Are the White Coat Days Coming to an End?

Paul E. Sax, M.D. explains “If you’re not immersed in the ID or the Infection Control world, you might not be aware that there’s currently quite the controversy about whether doctors should wear white coats.”

The medical question is of course about the danger of infection, but once the doctors’ traditional uniform is threatened larger cultural issues come into play.  For example, what is the patient’s expectation and how does that impact the visit?  How does the doctor maintain his/her authority?

In any visit to the doctor there is a bit of theater involved.  The stage is set and costumes are worn.  But perhaps things are changing.  A recent article by Abigail Zuger M.D “The Costumes That Obscure Doctor and Patient”  suggests that the days of the white coat may be coming to an end.  Dr. Zuger points out that is has been 10 years since the  British Health service cut the traditional white coat .

A literature review by Petrilli CM, Mack M, Petrilli JJ, et al in BMJ Open on the subject finds that while there is some desire on the part of the patient for more formal dress from the doctor, the preference varies so much based on geography, age, culture and tradition that it is hard to draw any uniform conclusions (pun intended).

While some of the discussion on what a doctor should wear is based on the science of infection control much of it is more subjective.  The same is of course true for what the patient wears.  Dr. Zuger writes ”The symbolism surrounding patient gowns is just as fraught. They are cheap, demeaning, undignified and chilly.”

It is interesting that what starts as a question about infection so easy transforms to a question about the human nature of the doctor-patient interaction.  As Dr. Zuger notes:

“We are never more human than when we are dressing and undressing, and yet for our medical care, we have, for some reason, decided to posture in front of one another fully costumed, pretending that, encased in our separate roles, we will get to the bottom of the pain.”

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