Should doctors be wearing white coats?

For years when you thought of a doctor, you thought of someone in a white coat. Yet this garment has long been consigned to the waste bin. Go on to any hospital ward now and you will see doctors wearing open necked shirts or, sometimes, scrubs—but never, ever a white coat.

In fact, they have actually been officially banned in many hospitals and those who dare to try wearing one risk being rugby-tackled to the ground and having it torn from their backs by a manager. But does the humble white coat really deserve it’s new found pariah status? The truth is that the white coat has been politicised, and the reason it was banned isn’t as straightforward as we’re led to believe.

White coats were banned, along with things like ties, because it was claimed that they were an infection risk. Many doctors have taken umbrage at this—not because they are being required to do abide by rules, but because the rules make no sense.

The initial argument was that most doctors waited until their white coats were so covered in organic matter before washing them that they could have taken themselves off to the laundry. They have been replaced by plastic aprons for medics when they have to do a procedure or examine a patient.

But these still leave a good proportion of your nicely laundered shirt or blouse exposed. So white coats have been replaced with something that, truth be told, doesn’t really protect the patient from the doctor’s clothes and certainly doesn’t protect the doctor’s clothes from the patient.

In fact, I’d go so far to say that it’s actually a dangerous policy because it obscures the real problems faced when tackling hospital-acquired infections. Along with hand washing, the only other variable that has been consistently shown to be implicated in hospital-acquired infections are bed occupancy rates. Put simply, the quicker the turnaround in hospitals and the more pressure there are on beds, the more infections there are.

Rather than look critically at the current model for the NHS, which is all about cutting beds, and realising that this is directly contributing to hospital infections, it’s far easier to look to the innocent white coat and ban that instead.  

By banning white coats, ties and insisting that staff are "bare below the elbows", doctors now don’t look "smart" on the ward—no ties, no long-sleeved shirts and no suits. Many have argued that they have lost their "presence" in hospitals and patients can no longer identify who is a doctor.

Unsurprisingly, this isn’t what patients want. A study published in the British Medical Journal that surveyed the opinions of several hundred patients found an overwhelming majority—especially in older patients—wanted doctors to wear white coats specifically because it made them easier to identify and stand out. 

Most frustratingly for doctors, who are encouraged to practice evidence-mased medicine, there’s no clear evidence that white coats actually carry any disease-causing bugs. A review commissioned by the Department of Health found that most of the bugs that were found on white coats were simply from the doctor’s skin and would be on any item of clothing they wore—and didn’t cause disease anyway.

The fact the white coats don’t spread disease is borne out not just by studies, but in practice too. In Hong Kong, for example, where white coats are still standard uniform for all doctors, the rates of hospital acquired infection are still considerably lower than UK hospitals. In fact, in other European countries where white coats are worn, the infection rates are also lower than the UK.  

The case against the white coat was flimsy and fuelled by politics not evidence. Surely it’s time doctors rose up and donned their white coats once more? 

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