In the previous post, I noted the symbolic power of the white lab coat, not only to those wearing it, but also to those in the presence of one wearing the symbolic vestment. The symbolic effects – such as enhanced performance on cognitive tasks and increased status have a largely positive outcome for all.
But there are some serious and troubling negatives associated with the white coat. For the wearer, traditional lab coats are bulky and expensive to maintain. Even though the cost of lab coats is modest, keeping them in top quality condition requires frequent laundering and attention. (It is possible that the rise of commercial laundries had a non-trivial role in the widespread acceptance of lab coats.)
However, here’s the biggest concern – let’s talk about germs. Lab coats are extremely effective microorganism transportation devices. Moving from one patient to another, the physician becomes a propagation device for all sorts of pathogens. Studies of the white coats worn by physicians to grand rounds at a large teaching hospital showed that 23% of coats were contaminated with Staphylococcus aureus. More troubling is that 18% of the organisms were Methicillin-Resistant (MRSA) strains. In fact, studies have found significantly more bacterial contamination on traditional lab coats than on scrubs .
For male health care workers, neckties are also effective pathogen transmission devices. In a study of neckties worn by physicians in a major teaching hospital in New York, 48% of all ties worn by health care providers carried harmful bacteria.  The traditional uniform of male physicians, the white coat, dress pants, shirt and tie certainly has symbolic value for patients and physicians, but also poses a real danger to patient health. Such observations prompted the UK National Health Service trusts to adopt a ‘bare-below-the-elbows’ and tie-less dress-code policy in September 2007.
In addition to the disease transmission potential of white lab coats, they can have a direct impact on patient health. White coat hypertension occurs when patients exhibit elevated blood pressure in a clinical setting, but not in other setting. Of course, diagnosis is difficult in the short term. Individual variation in normal blood pressure, consumption of stimulants and other drugs, technical difficulties, and anxiety of the patient are all contributing factors.
For those suffering from white coat hypertension, there is no evidence that this temporary rise in blood pressure during clinic visits has long-term effects on patient health, However, higher morbidity has been observed in those suffering from white coat hypertensionwhen compared to those with normal blood pressure. It is important to note that this finding is strictly correlational and no direct causality is implied. In sum, far from being a simple article of clothing for use in a clinical setting or laboratory as protection for the wearer, the lab coat has become a powerful symbol of wisdom, knowledge, science and medicine. Nevertheless, it also can cause harm, something that should be considered by both patients and physicians. Is it time to lose the coat and tie? I think so.
1. Munoz-Price, L.S., et al., Associations between bacterial contamination of health care workers’ hands and contamination of white coats and scrubs. American Journal of Infection Control, 2012. 40(9): 245-248.
2. Hueston, W.J. and S.M. Carek, Patients’ preference for physician attire: a survey of patients in family medicine training practices. Family Medicine, 2011. 43(9): 643-647.