Viewpoint: Bring back the white coat?

by Radhamanohar Macherla

An age-old symbol was ditched over infection concerns, but the evidence for doing so was not strong

Location: UK
Published: Friday 12 November 2021
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Who is the doctor? Was it the neat one in scrubs, with the stethoscope? Or the scruffy chap with the crumpled shirt hanging over his trousers?

I was in outpatients, as a patient, and I was struck by the same thought I often had in the later years of my medical career: if only doctors still wore white coats.

When I was a medical student, I couldn’t wait to put on my white coat. As I grew as a doctor, it gave me not just instant recognition, and a professional look, but a kind of camouflage when you had to spring out of bed and were only wearing pyjamas underneath.

A short history, especially for those who associate white coats only with period dramas and have no direct memory of them. More than a decade ago, healthcare-associated infections were growing, and the Government was under pressure to act.

So, in 2007, in came a new policy on ‘bare below the elbow’, and out went the last of the white coats. But were they really such a terrible infection risk? Actually, the evidence was far from clear.

A review commissioned by the Department of Health found contamination in white coats but ‘the majority of organisms isolated were nonpathogenic environmental bacteria or skin commensals probably originating from the wearer’.

It continued: ‘Although it has been hypothesised that contaminated uniforms are a potential vehicle for the transmission of pathogens, no studies demonstrated the transfer of micro-organisms from uniforms to patients in the clinical situation.’

Another study found no statistically significant differences in MRSA (methicillin-resistant staphylococcus aureus) or bacterial contamination between physicians’ white coats and newly laundered short-sleeved uniforms. It said: ‘Our data does not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis.’

This appears to have been borne out in the years since. It seems to me that MRSA steadily increased during the years when the use of white coats was in decline.

It can’t have helped that doctors were probably taking home more microbes on their clothing, with the risk that hospitals were becoming reinfected from the community. Other measures where there was actually evidence that they reduced MRSA, such as the use of disposable plastic aprons in high-risk clinical areas, could have been more vigorously pursued.

So, it seems there was little or no scientific basis for the ban. Yes, there were some doctors who looked like they had stepped out of a meat market, but such lazy behaviour could be addressed with an effective and hygienic dress code.

It might be paranoia on my part, but I do wonder if this was some ploy by those in the non-clinical hierarchy, who wanted to undermine the status of doctors. Other allied health professionals have persisted with their uniforms, as if they are magically microbe resistant.

And, so, who was the doctor in that outpatients’ department? The neat one in scrubs was a physio. The scruffy chap was a doctor, or at least that’s what he told me.

Radhamanohar Macherla, now retired, was for more than 20 years a consultant physician with Barts Health NHS Trust

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