Should Clinicians Strip Down or Suit Up?

Nurse's Cap

Don’t worry. We’re not turning this into a fashion blog. But the topic of what health care professionals should and should not wear is a hot topic lately, and I’m finding it fascinating.

On June 25th my fellow blogger Susan Shaw explored the issue and provided some thought provoking ideas in her post “What (NOT) to Wear”. A few days later, Globe and Mail columnist Andre Picard was asking “Why do physicians wear white lab coats?”.

Clearly, hospital fashion is all the rage this summer. And I for one am glad it’s up for discussion.

One of my biggest pet peeves as a patient/family member continues to be not knowing who my care provider is. When I go into a hospital and need assistance, am I asking for help from a care aide, an RN, a doctor, a student, a lab tech, or a nurse practitioner? I am always relieved when I see someone wearing a hair cap because then I know they are from dietary services. Or, wait… maybe they’re the scrub nurse from the operating room?!?

I agree with Susan that the white lab coat phenomenon does create a power hierarchy that can affect the relationship between the doctor and patients, as well as between the doctor and other care providers. But what’s nice about the white lab coat is that I can tell, almost immediately, that the person coming into my room is likely a doctor. And, I have to admit, I kind of like that.

In Lean they often talk about the “5 second rule.” Anyone should be able to walk into any area and find what that they need within 5 seconds. Can we say that about our health care providers? Can I readily assess who I’m talking to in a clinical environment within 5 seconds? If not, is that introducing waste by creating more opportunity for interruptions, or worse yet, safety issues?

Don’t get me wrong. I’m not saying we should go back to the days of hats, skirts, and white pantyhose. But there is something intriguing about visual identification of health care providers not only for patients but for other care providers too. Let’s face it, in a busy environment or emergency situation we forget to introduce ourselves. And who can read those tiny little nametags?  When I worked as an RN in a busy Calgary Emergency Deparment we did have some color coding.  Hospital issued scrubs that were navy blue for RNs, pink for porters, green for docs (with a lab coat), and light blue for care aides.  As a new employee I really appreciated being able to ask my colleagues for things in a rush understanding their role based on the color of their uniform before I knew them by name.

Nova Scotia tackled the issue head on last fall by introducing standard uniforms for RNs in the province: white top and black pant scrubs. The change has been welcomed by some and resisted by others.

So what do you think? Would patients and families appreciate being able to distinguish their care providers out by standardized uniforms? Does the “5 second rule” even apply in this case? What are the opportunities and risks of stripping down or suiting up in an effort to design better care and better teams?

Maybe there are bigger fish to fry in our system right now. But sometimes the things that seem small ultimately have the biggest impact on our patients.

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5 Responses to “Should Clinicians Strip Down or Suit Up?”

  1. C Fay Puckett
    May 21, 2013 at 2:03 pm #

    As a patient(in emerg on Sunday), advocate for my family and a nurse I echo your concerns about identifcation of health care personnel. When the person in green scrubs , whom I had never seen before, said to me in the empty waiting area of the eye care center”come with me” I responded “and you are who?” Turns out he was the opthamologist I was to see, could have been a porter or?
    During my time as chair of the provincial SRNA council several focus groups of members of the public shared your concern that no one in the health care system introcuces themselves, describes their professional role or describes to them how they may be involved in their care. When did we lose this and how do we get it back? This failure to enter into a care contract with our clients shows a profound lack of respect, simple good manners and very poor quality of care.

  2. Steven Lewis
    August 16, 2012 at 11:10 am #

    Great post Kyla – you are a gifted blogger. As for what do to, I think you’ve got the principle right – we should be able to identify people quickly and easily according to function in such an alien and complex environment. I find it annoying when I can’t tell the staff from the customers in some retail outlets. By contrast, it’s no mystery on airplanes (Austrian Airlines clads its female flight attendants in red, top to bottom, including the nylons), among couriers, or in fast food restaurants. It doesn’t have to be uniforms, but identifiability should pass the test of speed and accuracy for an 85 year old medical patient. Most name tags are horribly designed (at conferences, not just in health facilities). Why? Because no one bothers to test them on users.

    • Kyla Avis
      Kyla Avis
      August 16, 2012 at 12:13 pm #

      Thanks Steven – I take your praise in high regard from a writer/blogger who’s not too bad yourself!

      I think there has always been a level of resistance to seeing health care as similar to industry but I’m not sure why? There are some great things that industry does because it works, it make customers happy, and it improves their bottom line. I think identifiable staff is one of those things that works or it would be such common practice. We seem to tolerate a lot less from our health care system than we would from our retail outlets and restaraunts which seems a bit strange…

  3. Carolyn Thomas
    July 17, 2012 at 12:02 pm #

    Thanks so much for this, Kyla.

    Here’s a novel suggestion for hospital staff who would like to be recognized by their patients: try the common courtesy of simply making eye contact and introducing yourself. The white coat is no longer the exclusive apparel of doctors (in our hospital, lab techs, pharmacy staff and many others also wear the white coat – and don’t even get me started on the filthy white coats I have observed – particularly revolting when they are worn by off-duty staff leaning over the produce bins at the grocery store on their way home from a long shift!)

    Little tiny name tags are useless in terms of easily identifying name and job title. And as a heart attack survivor who’s become a frequent flyer of hospital wards/diagnostic labs/specialists’ offices, I can tell you how refreshing (and rare!) it is for hospital staff to maintain even minimal manners when in contact with patients ( basic things like “Hello, my name is ___ and I’ll be doing your ____ procedure today!”)

    A study on this pervasive issue published in the Archives of Internal Medicine last year found significant gaps between patients’ preferences of exam room etiquette vs. the actual reality as captured on videotape during the research. Another study out of Yale University found that only 18% of patients knew the name of the physician in charge of their care (although the majority of physicians studied just assumed that the patient somehow knew their names).

    I had a stress echocardiogram test done once that was so personally traumatic for me that I did something very few Canadians like to do: I formally complained to the department manager about the insufferable rudeness of the two techs who did my test. The manager was surprisingly receptive – mine turned out to be the second complaint in less than a week about these two. I later wrote this for her: “An Open Letter to All Hospital Staff”: http://myheartsisters.org/2009/07/10/open-letter/

    While I’ve been following the “what/what not to wear” health care employees’ discussion online with interest, I have to tell you that from a patient’s perspective, this is likely one of the least important quality indicators of a hospital visit compared to good old fashioned manners.

    • Kyla Avis
      Kyla Avis
      July 25, 2012 at 11:32 am #

      Hi Carolyn and thanks SO much for your reply to this post. It is quite a sad state of affairs when we are to the point where we, as health care professionals, have lost the most basic component of human interaction – making eye contact and introducing ourselves. The recommendations in your open letter seem so common sense yet we all know this basic level of respect can sometimes be lost in our health care system and I wonder what makes us struggle with maintaining the highest level of respect with every patient, every time.

      I think it is very commendable that you took a stand and spoke up about your experience I think it’s important for us to do that more often. Not only the negative experiences but sharing our positive care experiences with care providers, managers, directors, VPs, and CEOs so we can reinforce the behaviors we want to see in our health care system.

      Again, thank you for sharing your very important perspective in this disucssion.

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