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

Paul

 

[Apollyon]

Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department

Henri G ColtMD *, Jerald A SolotDO †
Received 9 February 1988; received in revised form 9 May 1988 and 11 August 1988; accepted 29 August 1988

Dude - I was still in high school when this was submitted. 17yrs is a LONG time!

I'll see if I can dig up the newer study.

 

[SoCuteMD]

Dude - I was still in high school when this was submitted. 17yrs is a LONG time!

I'll see if I can dig up the newer study.

You may have been in high school, but I was SEVEN when that was published.

 

[corpsmanUP]

University of Illinois at Peoria the EM residents/attendings do wear blue coats. it looks kind of weird, but they do.

later

I have a buddy who is an EM PGY2 at Peoria and he never once had put on the blue coat!

 

[peksi]

I also was in highschool, Ok maybe I had JUST graduated.


Here is the more recent study that was eluded to:

Paul


Patient Attitudes toward Emergency Physician Attire: A Randomized Trial

Siu Fai Li and Marc Haber
Jacobi Medical Center: Bronx, NY

ABSTRACT

BACKGROUND: Previous studies have suggested that ED patient satisfaction is unaffected by physician attire. In a previous unrandomized study, we found no difference in patient evaluation of physician performance between different styles of dress. We now follow up our original study with a randomized trial to confirm this hypothesis. METHODS:We surveyed a convenience sample of ED patients during a two-week period. In the first week, emergency physicians wore white coats and formal attire. In the second week, the same physicians wore scrubs. Patients were asked to indicate on a 100-mm visual analog scale (VAS) their ratings of physician appearance, satisfaction, and professionalism. The primary outcome was the difference in VAS scores between the two dress styles. Secondary outcomes included difference in VAS scores between the two dress styles stratified by patient age, sex, and race, and physician sex. We estimated that 55 patients were needed in each group. RESULTS: 111 patients were surveyed. There were no significant differences between patients' evaluation of appearance ( = –0.68, 95% CI –5.5 to 4.1), satisfaction ( = 0.83, 95% CI –3.0 to 4.6), or professionalism (= –0.46, 95% CI –3.6 to 2.6) between the two dress styles. There were no differences in preference of physician attire based on patient age, sex, or race, or physician sex. CONCLUSIONS: Emergency physician attire does not affect patient satisfaction.

 

[Jeff698]

You may have been in high school, but I was SEVEN when that was published.

Sigh. I was a junior in college.

Damn, that titanium in my hip is acting up again. 🙂

Take care,
Jeff

 

[tiene dolor?]

Oh, and I posted a tread in 'general' regarding everyone's thoughts on physicians wearing a blue coat, to distinguish ourselves from everyone else (which is what the white coat was for, initially, but now that we're in an era of diminished hierachy and not wanting to hurt anyone's feelings, we allow everyone to wear a white coat to help boost their self-esteem) IMO

Why are you so concerned about being seen as The Doctor? White coat or not if you introduce yourself to your patients, they will know who you are. The same can be said for all of the ER staff as well.

 

[roja]

Although a white coat may disguise one as a CNA...the rest of us wouldn't have that concern...

So, for the *rest* of us....

....I think it's important for people to be able to identify that for the most part *the rest of us* are not threatened if someone mistakes us for a tech, nurse, or a janitor. *Most* of us have security from within to know what we are and that a badge, uniform, stethoscope, or a *gold star* does not define us. To most, everyone in the hospital looks like a doctor or a nurse, except those of course who wear gold stars on their foreheads...

😕


Your white coat is not a way of defining yourself. 🙄 It is a way to allow your patients the knowledge of who is taking care of them and that indeed, a doctor has seen them. If you ask most non-medical people, they do care if a doctor has seen them and knowing WHO the doctor is. There have been multiple studies that have looked at patient satisfaction, etc and universally if then know and feel like thier doctor cares for them, they are happy. This entails that they KNOW who the doctor is. And if you think saying to someone writing in pain, vomitting thier guts out or staring at a gushing laceration that they computed that when you rapidly said, hey Im doctorXhowlonghaveyoubeenfeelingthiswaydoyouhaveanychestpain...blahblahblah. that they registered the doctorx more power to you.

I am sure that because 'the rest of us' don't need badges, 'you all' allow your patients to call you by your first name as well. I mean, really, what's the point of the title but a little star on your forehead? 😎

 

[southerndoc]

I am sure that because 'the rest of us' don't need badges, 'you all' allow your patients to call you by your first name as well. I mean, really, what's the point of the title but a little star on your forehead? 😎

During the first few months of my intern year, I would introduce myself by my first and last name. "Hi, I'm John Doe, one of the ED residents."

My program director told us to introduce ourselves as Dr. so and so because patients are often confused who is their physician, and many do not know that residents are actual physicians (some think we are still students).

After introducing myself by Dr. so and so for the last year, it seems that patients usually respect you more, listen more closely to your advice, and give better patient satisfaction scores on our surveys.

Maybe there is power in symbolism.

 

[12R34Y]

I have a buddy who is an EM PGY2 at Peoria and he never once had put on the blue coat!

They were all wearing them when I was there interviewing. Many had them on during conference and most were wearing them in the ED.

It may not be a requirement to wear them, but there were definately a lot of them wearing them when I was there. Enough for me and my fellow interviewees to comment.

later

 

[USAF MD '05]

Only on off service rotations. (like now in the CCU...barf)

 

[Apollyon]

During the first few months of my intern year, I would introduce myself by my first and last name. "Hi, I'm John Doe, one of the ED residents."

My program director told us to introduce ourselves as Dr. so and so because patients are often confused who is their physician, and many do not know that residents are actual physicians (some think we are still students).

After introducing myself by Dr. so and so for the last year, it seems that patients usually respect you more, listen more closely to your advice, and give better patient satisfaction scores on our surveys.

Maybe there is power in symbolism.

We have a new attending who finished last summer. When he and I go to the bedside, I start off by saying "Hi, I'm Dr. XXXXX, the senior resident. This is Dr. XXXXXXX, who is in charge." He is in scrubs without a white coat, whereas I am in business casual with the white coat. He says to the patients, "Hi, I'm Bill (not his real name)." This gets confusing. Also, I've seen him with patients when he says, "Hi, I'm Bill, the supervising doctor."

There is power in symbolism. I see 2 peaks - first is the interns, who are not comfortable in calling themselves doctor, and the second is the junior attending, who is newly in "the world".

 

[GeneralVeers]

Our ED is split about 70/30 with the majority choosing to wear the coats.

Personally I think the coats are worthless in the ER. Tons of dirty patients, bloody procedures, makes it a pain to wear. I also sweat to death when wearing it.

The loss of storage space is more than made up for by personal comfort and cleanliness.

 

[JackBauERfan]

I say attendings just start putting numbers on the back of white coats to distinguish residents within the medicine community. While they are at it, maybe in respect to NFL, all attendings should wear Headsets, and maybe that will start helping patients distinguish who is the 'man in charge' from all the underlings. Hmm, wonder what med students should wear...we'll definitely give them numbers, maybe a polo shirt.

I want number 16, in honor of Joe Montana. (also I was 16 on my high school football team!).

Ok, what number do you want to be and why?

 

[DrQuinn]

Yeah, I think this was this past year in JEM.
Q

I also was in highschool, Ok maybe I had JUST graduated.


Here is the more recent study that was eluded to:

Paul


Patient Attitudes toward Emergency Physician Attire: A Randomized Trial

Siu Fai Li and Marc Haber
Jacobi Medical Center: Bronx, NY

ABSTRACT

BACKGROUND: Previous studies have suggested that ED patient satisfaction is unaffected by physician attire. In a previous unrandomized study, we found no difference in patient evaluation of physician performance between different styles of dress. We now follow up our original study with a randomized trial to confirm this hypothesis. METHODS:We surveyed a convenience sample of ED patients during a two-week period. In the first week, emergency physicians wore white coats and formal attire. In the second week, the same physicians wore scrubs. Patients were asked to indicate on a 100-mm visual analog scale (VAS) their ratings of physician appearance, satisfaction, and professionalism. The primary outcome was the difference in VAS scores between the two dress styles. Secondary outcomes included difference in VAS scores between the two dress styles stratified by patient age, sex, and race, and physician sex. We estimated that 55 patients were needed in each group. RESULTS: 111 patients were surveyed. There were no significant differences between patients' evaluation of appearance ( = –0.68, 95% CI –5.5 to 4.1), satisfaction ( = 0.83, 95% CI –3.0 to 4.6), or professionalism (= –0.46, 95% CI –3.6 to 2.6) between the two dress styles. There were no differences in preference of physician attire based on patient age, sex, or race, or physician sex. CONCLUSIONS: Emergency physician attire does not affect patient satisfaction.

 

[GeneralVeers]

Yeah, I think this was this past year in JEM.
Q

The females in our program have been forced to improve their dress due to patient complaints. Some females were wearing T-shirts with the word "slut" or other suitably snappy slogans emblazoned upon them.

 

[Jeff698]

Some females were wearing T-shirts with the word "slut" or other suitably snappy slogans emblazoned upon them.

Wow. I can't imagine how any patient could possibly view that as unprofessional.

 

[kungfufishing]

Wow. I can't imagine how any patient could possibly view that as unprofessional.

Depends on your profession...

 

[Jeff698]

Depends on your profession...

Very good point.

 

[imagin916]

I say attendings just start putting numbers on the back of white coats to distinguish residents within the medicine community. While they are at it, maybe in respect to NFL, all attendings should wear Headsets, and maybe that will start helping patients distinguish who is the 'man in charge' from all the underlings. Hmm, wonder what med students should wear...we'll definitely give them numbers, maybe a polo shirt.

I want number 16, in honor of Joe Montana. (also I was 16 on my high school football team!).

Ok, what number do you want to be and why?

This is a great idea, I love it!

BTW, 16 is my number too!

 

[JackBauERfan]

This is a great idea, I love it!

BTW, 16 is my number too!

haha I like to relate a lot of medical stuff to football. I actually got an idea from one of my friends about match day. I think I'm going to get caps of my top 5 schools, and hopefully If I get one of them, I'm gonna wear it when I find out which school I matched at (assuming I match), just like they do on Draft Day in the NFL.