Dateline September 2007: The BBC rocks the medical establishment with a report on the United Kingdom’s National Heath Service ban on the wear of white coats, ties, and long-sleeve shirts during clinical activities. What! Doctors aren’t allowed to wear white coats or ties when they see patients! Strangely enough, this announcement wasn’t met with the expected outrage in the United States due to the data behind the new policy. Numerous studies have shown that white coats and full-length ties are fomites. What’s a fomite? According to Wikipedia, a fomite is “any inanimate object or substance capable of carrying infectious organisms, such as germs or parasites, and hence transferring them from one individual to another.”
Picture this. You are in your usual state of wellness and see your primary care physician (PCP) for your annual wellness exam. Your PCP sees a diabetic patient with a methicillin-resistant staphylococcus aureus (MRSA) infection prior to your 15-minute visit. As an aside, MRSA is now prevalent in most communities, including Ruidoso and the surrounding areas. Although your doc does an admirable job with hand-washing before and after the wound check, and wears gloves during actual patient contact, he thinks it is important to present a professional appearance and dutifully wears a long-sleeve shirt and tie and completes the look with the trademark white coat. We’ll give him extra credit for daily laundering of his white coat (folks-it doesn’t happen). During his exam, and unseen by the doc, the sleeve of his coat and the tip of his tie brushes against the open wound surface, picking up the MRSA bacteria without visible soiling of the sleeve or tie.
You are the next patient. Will you ask your doc to start out with a new wardrobe prior to seeing you? How many times have you asked your doctor to remove his shirt, tie, and white coat? Never? Me neither.
Numerous studies show that patients are placed at greater risk for infection due to the trademark professional appearance that most docs maintain. The United Kingdom made great strides in the fight against spread of hospital-acquired infections when they banned white coats and ties. I remember reading the initial report of the ban. While a professional appearance was required during my residency training, I hung my white coat on the door and wore short sleeves and a bow tie. (And yes, I CAN pull off the bow tie look.)
As a patient, I expect my physician’s highest priority is my safety and wellness. As such, professional dress should be redefined where my safety and wellness are the highest priority. Goodbye to the suit and tie! I expect my physician to wear either scrubs or a short sleeve shirt (without a coat or long tie) to ensure I am not placed at any greater risk. I understand that it is unprofessional to place me at greater risk for the sake of appearance or personal pride. The data supports this paradigm shift, not only in the United Kingdom but in the United States.
Join me in using data to drive our healthcare system toward increased efficiency, increased patient safety and decreased cost. The data is there. Let’s use it for our benefit.
This is the first article in a series entitled “Data Driven Docs”. The series will examine the available data concerning some important medical issues and compare current hospital policies and procedures with data-supported guidelines. Please feel free to email me questions relating to community medical policy during this article series. Stay tuned for a data driven checklist to keep you safe. Use it to replace the profit driven survey that “keeps you satisfied.”
Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He keeps a white coat solely for picture opportunities. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.