Why Do Doctors Wear White Coats?
Before the advent of modern medicine, many physicians resembled dark angels of death as they flapped about in black coats. Their customary tools and practices were primitive and unorganized. The prevalence of these alarming deficiencies began to dwindle away early in the 20th century, accompanied by the wider adoption of white coats. It is estimated that nearly three-quarters of all medical students and physicians practicing at hospitals wear white coats over more than 75 percent of their working hours.
A Probing Survey
According to a study published during January 1991 in Journal of the Royal Society of Medicine, questionnaires asking about the habitual donning of white coats were mailed to 197 clinical students in St. Mary’s and 424 practicing physicians in St. Mary’s and St. Charles, the two major hospitals in London. Several choices were given for the percentage of working hours marked by the wearing of a white coat: less than 25 percent, between 25 and 50 percent, between 50 and 75 percent, and over 75 percent. The wearers of white coats were also asked to choose the three most significant reasons for this mode of dress. Respondents declining to wear a white coat were asked to pick their primary reason for this divergence from the norm. Till now, this is the most important study on white lab coats used by doctors.
The Detailed Results
The overall response rate was 47 percent and the breakdown showed that, 55 percent of doctors completed their questionnaires, but only 31 percent of medical students bothered to reply. The finished questionnaires were graded for coat-wearers by giving three points to each primary reason, two points to each secondary reason and one point to each tertiary reason. After adding up the points assigned in this way, the relative popularity of each reason was expressed as a percentage of the total accumulation of all points across all reasons:
- Faster recognition by patients, nurses and other doctors, 25 percent.
- Large pockets for carrying items such as stethoscopes, 23 percent.
- Protecting clothes from being soiled, 15 percent.
- Emphasis on status as physician, 7 percent.
- Following social expectations for doctors, 7 percent.
- Protecting self against contamination from surroundings and patients, 5 percent.
- Exuding an impression of cleanliness, 5 percent.
- Protecting patients against contamination from self, 3 percent.
- Maintaining warm body temperature in often chilly hospitals, 3 percent.
- Erecting a psychological barrier and thereby not easily accessible, 1 percent.
- Other reasons, 6 percent.
The results showed that, 42 percent of survey respondents from the two hospitals wore their white coats during more than 75 percent of their working hours, and 29 percent of respondents shunned white coats. Also, 82 percent of those who eschewed white coats did so while fulfilling their duties as pediatricians or psychiatrists, thinking it may negatively affect the interactions with children and mentally disturbed patients. Anesthetists strongly opted for theater clothes, and a few consultants indicated that they wore suits to make themselves stand out from more junior doctors.
A Simmering Problem
White coats have not been without controversy. On June 2009, the American Medical Association (AMA) voted on a resolution recommending that the iconic white garment should be banned by hospitals, citing the probable spread of disease through frequently unsterilized coats splattered with the invisible aftermath of repeated exposure to sick patients. Despite studies (Microbial flora on doctors’ white coats) supporting the notion of unsanitary coats, the AMA ultimately punted the issue by referring it to a panel for further discussion. Many doctors have continued to ignore the potential dangers of these knee-length emblems of medical professionals, possibly out of an urge to project the same impression of scientific competence so strongly associated in popular culture with white-clad laboratory technicians performing research work rigorously.
Still, the future may hold changes. The famed Mayo Clinic requires its attending physicians to instead wear formal business clothing, and the Scottish National Health Service banned white coats in 2008, replacing them with color-coded scrubs. The classic white coat could yet become a relic of the past.