White Coats

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After many decades I can tell you that there is one - and perhaps only one - advantage to the white coat: the name (hopefully) stitched on it.

Sure people these days wear id badges but like toast landing butter side down, they are always turned the wrong way, Besides you look like a pervert if you stare too hard trying to read the name.

That may not matter in many specialties, but when you have a flow of physicians coming in and out, it definitely helps to have easy access to a name for figuring out new faces. Sure, any kook can pick up a white coat, but it is rare they would manage to embroider the name of the physician in the specialty you are expecting.
 
Vandalia said:
Sure people these days wear id badges but like toast landing butter side down, they are always turned the wrong way, Besides you look like a pervert if you stare too hard trying to read the name.
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This is sooooo true.
I keep telling nurse that them (since usually female) wearing their badge on chest is like me wearing mine on my belt 🙂.
 
At Mayo Clinic, no physician wears a white coat.

If you did, you would be mistaken for a tech from some lab or some ancillary help person.

For physicians from medical students to staff, it’s business “un-casual” (suit jacket, tie, etc., For females, conservative business clothing) for rounds, clinics, grand rounds, educational sessions, and all meetings.
 
Dejavu said:
At Mayo Clinic, no physician wears a white coat.

If you did, you would be mistaken for a tech from some lab or some ancillary help person.

For physicians from medical students to staff, it’s business “un-casual” (suit jacket, tie, etc., For females, conservative business clothing) for rounds, clinics, grand rounds, educational sessions, and all meetings.
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Interns don’t have to wear all whites anymore?
 
Dejavu said:
At Mayo Clinic, no physician wears a white coat.

If you did, you would be mistaken for a tech from some lab or some ancillary help person.

For physicians from medical students to staff, it’s business “un-casual” (suit jacket, tie, etc., For females, conservative business clothing) for rounds, clinics, grand rounds, educational sessions, and all meetings.
Click to expand...

Note to self: never work at Mayo.


Sent from my iPhone using SDN mobile app
 
I have to wear mine as a resident because it's a rule at my program if you're on nights, and I thought I'd hate it. But as a short female with a baby face, I've realized that when I don't wear it, I'm more likely to be the recipient of "you're not old enough to be my doctor!" so I'm probably going to wear one as an attending until I look old enough to appear credible.
 
how does wearing a white coat help nowadays? the patients still can’t tell if you’re a doctor, PA, phlebetomist, or social worker.
 
doctorhopefully said:
how does wearing a white coat help nowadays? the patients still can’t tell if you’re a doctor, PA, phlebetomist, or social worker.
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I hate to say it but sometimes, especially in clinic, I have to wear the white coat. I wear high heels, makeup and dresses. I also do complex and often dangerous surgery. I don’t “look the part” unless I’m in scrubs. The coat helps patients feel better and more confident in me —no one ever told me this specifically, but I can sense it. Personally I hate the white coat and want to burn it.


Sent from my iPhone using SDN mobile
 
doctorhopefully said:
how does wearing a white coat help nowadays? the patients still can’t tell if you’re a doctor, PA, phlebetomist, or social worker.
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No one else in my hospital wears white coats except physicians. In my residency it was a bit more of an issue. But patients typically think white coat = doctor. So they’re more likely to think a phlebotomist is a doctor than think you aren’t if you’re both wearing white coats.

I also wear mine because my patients otherwise may think I look too young. Since I take care of a predominantly older population, I dress more conservative.

And the pockets. Gotta keep that reflex hammer somewhere.
 
AdmiralChz said:
Where is this promised land
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Small community hospital. But I think I spoke too soon-I’m pretty sure one of the nurses that responded to a rapid in on of my patients today were wearing a white coat.

The wound care nurse I also found out wears one. But let’s be honest-the wound/ostomy nurse deserves a coat (or raincoat...)

So alas, not the promised land. It looks like it here though. But you pay for it...
 
OrthoTraumaMD said:
I hate to say it but sometimes, especially in clinic, I have to wear the white coat. I wear high heels, makeup and dresses. I also do complex and often dangerous surgery. I don’t “look the part” unless I’m in scrubs. The coat helps patients feel better and more confident in me —no one ever told me this specifically, but I can sense it. Personally I hate the white coat and want to burn it.


Sent from my iPhone using SDN mobile
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I'm in psych, we generally don't wear white coats. But our consultation service does and they're especially picky about that with the women. I think it's for this reason--wanting to make sure our staff are perceived as doctors.
 
FaytlND said:
So are...all clothes. I guess the options are decon showers and bunnysuits between every patient, or just rolling through rounds naked. I could go either way.
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How many other things are worn for multiple days of direct patient contact without getting washed?
 
johnnydrama said:
How many other things are worn for multiple days of direct patient contact without getting washed?
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all the dry clean only shirts and slacks and ties people are wearing

they get alternated days and don't get as many days as the coat, but it's all in direct patient contact and almost never washed right after one time wear

my coat I can boil from home if I want

I iron and starch it too
 
Crayola227 said:
all the dry clean only shirts and slacks and ties people are wearing

they get alternated days and don't get as many days as the coat, but it's all in direct patient contact and almost never washed right after one time wear

my coat I can boil from home if I want

I iron and starch it too
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Ties are disease vectors too and really have no place in clinical medicine.

Personally would always wear new shirts, would prefer clean scrubs when appropriate.
 
Last edited by a moderator:
Crayola227 said:
all the dry clean only shirts and slacks and ties people are wearing

they get alternated days and don't get as many days as the coat, but it's all in direct patient contact and almost never washed right after one time wear

my coat I can boil from home if I want

I iron and starch it too
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Only suckers buy dry clean only clothing
 
agree with these points, but I know plenty of docs that don't wash slacks or shirt after one wear, even machine wash ones

not saying they shouldn't, but in some facilities the white coats are cleaner than any other thing the person might wear besides fresh machine scrubs or disposable gowns

I love hospitals that have wash service for the white coats, so classy
 
johnnydrama said:
Ties are disease vectors too and really have no place in clinics medicine.

Personally would always wear new shirts, would prefer clean scrubs when appropriate.
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Unless something new has come out recently, pretty sure that despite multiple studies we have no evidence that ties/white coats lead to more nosocomial infections.

I wear neither, but I'd just as soon not ban something without evidence.
 
VA Hopeful Dr said:
Unless something new has come out recently, pretty sure that despite multiple studies we have no evidence that ties/white coats lead to more nosocomial infections.

I wear neither, but I'd just as soon not ban something without evidence.
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We have no “evidence” that spitting in your hand before shaking hands with someone spreads disease either. We do however have the germ theory of disease. (I’m sure someone could study this and get a notch on their CV, but that would require a fairly large study across multiple specialties.) Absence of evidence is not equivalent to evidence of absence.

Ties serve no purpose (so yeah, ban long ones, bow ties can stay) and white coats could be hung on the door before hand washing (no need to ban) or at least washed every day like scrubs.
 
johnnydrama said:
We have no “evidence” that spitting in your hand before shaking hands with someone spreads disease either. We do however have the germ theory of disease. (I’m sure someone could study this and get a notch on their CV, but that would require a fairly large study across multiple specialties.) Absence of evidence is not equivalent to evidence of absence.

Ties serve no purpose (so yeah, ban long ones, bow ties can stay) and white coats could be hung on the door before hand washing (no need to ban) or at least washed every day like scrubs.
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You're being ridiculous. Its been proven that not washing your hands results in increased infection so its not a stretch at all to say that spitting in your hand (and then not washing it) spreads disease. You're making it dirtier than a plain unwashed hand.

While there are a couple of (very weak) studies that show that sleeve length doesn't result in patient contamination.
 
VA Hopeful Dr said:
You're being ridiculous. Its been proven that not washing your hands results in increased infection so its not a stretch at all to say that spitting in your hand (and then not washing it) spreads disease. You're making it dirtier than a plain unwashed hand.

While there are a couple of (very weak) studies that show that sleeve length doesn't result in patient contamination.
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But you don’t have any evidence of that.

This is one of the issues with over reliance on evidence based medicine. We can’t test everything, sometimes a bit of common sense is in order.
 
Raryn said:
I still dry clean my collared shirts.

Too lazy to iron.
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I think they wash them and then press them but I am not sure. They always run deals for like 50 cents a shirt or whatever but charge women extra even if it is a plain button up shirt equivalent to a men's shirt.
 
dpmd said:
I think they wash them and then press them but I am not sure. They always run deals for like 50 cents a shirt or whatever but charge women extra even if it is a plain button up shirt equivalent to a men's shirt.
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You're right - I take my shirts to the dry cleaner but they typically launder them. I still typically will wear them a couple days each before taking them in. With a new undershirt each time of course.
 
Where do you put all of your stuff? Pager, phone, wallet, keys, couple pens, my rounding list, IDs. I'm a woman and finding dress pants with actual pockets that hold stuff is always a challenge. I can't think of a pair of dress pants I own that would accommodate all that stuff. If I drop by the grocery store on my way home, I usually only take keys and wallet as I don't have a spot for the phone and leave it in the car. If I'm wearing scrub pants with the cargo pockets, then I could pull it off.
 
shiftingmirage said:
Where do you put all of your stuff? Pager, phone, wallet, keys, couple pens, my rounding list, IDs. I'm a woman and finding dress pants with actual pockets that hold stuff is always a challenge. I can't think of a pair of dress pants I own that would accommodate all that stuff. If I drop by the grocery store on my way home, I usually only take keys and wallet as I don't have a spot for the phone and leave it in the car. If I'm wearing scrub pants with the cargo pockets, then I could pull it off.
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The only think I carry on my person is a stethoscope and my phone these days. Everything else lives in my desk until I leave for the day.
 
shiftingmirage said:
Where do you put all of your stuff? Pager, phone, wallet, keys, couple pens, my rounding list, IDs. I'm a woman and finding dress pants with actual pockets that hold stuff is always a challenge. I can't think of a pair of dress pants I own that would accommodate all that stuff. If I drop by the grocery store on my way home, I usually only take keys and wallet as I don't have a spot for the phone and leave it in the car. If I'm wearing scrub pants with the cargo pockets, then I could pull it off.
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I bring a purse to work, but stash it in a locker/desk when I get to work. I typically only carry my phone, a stethoscope, and a clipboard with a pen or two when I was a resident, and my iPad as a fellow.
 
VA Hopeful Dr said:
The only think I carry on my person is a stethoscope and my phone these days. Everything else lives in my desk until I leave for the day.
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I leave my phone on my desk as well. I only carry my stethoscope into the exam room. When I have to round in the hospital (mercifully rarely) I’ll grab my phone in case my office needs to reach me.

But we’re both outpatient. If I was still a resident, or a hospitalist, I’d probably wear a white coat just for the pockets
 
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johnnydrama said:
Yeah, only one RCT, followed for only 3 days. Other papers included show evidence of bacterial colonization and potential for transmission.

All this says is that it hasn’t been studied very rigorously.

What little evidence there is points to a small risk. So the question becomes risk vs benefit.

What is the benefit of the tie? None.

What is the risk? Small chance of increased nosocomial infections, although insufficient evidence to confirm.

Also, there’s this:

frequentists_vs_bayesians.png
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There absolutely is benefit. There's good evidence that patients prefer the white coat on their doctors. Evidence behind ties is weaker but I think still there.

We can also look at it this way, the UK has banned long sleeves. Is their rate of nosocomial infection lower than ours since that change?

I don't know the answer to that, but I feel like if it were it would have been big news.
 
VA Hopeful Dr said:
There absolutely is benefit. There's good evidence that patients prefer the white coat on their doctors. Evidence behind ties is weaker but I think still there.

We can also look at it this way, the UK has banned long sleeves. Is their rate of nosocomial infection lower than ours since that change?

I don't know the answer to that, but I feel like if it were it would have been big news.
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We’re going with patient preferences now? Who do you think you are, Press Ganey?



Our job is not to give the patients what they want, it’s to help them. Leave it to the bean counters to rearrange the furniture in the lobby and design organ shaped pillows.

As for the UK, comparison would be pre and post intervention, not to us. I’d bet they started off better than us.
 
johnnydrama said:
We’re going with patient preferences now? Who do you think you are, Press Ganey?



Our job is not to give the patients what they want, it’s to help them. Leave it to the bean counters to rearrange the furniture in the lobby and design organ shaped pillows.

As for the UK, comparison would be pre and post intervention, not to us. I’d bet they started off better than us.
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On its own, patient satisfaction doesn't matter. But that's not all the recent study about the white coat looked at. Patients trust doctors more in them. We know that if patients don't trust us, they are less likely to follow our treatment plans. Now you could argue that this shouldn't matter, and I do wish we lived in that world, but we don't and so it does.

I'll look into finding that UK data later
 
VA Hopeful Dr said:
On its own, patient satisfaction doesn't matter. But that's not all the recent study about the white coat looked at. Patients trust doctors more in them. We know that if patients don't trust us, they are less likely to follow our treatment plans. Now you could argue that this shouldn't matter, and I do wish we lived in that world, but we don't and so it does.

I'll look into finding that UK data later
Click to expand...

Many patients also express racial and gender preferences for their doctors. Should we stop letting minorities and women become doctors because patients might be less likely to trust their authority?

Do you have any evidence that patients are more likely to follow instructions from someone wearing a white coat?
 
johnnydrama said:
Many patients also express racial and gender preferences for their doctors. Should we stop letting minorities and women become doctors because patients might be less likely to trust their authority?

Do you have any evidence that patients are more likely to follow instructions from someone wearing a white coat?
Click to expand...
Nope. But there is evidence that if a patient trusts their doctor, they are more likely to follow treatment recommendations: Patients’ Commitment to Their Primary Physician and Why It Matters

We also have evidence that white coats and more formal attire (ties) increase patient's trust in their doctors: Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA


As for racist and sexist patients: we do allow patients when possible to choose their doctors. Can't do much better than that since not everyone prefers the same gender/race in their doctors.
 
doctorhopefully said:
As a profession, we (physicians) are weak and un-organized. if flight attendants started wearing the same uniform as a captain with 30 years of experience, what would be the reaction from the pilots’ union? if seargants started wearing the same uniform as a 5-star general, would that be acceptable?

why do we force medical students to wear short coats? if the uniform doesn’t matter anymore, let the students wear regular coats.
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When I trained, interns had to wear short coats. We had a visiting med student from Florida who had a long coat. Rounds were confusing, to say the least.


Sent from my iPhone using SDN mobile
 
VA Hopeful Dr said:
Nope. But there is evidence that if a patient trusts their doctor, they are more likely to follow treatment recommendations: Patients’ Commitment to Their Primary Physician and Why It Matters

We also have evidence that white coats and more formal attire (ties) increase patient's trust in their doctors: Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA


As for racist and sexist patients: we do allow patients when possible to choose their doctors. Can't do much better than that since not everyone prefers the same gender/race in their doctors.
Click to expand...

This is the entire reason I wear both ties and the white coat (buttoned down so the tie doesn’t come in contact with my patients when I examine them). I feel stodgy, but I have an older population and everyone things I’m Doogie Howser since I’m a recent grad.

My patients seem to like the way I dress. It seems to impress admin as well, but I’m not doing it for them. I’m doing it to help set my patients at ease and convey professionalism. Hospitalized patients are in a vulnerable place-the least I can do is to do whatever I can to minimize their discomfort/anxiety ties.

I’m a bit of a hypocrite though, because I prefer that my PCP doesn’t wear ties or the white coat.

The coat also protects my son. He likes to jump on me when I get home, before I’ve changed. The white coat is a barrier to keep germs off my clothes.
 
RangerBob said:
This is the entire reason I wear both ties and the white coat (buttoned down so the tie doesn’t come in contact with my patients when I examine them). I feel stodgy, but I have an older population and everyone things I’m Doogie Howser since I’m a recent grad.

My patients seem to like the way I dress. It seems to impress admin as well, but I’m not doing it for them. I’m doing it to help set my patients at ease and convey professionalism. Hospitalized patients are in a vulnerable place-the least I can do is to do whatever I can to minimize their discomfort/anxiety ties.

I’m a bit of a hypocrite though, because I prefer that my PCP doesn’t wear ties or the white coat.

The coat also protects my son. He likes to jump on me when I get home, before I’ve changed. The white coat is a barrier to keep germs off my clothes.
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If you are wearing your coat while caring for patients then it isn't the barrier you think it is for your kid (not that you really need one)

Edit: unless you mean you take your coat off before entering the house.
 
dpmd said:
If you are wearing your coat while caring for patients then it isn't the barrier you think it is for your kid (not that you really need one)

Edit: unless you mean you take your coat off before entering the house.
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Yes-the coat stays at the hospital. I try to keep my car as MRSA-free as I can.

And yes, it isn’t necessary. But it’s as added extra bonus. The primary reason I wear the coat is to appear more professional-patients will judge me in the first 15 seconds or so of meeting me, and my age (though I’m not that young-I was a nontrad) works against me there.

As I get older and more comfortable at the job I may stop wearing the coat and tie. But then I still run into the problem of where to put my reflex hammer and penlight. The reflex hammer is more bulky since in PM&R, we use real hammers (though mine isn’t as hardcore as the neurologists I’ve seen using a queen square with a foot-long handle...) And half the time I do keep my stetoscope in the pocket as well
 
doctorhopefully said:
As a profession, we (physicians) are weak and un-organized. if flight attendants started wearing the same uniform as a captain with 30 years of experience, what would be the reaction from the pilots’ union? if seargants started wearing the same uniform as a 5-star general, would that be acceptable?

why do we force medical students to wear short coats? if the uniform doesn’t matter anymore, let the students wear regular coats.
Click to expand...

Yep, the more and more I progress into the profession I see that we don’t look out for each other very well as a profession. It’s very much each specialty for itself which is a ridiculous reality, but when scope of practice battles come up you just don’t see subspecialties band together. And don’t even get me started on the politically-motivated AMA...

Very frustrating.
 
RangerBob said:
This is the entire reason I wear both ties and the white coat (buttoned down so the tie doesn’t come in contact with my patients when I examine them). I feel stodgy, but I have an older population and everyone things I’m Doogie Howser since I’m a recent grad.

My patients seem to like the way I dress. It seems to impress admin as well, but I’m not doing it for them. I’m doing it to help set my patients at ease and convey professionalism. Hospitalized patients are in a vulnerable place-the least I can do is to do whatever I can to minimize their discomfort/anxiety ties.

I’m a bit of a hypocrite though, because I prefer that my PCP doesn’t wear ties or the white coat.

The coat also protects my son. He likes to jump on me when I get home, before I’ve changed. The white coat is a barrier to keep germs off my clothes.
Click to expand...
I do think it matters more if you don't have a long-term relationship with patients. As a PCP, I don't wear one and my patient seemed fine with it. If I was a hospitalist or working in the ED I probably would wear one.
 
VA Hopeful Dr said:
I do think it matters more if you don't have a long-term relationship with patients. As a PCP, I don't wear one and my patient seemed fine with it. If I was a hospitalist or working in the ED I probably would wear one.
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Personally I see it as a bit of a barrier in the outpatient primary care setting, which is a more intimate relationship. I can’t remember the last PCP I met who wore a white coat (not that my sample size is that huge)

I think the setting/situation makes a big difference. I didn’t expect the pediatrician who took care of my son in the hospital to wear a white coat. I figured he’d be dressed more casual. But relaxed fit cords with vans and a short sleeve shirt went too far in the casual direction. He looked like he was ready to go skateboarding. And he wasn’t on call.
 
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