Bring back the white coat?

by Neil Hallows

In a previous issue, retired consultant Radhamanohar Macherla made a case for the return of the white coat. They were thrown out on the basis of flimsy evidence, he said. Judging from your responses, a lot of doctors agree with him. Here is a selection

Location: UK
Published: Thursday 17 February 2022
white coats

The article was correct. The white coat was abandoned to reduce the influence of doctors in the NHS, not to stop infections. There was never any evidence to show white coats caused the spread of infections in hospitals, but a cynical decision was made in Whitehall to strip doctors of their uniform. After 35 years working in the NHS, I have come to realise politicians consider doctors part of the problem, not part of the solution to challenges in the health service. The banning of white coats is just one visible example of this. Patients like to be able to identify doctors in hospitals. This is facilitated by a clearly identifiable uniform, the white coat. Nurses continue to wear their uniforms without causing an infection risk so why should doctors not return to wearing their white coats?

Cambridge consultant surgeon Richard Hardwick

There is little if no evidence white coats pose an infection risk. Indeed, were the hospital laundry (remember them?) to launder them, one could at least be assured the outermost layer of a doctor’s attire was clean. Of course, there is no certainty as to how often ‘civilian’ clothes are cleaned – if ever! I have long since thought a strong motivation to be rid of the white coat was to undermine and de-professionalise medicine.

Gloucester consultant trauma and orthopaedic surgeon Matthew Henderson

I wholeheartedly agree with re-introducing white coats (I never agreed with the decision to scrap them in the first place, as it was a purely emotional decision not supported by any evidence at all). I would just add one element that is not clear from Dr Macherla’s article. There is absolutely no reason why white coats cannot be freshly laundered every day in the same way as ‘scrubs’ in which case there would be very little difference between them. The main difference of bare arms is of no consequence, unless clinicians scrub their arms between each patient contact, but any material difference of this practice has not been studied.

Retired consultant cardiologist Michael James

This was such a good read. I totally agree with Dr Macherla that the white coat needs a comeback. Most doctors now are reliant on a phone for means of communication in the hospital and this guarantees somewhere to put your phone. More importantly the concept of the white coat being the sole vector for transmission of infection is clearly not the case as we continue with many infections in hospitals. The re-introduction could still ensure we are bare below the elbow by having half-sleeved coats. During the pandemic many doctors resorted to wearing scrubs irrespective of specialty (including GPs, dermatologists, paediatricians etc) so the concept of washing uniforms regularly, which may have hindered the clean white coat in the past, is dated. Please start a campaign to bring back the white coat. We could even follow the US system of a short coat for medical students and a long one for qualified doctors. At least we would know who is who.

Birmingham consultant in emergency medicine Sa Narang

I was a psychiatrist in the Royal Navy and was a ‘brass-hat’. We wore full uniform when on duty in the naval hospital. I felt this would be intimidating to my patients and I was seen as dangerously progressive as I wore a white coat. I retired in 1976 and took up an appointment in the NHS as a community psychiatrist. I wore a white coat. We were in full enthusiasm for multidisciplinary working and I was told I was hiding behind a white coat. I did not take it off but then management ceased to supply white coats so I had to appear uncovered. I did notice that if things went wrong I seemed to be responsible. At the same time there was a move to close down doctors’ dining rooms for being elitist. It’s now water under the bridge as one might say but interesting psycho-dynamics that perhaps we should explore. We could have been seen to be arrogant. I do not know from personal experience what it is like now.

Retired consultant psychiatrist David Marjot

As a doctor who trained in Europe, this is the most memorable culture shock of my professional career. In European medical schools, soon-to-be doctors look forward to donning their white coats when attending clinical duties. It is a rite of passage. A sign that all that hard work has paid off. Following graduation at the start of your first ever post as a fully fledged doctor, you are given a pair of white uniforms, consisting of a white, smart button-up, short-sleeved top and white trousers. These get laundered on-site and never leave the hospital. There is no uniform-related transmission of pathogens to home environment while retaining the all-important bare-below-the-elbow mantra, as well as maintaining a professional look. Furthermore, the patients instantly know what the roles are when they come in contact with hospital staff. But here, in the UK, orthopaedic consultants look like bankers, geriatric consultants adopt the jumper look, general surgeons walk around in scrubs and some junior doctors seem to think a wrinkled shirt and worn-out shoes are the peak of fashion. Doctors then wear those same clothes to the pub, on trains and the Tube, and ultimately their homes, potentially spreading disease. We all know nobody has time to don a flimsy plastic apron for every patient on a marathon medical ward round. Personally, I have opted for a hospital scrub top and ‘work trousers’ – one of three pairs used exclusively for work, and nothing else, that stay at work for the week. Although I sometimes get disapproving looks, I feel this is a sensible balance of appearing professional while also protecting my family at home. I am in full support of bringing back a modern doctor’s uniform.

Bristol radiology registrar Simon Rupret