WhiteCoat

The Fall of a Tradition?

Physician LabcoatWhite lab coats may be on their way out.

The AMA is considering a proposal to follow the lead of the British National Health System by recommending against the use of white coats by physicians. The Brits have a “bare below the elbows” policy to help prevent infections. Supposedly physician lab jackets carry too many germs and contribute to the incidence of infections – although there is little data directly linking white coats to incidence of infections. The NY Times article does cite one study in which 48% of a small sampling of physicians ties had some type of infectious organism on them.

The problem that I see with the recommendation is that it is based on assumptions and not on data. The British National Health System policy went into effect a couple of years ago. Where is the data showing the drop in the number of infections? I couldn’t find anything on an internet search.

Lab coats aren’t just for show. They also protect a physician’s clothing. I’ve gotten all kinds of bodily fluid splattered on my lab jacket at one time or another. Now that I usually just wear scrubs, it isn’t uncommon for me to get splashed with blood or other bodily fluids. If I do wear a lab jacket, I usually roll the sleeves up to my mid-forearm anyway.

The article brought up a good point. Once the lab coats are gone, then will they then recommend that we wear tank tops to avoid the inadvertent contamination of a short sleeve onto a patient’s body? One doctor in the article asked “Are we going to go around naked?”

Besides, what would I use as my nickname if white coats were banished?

Somehow Dr. BareElbows just doesn’t have the same ring to it …

32 Responses to “The Fall of a Tradition?”

  1. Chris says:

    In the UK there is also a move towards (junior) doctors wearing uniforms. This goes some way towards protecting their clothing.

  2. rlbates says:

    I think perhaps they should recommend that doctors each have 5-10 white coats that they change daily and regular wash/dry clean. :)

  3. Doc99 says:

    Perhaps we should call this ABM – assumption-based medicine. Medicine swings like a pendulum do. Come to think of it, where’s the underpinning of evidence for Pay For Performance?

  4. Amy says:

    I have 4 or 5 white coats and wash them all after a little less than a week’s wear each. Apparently the studies done on germs on white coats show that they are germy again within hours of washing. I have a few off service rotations that will require me to wear my own clothes most days and there’s no way I will do so without wearing a lab coat. If my program wants me to wear dress clothes they will either have to a) give me a clothing budget or b) allow me to cover them with something they provide. I simply can’t afford to dress in business casual on a daily basis otherwise as my laundry (I do my own) and dry cleaning bills are far too expensive.

  5. Pod A says:

    Bullhockey. I wear kakhis and a button up or polo. What am I going to do when something nasty comes in? Change into scrubs quickly? I don’t think so.

    Ridiculous rules like this are causing the downfall of America.

  6. Pod A says:

    Also, I refuse to take off my wedding ring and watch. I cover them with gloves and wash regularly.

    I’m glad I’m not in the UK.

  7. CrankyProf says:

    Is this the same British Healthcare System that decided that it would be cheaper to turn sheets over, rather than wash them between patients?

    http://www.dailymail.co.uk/health/article-448395/Hard-hospital-orders-staff-Dont-wash-sheets–turn-over.html

    • SeaSpray says:

      Ewww… that is just so wrong!

    • It’s being done in the States, too, though I doubt anyone’d be stupid enough to normalize it as “policy.” I was in ICU and went 3 days without being bathed or having the sheets changed. Positively begging for a wash-up, the nurse told me to wait until I was transfered out to the floor — “they love to do that kind of thing there.” During another visit, this time just on the regular floor unit, the only time my sheets were changed was after I dumped coffee all over them — and then only the top sheet was changed. Needless to say, I began to be a [predictably] clumsy coffee drinker.

      The “reasons” given for this sloppy patient care? Overwork, not enough nurse’s aides.

      (This was at an award-winning, university-affiliated, metro teaching hospital.)

      Of course, I am just going on the *assumption* that my dirty sheets harbored icky bugs ‘n such. There’s no evidence whatsoever that nasty sheets (or the sleeves from the coat of the doctor who just lanced a MRSA-infested boil) imperil anyone…

      Ewwww!

      • WWWebb says:

        @Bianca Castafiore: I have found that “spilling” one’s urinal does the trick.

      • CrankyProf says:

        It’s one thing to sit in your OWN dirty sheets for three days — that is, indeed, gross. However, how would you feel knowing that you’re sitting in a previous patients’ dirty sheets?

  8. DaveyNC says:

    “BareArm Rants”
    “HairyArm’s Call Room”
    “Bare-chested Medicine”
    “Sleeves Rolled Up and Ready to Resuscitate”

    Just trying to come up with a new name for the blog. Ideas, anybody?

    If you bare your arms, do you then have to shave them? I mean, you shave a person when you are getting ready to operate, wouldn’t your arms need to be smooth as a baby’s butt, too?

    “Barehanded Healer”

  9. Katy says:

    Why not start making lab coats that finish at the elbows?

    Also somebody mentioned above above refusing to remove wedding rings and watches, but, as somebody who used to have to change watch batteries (as my job), and after seeing the amount of dirt and dead skin lodged in them, the thought of even wearing one makes me nauseous. =S

  10. SeaSpray says:

    I think anything repeatedly exposed to contaminants is going to pick them up. Perhaps you could step into some kind of decon wash down prior to each patient contact/exposure.

    Dr Clean is refreshing. Or we could call you Dr Soggy!

    I’m just sayin. ;)

  11. Brenda Mears says:

    I have had medical students and residents admit they may wear the same coat for weeks.
    I have 3 lab coats and wear them for only a single shift before washing them. White lab coats can be bleached when necessary. If sleeves are a problem, they can be shortened.
    I have seen no data that lab coats become contaminated faster than regular clothing. Why can’t we just tell people to wash their coats each time they wear them?

  12. rn90 says:

    I think it would be Dr. Drybows to you sir !!! ;)
    Use some of that corporate provided lotion to soothe that ‘gator skins !!!!

  13. jb says:

    I wear gloves with each patient interaction. Also I stopped wearing white coats about three years ago when the initial study came out. I wear scrubs at work. It’s not that big of a deal.
    Actually, I prefer not to wear them. I use to have to wash and iron them once a week. That hassle is gone.

  14. Finn says:

    Assumption-based medicine indeed. Reminds me of a local “news” story several months back attempting to whip up hysteria about staff leaving the many Boston hospitals in their (presumably germy) scrubs to buy coffee and whatnot. The horror! Of course the piece went on & on about these people spreading infectious diseases willy-nilly all over neighboring shops, the subway, etc. While they had some data showing that germs sometimes ride along on scrubs, there was zero evidence that these germs then hopped off the scrubs to contaminate environments or infect people outside the hospitals.

    I suppose next you’ll be required to work stark naked and autoclave yourselves between patients.

  15. osh says:

    Naked !!! Should I ever break down & visit ER for my chronic-pain-related-issues… naked docs would def. help w/pain distraction. :D

  16. WWWebb says:

    @osh: to quote myself:

    “The problem with both karaoke and nudism is that it’s usually the wrong people.”

  17. EM says:

    WWWeb that is a great quote. Can I use it sometime?

    What I find so crazy is that the AMA, admidst all of the current issues in healthcare, has wasted their time on an issue like this.

    This is yet another reason I am not a member.

  18. 2nd yr says:

    How am I supposed to carry all that unnecessary crap next year and through residency until I realize I don’t need it?

    I want crossed bandoliers then, that’d be awesome, imagine having iPhone, trauma shears, reference books and ophthalmoscope hanging off of you. And lots of the little dental ampules of lidocaine for effect.

  19. WWWebb says:

    @EM: I am honored, and glad that you like it.

    Use freely, with attribution if appropriate.

  20. VK says:

    I sure wouldn’t mind a recommendation against wearing ties…

    Also, I must be a slob. I never wash ties and wear my white coat 3-4 weeks before washing it…

  21. wwwebb–Your quote is hilarious and completely apt. I plan to make it my next (completely non sequitur post.)

  22. WWWebb says:

    @VK: I work in IT. What this means is, if *I’m* in a suit and tie, it’s a sign that somebody’s either gettin’ married or buried.

    If there are not clinical studies that prove that the wearing of neckties is a major cause of impaired blood flow to the brain, then there should be.

    Look at who all wears the damn things these days, and the resultant quality of their decision-making…QED.

    @Albinoblackbear: Two compliments in one thread?

    (blushes)

    Awww, shucks, y’all.

  23. WWWebb says:

    @Albinoblackbear: Just scoped your blog.

    You’re added to my RSS collection.

    I’ll give you another original halfwitticism:

    “Population density is a phrase that has two meanings.”

    Zings right past about 95 percent of those who hear it, thus validating its accuracy.

    Again, QED.

    Good luck with the med school.

    If they made all doctors become nurses first, IMHO the MDCSR** would be greatly improved.

    WWWebb

    ** M.D. common-sense ratio (ducks, runs)

  24. SumDood says:

    I commented on this issue on WhiteCoat’s old site, and why, as has been stated, this philosophy is flawed:
    http://whitecoatrants.wordpress.com/2009/01/08/filthy-lab-jackets/#comment-8441

    BTW, the quote works for lesbians, too.

  25. Finn Haddie says:

    3-4 weeks between washings for your white coat? Yes, you must be a slob. Mine was washed at least weekly–and I was just a ward clerk with no direct patient contact. (Yes, white coats on ward clerks is ridiculous, but my stupid dinky hospital insisted.)

    Instead of eliminating white coats, why don’t hospitals just require that they be laundered every so many days? They’re laundering sheets & scrubs anyway; how much more work can it be to add in white coats?

  26. WWWebb says:

    There is the classical approach: black ones to hide the grime and blood.

    It was good enough for the 19th century…

  27. thales says:

    As a dentist, I do many rather messy procedures on a daily basis. I also consult with patients in a non-surgical environment, also on a daily basis.

    I like to wear the white coat with necktie in situations where infection control or stains are not a big consideration. It still needs to be well laundered and fresh.

    For surgical (outpatient only) or infection control situations I like the disposable gown that covers everything from wrist to neckline. It gets changed whenever there has been any reasonable risk of significant contamination, or if there is any visible stain on it. They are not expensive compared to the cost of laundering and the risk control benefit.

  28. Glen says:

    Consider the surface area of the arms and hands from eblows to finger tips.
    Then consider a .5mm layer of 64% ETOH alcohol gel sanitizer over that surface area.

    Assume 25% of that ETOH makes it to blood stream.

    A thorough sanitizing for each patient encounter could make the ED a most pleasant place to work-though you might need to take a cab home.

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