How many of you have walked into physicians’ offices and seen sloppily dressed lady doctors with frayed slippers and eschewed saris or crumpled suits as if they’ve walked into their clinics straight from their beds. Or male physicians with grimy collars and scuffed shoes all topped with that yellowing ‘white coat’ as if to add insult to injury. Not everyone is blessed with good looks, but the elegance of a well-dressed physician creates a good first impression and that counts, more than we think we know. It is not only about our physical appearance, but our surroundings, our staff, all should exhibit this professional facade which instills confidence. As a physician and medical teacher for over 32 years now, I think I can voice my humble opinion and call a spade a spade….
In the nineteenth century, respect for the certainty of science was in stark contrast to the quackery and mysticism of nineteenth century medicine. To emphasize the transition to the more scientific approach to modern medicine, physicians sought to represent themselves as scientists, and began to wear the most recognizable symbol of the scientist, the white laboratory coat. But is it really relevant in modern medicine where we battle the bugs incessantly and the poor white coat that remains unwashed for weeks or months , forlornly hanging on the back rest of the doctors seat at the end of the busy day crying to be laundered? Recently, white coat ceremonies have become popular amongst those starting medical school and having hosted one recently I wonder what we are passing on to the next generation. The modern white coat was introduced to medicine in the late 1800s as a symbol of cleanliness, but is it really?
My own experience as infection control doctor and many others have shown that doctor’s coats worn in hospitals can harbor serious bugs including MRSA, Drug resistant E.coli etc. so the health authorities like the UK NHS started banning long-sleeved coats. A study published in 2011 investigating the effectiveness of the NHS ban showed no difference in contamination levels between residents wearing long-sleeved coats and those wearing short-sleeved scrubs, so what’s the way out?
Interestingly, in a study of medical students who were residing at home tended to have white coats that were more contaminated (72.9%), whereas those who were residing in the hostel had less contaminated coats (63.1%), which was a worrying prospect, as the hospital organisms were likely to spread in the community. Most of the students are of the opinion that white coats were worn to appear professional and I recall the days when we walked out of our homes with the white coat displayed with pride on our arms. I must confess we’ve even used this as an excuse to get cinema tickets to see particular matinee show!
Most students in both clinical and the non-clinical areas do have a high level of awareness regarding the contamination of the white coats but they still wear it in different areas of the college such as the library, reading rooms, canteen, classes and even outside the hospital premises when it is really not necessary. But what to do with the oldies who continue to work in their grimy coats and I cringe when such a dirty coat clad physician bends over the patients to examine them and walks coolly to the next one while my microscopic eyes cringe at the bugs being transmitted. How many of my colleagues out there will raise their hands when asked that they use a newly washed one every day?
As for the personal grooming, I reflect and realize that these are part of life skills that we usually pick up in school and family upbringing. And a good doctor is made much before he or she passes the graduation exam. If we have a ward, a friend or an acquaintance who we feel exhibits these traits, do we just sit back and not comment? I’ve had the notorious distinction of pointing out bad body odor and oily flaky dandruff hair issues to nursing colleagues but physicians are sacrosanct. Even when confronted with MRSA positive cultures from his coat pockets, one ‘gentleman’ accused us of mixing samples!