The People's Perspective on Medicine

Is Your Doctor’s Tie and White Coat Making You Sick?

Doctors love a long white coat. For many it is a way to distinguish themselves. But white coats, ties, long sleeves and jewelry can spread germs.

Several years ago we learned that British health professionals were told that they could no longer wear ties or white coats. In 2008 the UK’s National Health Service (NHS) banned ties and white coasts for doctors and nurses. The rule was that healthcare staffers needed to be “bare below the elbow.”

The point of the exercise was to try and reduce the risk that patients would be exposed to bad bugs: bacteria, fungi, viruses, etc. If the arms were bare below the elbow it would be easier to wash them thoroughly. The NHS was hoping to reduce the spread of MRSA and Clostridium difficile (C. diff) infections among others.

Sources of Infection:

Doctors have a name for things that transmit infection. They are called FOMITES. The Merriam-Webster dictionary defines fomite as:

“an object (as a dish or an article of clothing) that may be contaminated with infectious organisms and serve in their transmission.”

Long sleeves, white coats, ties, stethoscopes, computer keyboards, doorknobs and jewelry can all harbor nasty stuff. And keep in mind that hospital acquired infections are a huge problem. The CDC has estimated that 100,000 people die in hospitals each year as a result of infections they caught in these institutions.

Resistance By U.S. Doctors:

I used to serve on a Patient Safety and Clinical Quality committee at one of the nation’s most prestigious hospitals. When the NHS announced the banning of white coats, ties and jewelry in the U.K. I asked the experts at this hospital about its plans to follow suit. I wasn’t exactly laughed at, but it was clear that the culture of medicine in America would not give up white coats easily. The infectious disease experts at this institution made it clear that there were no data indicating that white coats posed a problem. Without data they were not about to institute changes.

I was also puzzled to discover that there was no policy on cleaning white coats or ties. Interns, resident and attending physicians determined how often they would clean such articles of clothing on their own schedule.

Dr. Peter Pronovost Challenges His Colleagues:

Peter Pronovost, MD, PhD, is one of the world’s foremost patient safety experts. He is senior vice president for patient safety and quality at Johns Hopkins Medicine. On December 19, 2015 he wrote an article titled, “Why White Coats Should Be Optional.” It should be required reading for patients, physicians, nurses and any health care worker who comes into direct contact with patients.

Here are just a few key points:

“Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?

“After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily or every other day. What is the harm in adopting a ‘bare below the elbows’ policy for health care professionals — as has been done in the United Kingdom — to reduce the chance of transmission?”

Dr. Pronovost points out that doctors often resist new ideas unless they can be proven beyond a shadow of a doubt. That is probably why the infectious disease experts completely rejected my suggestion several years ago that going bare below the elbow might be beneficial for patients and reduce hospital acquired infections.

Rejecting the Germ Theory of Disease:

This attitude is reminiscent of the 19th century. In the mid 1800s childbirth was extremely dangerous. Something called childbed fever killed many women shortly after childbirth. In those days doctors did not know about germs.

A physician researcher named Ignaz Semmelweis was practicing medicine at the Vienna General Hospital. He noted that women experienced a much higher death rate after a medical student delivered a baby compared to a midwife.

Dr. Semmelweis discovered that the students were dissecting cadavers in a room next to the maternity wards. They rarely washed their hands after dissections or between deliveries.

The midwives did not deal with the cadavers and thus avoided exposure to such germs. They were far less likely to spread germs from a dead person’s body than were the medical students.

Hand Washing Miracle:

Dr. Semmelweiss suspected that hand washing might make a big difference. He came up with the radical idea that medical students should disinfect their hands after their anatomy labs with the cadavers and between patients. After he instituted this hand hygiene practice the death rate after childbirth dropped dramatically. He didn’t know why the practice worked, he just knew it did.

One might imagine that Dr. Semmelweiss would have become a hero within the medical community and that his discovery would have been quickly adopted. On the contrary. Dr. Semmelweiss became a pariah. His colleagues rejected and ridiculed his research. He was forced into an insane asylum where he soon died. His plea that doctors wash their hands before delivering babies or touching patients was ignored for decades.

The 21st Century Mindset:

Modern medicine likes to pat itself on the back for its patient-centered approach. Yet it seems to us that too many health professionals are willing to accept 100,000 deaths annually as inevitable, just as doctors in the 19th century believed childbed fever was a natural consequence of childbirth.

Dr. Pronovost sums it up beautifully:

“My stance: We could voluntarily ditch the white coats without needing a clinical trial to tell us its OK. We know that white coats can carry pathogens, and it is logical to think that germs could be transmitted from physician to patient. Given that confirming this theory could be prohibitively expensive, we can look at the implications of acting and not acting…

“The real cost of abandoning white coats, it seems has less to do with preventing infections and more to do with the potential emotional or social consequences…”

Read Dr. Pronovost’s brilliant blog here and send it to your doctor or nurse.

Please share your own thoughts about this issue below. Would you think less of your health professional if he or she failed to wear a white coat? What about a tie? Could you bring yourself to ask your doctor to wash his hands or clean his stethoscope? Please vote on this article at the top of the page.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Please, tell them to quit taking chances with those white lab coats. While you’re at it, tell them it is gross to put a thermometer under a patient’s tongue, stick it back into a vial of disinfectant, and then go to the next patient, pull it out and put it under his tongue. I don’t want the drippings of the disinfectant along with a variety of sterilized “bugs” going into my mouth. Please help spread the word! Add the cost of a new thermometer for each individual. It’d be worth it.

What’s to say the clothing the doctor wears is not going to be susceptible to germs? At least with a white coat, you can see how clean the doctor keeps him/herself vs. without it. Why not disposable coats or better still, daily washing of coats? And coats with 3/4 sleeves perhaps?

Our Internist insists on shaking our hands when he enters the exam room. I tell him I don’t like shaking hands with anyone, particularly a dr., even tho he quickly “washed” his hands. Our church encourages shaking hands and even has a time set aside for that every week. I can’t stand that! Peoples’ hands are disease-spreaders!!

Obviously past experience is important. Florence Nightingale saved lives with soap and water too! The color of the coat (other than light so that it would show up obvious dirt), may be irrelevant, but the short sleeves and no long flowing tie makes sense, and laundering regularly must surely be a priority. Then again, some male doctors may have very hairy arms: another dilemma?

In the patient/doctor scenario “cleanliness is next to godliness” seems like a good thought to promote. Hand and lower arm washing (as done during surgery) must surely be of benefit. It would only raise my esteem for any doctor who is conscious and considerate of all his patients. A doctor can still talk and analyze while washing.

Here in NZ, in the ICU in particular, it is policy for all patients to be “bare below the elbows” (no exceptions), and there are no curtains. Individual ICU patients have their privacy maintained by the positioning of the beds and cubicles.

Ask the non-medical politicians, they have the last say in what we can and cannot have, think and do to our bodies.

If the infections and other things would be cut down in hospitals, I vote that the Drs do not wear their WHITE coats into a pts. room. the bed side should all have a bact. hand wash before he/she touches a pt. scope to be cleaned at bedside also. some Drs are very lax at this practice. They are in 2 much of a hurry! I would not be in a hurry to pay the co. pay if they can’t do the right thing for me!

My husband’s urologist always wore subdued Hawaiian shirts – obviously expensive ones. Our family doctor wears short sleeved pastel lab coats – usually salmon-colored. We haven’t seen white lab coats in years.

Another hospital pathogen harboring item are the curtains dividing the patient room. I ask the infection control person at a hospital the frequency the curtains are laundered. To my surprise she told me there was NO scheduled laundering, she added, only when a highly infectious patient was in the room would they be changed. With everyone touching the curtain and it being subjected to concentrated germ environment, they should be changed like the bedding is – after every patient at a minimum and optimally daily!

wonderful idea. i’ll mention this to him next trip.

Re: White Coats/Ties – bare to the elbow.
I had never heard/read of that before but it makes a lot of sense. I personally don’t care if my Dr. wears a coat/tie or not and what the color is. My one Dr. wears a short sleeved colored shirt/tie and no coat. Fine with me. Anything to cut down on spread of germs!

My orthodontist always wore a short-sleeved Mexican wedding shirt or guayabera. With the knife pleats and small scale white embroidery on the white shirt, these made a nice looking uniform. Something like this, with some added symbol could be substituted for the white coat. I’ve noticed that a lot of doctors these days don’t wear a white coat.

I recently gave my daughter’s boyfriend a second bow tie. He’ll be starting medical school in the fall. I told him when I gave him the first one that doctors need to switch to bow ties because the long ties are full of germs. Glad to see someone agrees with me. And he got compliments on his bow tie at each of his med school interviews.

I have one doctor who does not wear a white coat – and he also wears a bowtie! Always admired that. And now that I think about it I can only think of one doctor who does wear a white coat.

I have one doctor who does not wear a white coat – and he also wears a bowtie! Always admired that. And now that I think about it I can only think of one doctor who does wear a white coat. But the whole cardiologist practice does wear white coats. Interesting.

Why not have disposal lab coats. I love to wear lab coats , feel I need all those pockets , for pens , and pulse ox . I always have 2 clean lab coats besides the one I’m wearing in our office. I’m old school , white lab coats make people look clean and professional. I’ve seen nurses in nursing homes with short sleeve scrubs that look so nasty. A lab coat is like a kitchen apron has to be taken off to go to rest room. We just have to get into the habit of cleaning our stethoscope , pens , pulse ox , etc..

So if doctors ditch white coats what would they wear instead? Jacket and tie? Suit? There would still be the same problem of germs.
It seems to me it would be better if hospitals instituted a policy of mandatory daily clean jackets. Patients’ sheets get changed daily-why not lab coats? It’s certainly easier/cheaper/quicker to launder a lab coat than dry clean a suit/jacket.

scrubs? my next door neighbor is a podiatrist at a prestigious hospital and that’s what he wears to work.

phones – they handle their phones and don’t wash their hands

With all the TV shows with doctors in scrubs, it would not make a difference to me in my respect level towards a doctor if they were wearing scrubs.

Now, as someone who gets cold, I could see some people wanting to wear long sleeves and even jackets for that reason!

I understand about long sleeves, but the whole coat goes from patient room to patient room, carrying fomites on it. Seems like a better practice would be to wear a disposable gown over your clothing, using a fresh one for each patient.

Perhaps a freshly laundry one everyday would help and the doctor washing his hands before examination . The doctor for our children did that . There was
a sink in the exam room. People here could ware masks more when they carry some germs.

There is a device tjat attaches to your clothing with a magnet and cleans your stethoscope bell.

I think it was designed by a nurse…all healthcare providers should have one–and use it between each patient.

What if the white coat were assigned to the room where the patient was, and the doctor would put it on when coming into the room, after a thorough hand and lower arm washing?

We are foolish to ignore the power of symbols, and it appears that this is the issue. I recall noticing in a spa that the attendants wore white doctor-type coats because, I am certain, they wanted to convey seriousness for the various skin peels and other procedures they performed.

I am a victim of HMRSA (Hospital [acquired] Methicillin-resistant Staphylococcus Aureus). I had colon cancer and had a resection and was to be in the hospital 10 days. One of my fears was being exposed to MRSA.

After 6 weeks of the surgeon and his staff reassuring me it was not MRSA and refusing to test me I went to my primary care and she tested the wound (positive for MRSA) and treated me. After 10 days on antibiotics the wound healed.

I think scrapping white coats is a good idea but I also think health care providers should be required to test for MRSA on a regular basis. MRSA is an air-borne disease. Just think about that and those white coats.

I had a doctor once tell me “I’m not going to touch your feet, I have other patients to see” I asked him incredulously “You don’t wash your hands between patients?” He abruptly got up, walked out and sent in an assistant with prescriptions and never came back in. Ego is an affliction that doctors should have treated.

I consider a white coat a bad sign about doctors, and I think med schools should find some other ritual than one focused on white coats. I once saw a doctor (an ENT to see what was going on with my nose/breathing problems) and was turned off because he wore a white coat. There has been research out there for years saying that infection rates go down in hospitals (I think mostly it’s been in Europe) when they don’t wear white coats, and his white coat signaled to me that either he wasn’t keeping up with research or that his ego was more important to him than patient safety and outcomes. The guy was pretty arrogant in other ways, too, so it fit a pattern. He recommended surgery, but I decided I wouldn’t want to do it with him, so I walked away and later got another opinion with someone else, who also did the surgery. My regular doctor does not wear a white coat, and I think I wouldn’t want to have one who did. It’s nothing but a maintenance of distance and a claim to status (do we really not know which person in the room is the doctor?), and I want doctors who will work with me readily as a full partner.

Hospital personnel should wear short sleeves in order to do some good handwashing! And turn off those filthy faucets with a paper towel! And then there’s the physician’s tie dragging over the patient when he listens to the chest…ugh.

Florida former Infection Control Practitioner

“White coat syndrome” has always been a recognised phenomenon which probably still affects some patients when consulting with a doctor / medical professional. The idea that clothing is a potential source of contamination within in particular a hospital setting may be justified, but it should perhaps also be remembered that hospital “superbugs” such as MRSA are also transmitted via the nares/nasal passages and hands of course. As such how would it ever be possible to completely clean or disinfect body parts like these? Of course thorough hand washing and efficient laundering are vitally important but can only be partly effective in infection control.
As for a white coat and tie worn by doctors – what is wrong with a dress code in any profession? How would we feel if we met with a bank manager or solicitior wearing a teashirt for example? Old fashioned though the concept may be of a dress code, we all identify with symbols and symbolism, and tend to judge others by their appearance, whether we like it or not.
The greater risk of white coats not being worn by doctors and other health professionals may not be the pathogen issue but a gradual loss of respect for such vital professions.

I would not like to have a doctor who had to rely on his uniform to gain respect. But if you feel like you really need it, why not short sleeves and bow tie? Better yet, instill respect by listening to your patients.

I would prefer drs to wear their own clean clothes every day. Coats washed only once a month could carry germs of all kinds. Another way patients could pick up skin bacteria from other patients is from chair arms in each exam where loads of others have rested their arms. What about blood pressure cuffs used over and over?

Don’t throw away the coats, silly. Just shorten the sleeves. Logical to me way out here. I know how sleeves get so dirty at the wrists, and there’s more ‘dirt’ beyond what we can see.

Why can’t they just wear clean white coats each day or change mid day? I feel that the white coats, just like the former white nurses uniform with cap, shows professionalism and identifies the person wearing it as one who has studied, earned the recognition and can easily be identified to the patients. Often times now you cannot tell who is a worker that has six months of schooling versus many years of study and that you are depending upon and trusting your health care to. As a retired pediatric nurse I believe that the hand washing and cleaning of instruments should be done regardless of what color clothing is being worn!!

Joe wrote “Long sleeves, white coats, ties, stethoscopes, COMPUTER KEYBOARDS, doorknobs and jewelry can all harbor nasty stuff.” [emphasis mine]

Am I the only one concerned that the mandated increase in Electronic Health Records requires transitions between patient and keyboard. The caregiver will either transfer the prior patients’ organisms to you, or yours to the next patients or both.

My dentist changes tools (and a foil cover on the handle of the light) between every patient. Correspondingly, my doctor should replace a disposable keyboard cover between each patient. I have yet to see this.

Where would one look to find information about birth followed by death (baby or mother) because of unsanitary conditions. I understand from the article that medical students would go straight from cadavers to delivering babies, thus transmitting disease. But what about before this time. Do we know any statistics about babies delivered without medical doctors involvement? Was there a time when babies and mothers didn’t die from these kinds of infections?

I’m 75 years old and I don’t remember my doctor, or any of the others, wearing a white coat when I was a child. It wasn’t until I was much older that I saw my first woman MD and she was the first doctor I saw with a white coat.

I’m wondering what the data is from the UK on this change. Surely with making this change, they have collected data to determine if it made a difference. I also work in healthcare. I have noticed many hospitals have different colors of scrubs for different departments. Many doctors already wear the green “surgical scrubs”. You could easily replace the long sleeve coats with short sleeve coats or a certain color scrub.

The article sounds, like nothing else can transfer germs as a white coat. Nuisance. Or should they work naked?
What I would suggest, that doctor offices or medical centers should have their own some kind of “medical laundromat”, where medical staff can drop off their white coats (make it as a policy) every day or so after work to be properly washed and when they come back to work, they could put it on clean.

Seriously!?! I prefer some type of uniform. Yes, it’s professional. You’ve earned it! I’m not a doctor, but I think it’s important to be able to identify one. My mom’s nurse uniform (including hat!) from the 60’s identified her as an RN. It looked incredibly neat, clean and professional.

Maybe if they think they’re God’s gift to healthcare, they might become just that! Actually, everyone takes a few years to get to reality in their profession. In the meantime, we can be jealous of their energy and zest for their career!

There definitely should be a uniform protocol to prevent infections, etc., as part of the jacket design. As well as cleaning common elements everywhere in healthcare facilities.

(Obama had no problem parading out the white coats to push his train wreck ACA. Some of them weren’t doctors!!!!)

I am also a retired pharmacist and agree with the above poster.
It’s worth mentioning that while I worked at a children’s hospital, in the 1990’s; nobody wore white coats–except the students (doctor, pharmacy, etc). Only the newbies wore whites coats, I think to boost their confidence. We (the staff) deliberately dressed very casually so we wouldn’t scare the kids any more than necessary. It had nothing to do with decreasing germ exposure. That was simply a “side benefit”.

Dr. Pronovost gives a lot of good and useful advice on nearly everything having to do with healthcare. That’s his job as a writer. But he apparently does not take his own advice. Look at any photo of him you can find on the web (and there are many). His uniform outside of a business suit apparently consists of a long-sleeve white coat, probably full length, with his name sewn neatly above the left pocket and wearing a four-in-hand tie (a long, floppy tie that has probably never been washed). Just like nearly all those other stature-conscious physicians he talks about. He says, “Can we replace the white coat with a new symbol that says, I am a physician? I am not sure what that would be … .”

While he ponders that and searches for an answer, you’ll be likely to find him in the hospital this week wearing his long-sleeve white coat and four-in-hand tie. He could at least switch from a four-in-hand tie to a bow-tie. A bow-tie is acceptable under the U.K. dress code for doctors. A tucked-in short-sleeve white shirt with a bow-tie and name and title above the left pocket, washed daily would say, nicely, “I am a physician who wants to keep my patients from being infected by bacteria I have on my clothing.” That’s better than just wearing a white T-shirt.

I believe that all health care providers should wash up to elbows between each patient – esp. in nursing homes and doctors offices where they see patients in rapid succession. I’ve had experiences with both places and I know they DID NOT wash.

thank you.

I’m thinking the major reason doctors won’t give up white coats is that it takes away some of their authority, prestige, superiority. It works, and causes higher blood pressure readings in their office. Patients are somewhat at the doctor’s mercy, as doctors do have more data in their brains about drugs, parts of the body, what makes the average person feel better and, some of the doctors have knowledge of what makes people healthier in the long run, but patients rarely follow his advice here. I have one doctor who dresses in regular casual pants and shirt (but not blue jeans and sweat shirts). I feel much more comfortable with him than those with white coats. The interaction is better and I learn more.

Why not have the hospital laundry furnish clean white coats daily to doctors and have the coats have elbow length sleeves?

As a pharmacist, I would of course agree that physicians should abandon white coats because it seems logical the coats harbor pathogens.

I clicked on and read Dr. Pronovost’s entire blog in which he comments on the “perceived stature or power” connoted by the white coat. Many physicians may be opposed to abandoning white coats because they feel that the coats and dangling stethoscope convey status and prestige.

Dr. Pronovost ends his blog with the following paragraph:

The real cost of abandoning white coats, it seems, has less to do with preventing infections and more to do with the potential emotional or social consequences. We often say that people do not fear change itself; rather, they fear loss. Symbols and rituals play important roles in our lives, and loss of these may cause distress for some. To influence change, we need to seek to understand and mitigate that loss of perceived stature or power. Can we replace the white coat with a new symbol that says, I am a physician? I am not sure what that would be, but if we found an answer, it might help advance this debate.

As a pharmacist, here are some additional reasons that I feel white coats should be abandoned.

White coats clearly intimidate many people as evidenced by the well-recognized phenomenon of “white coat hypertension.” In our fast-paced managed care system, patients are lucky to be with their physicians for fifteen minutes. What if the physician prescribes blood pressure drugs to patients who, in reality, have only “white coat hypertension”? That would surely be substandard medical care but I doubt that it is rare. Once patients are prescribed blood pressure drugs, they often remain on those drugs for the rest of their lives, with any associated side effects.

During my career as a pharmacist, I preferred not to wear a white coat because it seemed to increase the distance between me and the customers for whom I was filling prescriptions.

Of course, my district supervisors weren’t pleased whenever they walked in the chain drug store where I was working and noticed that I wasn’t wearing the corporate-issued white pharmacist’s smock. The corporation wanted uniformity and that included wearing a white coat and tie.

Many pharmacy schools and medical schools recognize students for their achievements with what are known as “white coat ceremonies.”

In my experience, many pharmacists enjoy wearing a white coat because it conveys prestige: I am a health professional.

A white coat helps build the ego of newly minted pharmacists whose egos have already been built to stratospheric levels by their parents and pharmacy professors. Pharmacy students graduate with a belief that they will be God’s gift to our health care system.

During my career (I am now retired), I was never eager to wear a white coat because it implied to me that I was part of a medical-industrial complex which promotes a quick-fix pill for every ill.

I am a strong advocate of disease prevention via (sometimes major) lifestyle modifications, changes in diet, weight loss, exercise, avoiding tobacco and alcohol, etc. Modern medicine gives lip service to prevention but in fact greatly prefers drugs over prevention.

I avoided wearing a white coat in pharmacy school and during my career because I wasn’t proud to be part of an egotistical and greedy enterprise that promotes pills rather than prevention.

Wow…Excellent comment! I appreciate the opportunity to consider this issue from your point of view and applaud your resistance to the system.

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