Ask doctors to nominate the symbols of their profession and many
will select the Hippocratic Oath or the serpented staff of Aesenlaplus. Ask the
same question of a person in the street and the stethoscope or the doctor’s
black bag, are common response. However, the most recognisable symbol of the
profession is the white laboratory coat (Harnett, 2001). The physician’s white laboratory
coat was worn initially for the purpose of protection against cross contamination
spills (from reagents) and also because white laboratory coat connotes life,
purity, innocence, goodness etc (Wear, 1998) and Van Der Weyden, 2001) and
hence the wearing of white laboratory coat is used to emphasize the humanistic
value of medicine (Harnett, 2001). Among the many recent changes in the way
medicine is practice, one little-studied change has been the disappearance of
‘laboratory coat’ doctors in many hospitals (Harnett, 2001).
As the 20th century
advanced, and sociologists turn their attention to medicine (Annandale, 1998) and (Freidson, 1970) and the
dynamics of the patient-doctor relationship, the white laboratory coat was seen
increasingly as a barrier to effective communication. In an attempt to dispel
these perception paediatricians, psychiatrists and doctors in private practice
shed the white laboratory coat (Van Der Weyden, 2001). Furthermore, the changes
in the society and healthcare workers turned physicians into ‘healthcare
providers’ and patients into ‘clients’ also witnessed the extinction of the
white laboratory coated physicians.
What then do patients want their
physicians to wear? Studies by Douse et
al., (2004), Harnett, (2001), Tiwari et
al., (2001) and Dun et al.,
(1987) showed that patients favoured doctors wearing white laboratory coats.
The reason given were tradition, ease of identification, looks professionals
and prevents infection. These studies also showed that patients aged over 80
years of age prefer their doctors to wear white laboratory coat while younger
patients (30-39yreas) do not want their doctor to wear white laboratory coats.
However, physicians do not all agree
with the patients’ view of wearing a white laboratory coat because they
consider them an infection risk. This was shown by the work of Douse et al., (2004) and Harnett, (2001).
Although no work has proved the involvement of white laboratory coat in infection
transmission, several works have shown that they are contaminated by nosocomial
pathogens. For instance, the studies by Treakle et al., (2008) and that by Wong et al., (1991) showed that of 149
and 100 white coats sampled respectively, 23% and 25% were contaminated
respectively by S. aureus.
Older physicians were more likely to
favour the traditional white laboratory coat as well as surgeons and gynaecologists
(Douse et al., 2004) while
psychiatrists and paediatricians were the lease likely to feel that white laboratory coats should be worn (Dose et al., 2004).
According to Mr. John Heyworth, an
accident and emergency physicians at Southampton General Hospital., physicians
prefer to wear scrubs outfits rather than white laboratory coat (BBC News, 2011).
White laboratory coat tend to be hot and uncomfortable to wear, and people tend
to use them to store unnecessary bit of kits’, he said. There is also the
phenomenon of ‘white laboratory coat
hypertension’ where a patient’s blood pressure can go soaring when they
spot a doctor wearing a white laboratory coat (BBC New, 2011) and Wikipedia,
2011). Scrubs are preferred because they are more comfortable and are easier to
wash.
Although most patient prefer their physicians
to wear white laboratory coat for easy identification, it has been pointed out
that several other groups of health care workers wear white laboratory coat, so
they may not be the best form of identification (BBC New, 2011). But it is
suggested that the days of the white laboratory coat may not be over. In Australia there
seems to be a movement towards rediscovering the white laboratory coat as a
symbol of “Purpose and Pride as a Profession” (Van Den Weyden., 2001). While in
the United State, the white laboratory coat “robbing
ceremonies” are common (Wear, 1998). This is a relatively new ritual that marks
one’s entrance into medical school and more recently, into a number of health-related
schools and professions. It originated in Columbia University’s
College of Physicians and Surgeons in 1993 (Huber,
2003) and involves a formal “robbing” or “cloaking” in white laboratory coats.
The students are welcomed into the profession by the assembled faculty of the
medical school. After an address by an eminent member of the profession, each
student is presented with and helped into his or her white laboratory coat by
the dean and other faculty members. This robbing ceremony is followed by a
public proclamation by the students of their professional commitment akin to
the Hippocratic Oath (Van Der Weyden, 2001). The white laboratory coat ceremony
is not without it critics who question its appropriateness and perceive a
darker symbolism (Van Der Weyden, 2001) nor are there comparable exercise in
other parts of the world.
The department of health’s working
party states that dress makes an impression. The way staff dresses will send
messages to the patient they care for and to the public. It is sensible for
trusts to consider what messages they are trying to convey and to advise on
dress codes accordingly (Department of Health, 2009) even if white coats are to
be discarded. Possibly as a result, some trusts have gone one step further and implemented
formal dress policies for clinical staff and this includes the bare below the
elbow policy that specified that staff should wear short sleeves, no wrist watch
and jewellery and aliened to this the avoidance of ties when carrying out
clinical activities. This new clothing guidance will ensure good hand and wrist
washing (Johnson, 2007).
Current data indicate that white
laboratory coat can only be considered a personal decision, and the preference
can only be considered a personal decision and the preference of the medical
professional should be respected accordingly (Kazory, 2008). In industries and
institutions related to biology, white and green coats are used. Typically,
white laboratory coats are used in laboratory work. In Argentina, students and
teachers of most public primary schools wear white coat that resemble
laboratory coats as a daily uniform (Wikipedia, 2011).