What Should Doctors Wear? Even Lab Coats Could Spread Disease

By Elaine Schattner

With reports proving that germs can reside on scrubs, ties, stethoscopes, and white lab coats, some have said doctors should just go naked

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In 1990, a young female physician might wake in the early morning and, while dressing, contemplate if her attire were sufficiently professional and comfortable for a long day's work on her feet. Her choices were slim: to don a simple dress, or wear a modest blouse neatly-tucked into a skirt or slacks. Frumpy shoes were an asset. Guy-docs kept it simple, too: they'd select a suit or belted pants, worn uniformly with a pressed, long-sleeved shirt, and a tie -- styled long or bow.

This year, an AMA newsletter pronounced that scrubs and white coats are equal opportunity bacteria spreaders.

Upon arriving at an office or hospital, of course, she'd exchange her jacket or sweater for long white coat. This ubiquitous symbol of hygiene, science -- and perhaps virtue -- was essential to the physician's image in 20th-century America. Back then, you'd have been hard-pressed to find surgical "scrubs" -- short-sleeved, V-necked tops paired with draw-string, loose pants -- anywhere outside of an operating room except, perhaps, after midnight on a sleepy intern.

Nowadays, with worries like Contagion in the eyes and minds of patients, a physician might think thrice about her outfit. What doctors wear, and how often they change their garments, is, some suggest, a matter of public health.

There's no doubt germs can reside on white coats, scrubs, ties, stethoscopes, and phones. As far back as 20 years ago, the British Medical Journal reported findings of Staph aureus bacteria on doctors' white coats. In 2007, Britain's National Health Service took measures to restrict providers' coverage. The NHS went so far as to advise that physicians bare all below the elbows. In 2009, the American Medical Association considered adopting a no-coat policy in the U.S. The proposal was scuttled. Clinicians voiced firm affinity for their traditional gowns. Some echoed earlier anonymous arguments by reductio ad absurdum, pondering if doctors should go naked.

A physician wearing a white coat came to symbolize 20th-century medicine, argues Dr. Mark Hochberg, a professor of surgery at NYU's Langone Medical Center. Before the late 1800s, doctors usually wore black because it was considered formal, he wrote. The shift to white paralleled progress in science and, eventually, the public's awakening to germ-fighting habits. A 1979 review in the Annals of Internal Medicine by Dr. Dan Blumhagen detailed the white coat's emergence in three realms: the operating room, the laboratory, and the hospital.

Both authors cite Dr. Joseph P. Kriss, who in 1975 wrote in the New England Journal of Medicine:

The physician's dress should convey to even his most anxious patient a sense of seriousness of purpose that helps to provide reassurance and confidence that his or her complaints will be dealt with competently. True, the white coat is only a symbol of this attitude, but it has also the additional practical virtues of being identifiable, easily laundered, and more easily changed than street clothes if accidentally soiled.... Casual or slovenly dress is likely to convey, rightly or wrongly, casual or inattentive professional handling of their problem....

The coat confers a sense of doctors' authority and cleanliness. "Patients expectations vary," Hochberg relates. "Psychiatric patients may not prefer seeing doctors in white coats, and children may be frightened by them," he says. For this reason, psychiatrists and pediatricians at some medical centers don't usually wear white coats. "White coats may be reassuring to some patients, but for others they may create anxiety," he says.

Julia Hallisy, of San Francisco, is a 48-year-old mother and dentist who lost her young daughter, Kate, to cancer after a course complicated by a hospital-acquired infection. Now, she's keenly aware of hygiene in any health care setting, and a fierce advocate for patient safety.

"Back in 1997, when my daughter had her infection, I started to look around the hospital with a much more critical eye," she says. "I started noticing staff members were going upstairs, to the cafeteria, to the gift shop, and then right back to the wards." With a protective mother's eye, informed by her training in dentistry, she realized germs could be present on doctors' scrubs, on the curtains surrounding hospital beds, and on almost any object touched by the hospital staff and patients' families.

"It's clear you can culture organisms from doctors' garments," says Dr. Lewis Drusin, a professor in medicine and public health at Cornell University. "It's an open question," he admits. "But there's no published evidence that this is how disease spreads."

Indeed, many physicians are loath to ascribe infection to a particular uniform. This year, an AMA newsletter pronounced that scrubs and white coats are equal opportunity bacteria spreaders. A small, randomized study found that newly-cleaned scrubs and infrequently washed white coats carry similar rates of bacterial contamination after an 8-hour workday.

"To reduce infections, doctors should wash their hands and practice good hygiene," Drusin says. "It doesn't matter if it's a gown, or scrubs, or a white coat over professional attire. Whatever it is, it should be clean."

Hallisy still likes seeing doctors in crisp white coats. "At least a lab coat is hopefully getting washed every day," she says. "As a health care provider, you sometimes feel like you can't win," she adds. "Rules can be frustrating and a hassle for doctors."

"The problem is we can't see these bacteria. The damage they cause is devastating," Hallisy says. "This is an invisible enemy."

Image: fbmadeira/Shutterstock.

This article available online at:

http://www.theatlantic.com/health/archive/2011/11/what-should-doctors-wear-even-lab-coats-could-spread-disease/247987/