“I knew it was going to go badly when I saw her dirty lab coat”
At brunch this weekend with friends, the conversation turned to a bad experience one of my dining companions had when seen by a doctor covering for her family physician. My friend made a prediction (which turned out to be accurate) of how her visit was going to go based on the state of the doctor’s lab coat. This started me thinking about why doctors historically wear lab coats and why many of us now don’t.
The white lab coat has been a symbol of the medical profession since the late 19th century. We adopted it in part to make us look more like scientists than quacks. We also hoped the white coat would protect us or perhaps our patients from cross-contamination. White is a colour associated with hope, health, and truth but one of the more practical reasons lab coats are white is to help us to see when they get dirty.
Three weeks ago, the University of Saskatchewan College of Medicine Class of 2016 received their acceptance letters. In three months these medical students will participate in a White Coat Ceremony, a ritual recently adopted by a variety of health care schools across North America. I can only imagine the excitement and pride that will be felt by the students and their families as white coats are donned for the first time. But I also wonder how much longer we should perpetuate the white coat as a symbol of our profession.
I stopped wearing a white lab coat about 12 years ago at the same time my health region stopped providing a laundry service for lab coats. If I wanted a clean lab coat, it would be up to me to wash it myself. And there was no way I wanted my hospital-acquired grime accompanying me home to be washed in my non-commercial washing machine. I started wearing hospital isolation gowns when I needed to be in close proximity to patients.
In 2008, the United Kingdom Department of Health banned the white lab coat (along with wristwatches, ties, and sleeves below the elbows) citing infection control concerns. While a strong link between lab coats and the spread of infection has not been clearly established, lab coats interfere with good hand-washing techniques and can harbor bacteria particularly around the cuffs and pockets. While some doctors protested in the press, many physicians had already changed their practice.
As first noted by pediatricians and psychiatrists, white coats can be scary and intimidating. The white coat is also an explicit reminder of the hierarchies in healthcare, acting as a barrier between the physician and patient. It brings with it a sense of authority that borders on the authoritarian. It’s supposed to be a reminder of cleanliness but as my friend noted at brunch, not all lab coats stay white. As we make the necessary moves to providing patient-centered healthcare, it makes sense to me to rethink the symbols of our profession.
What comes to your mind when you think of a white coat? Does the medical profession need a visual symbol or are our actions and words sufficient? And what laundry tips do you have for our new medical students?