Do Medicos Really Need to Wear White Coats and Stethoscopes in Public?

“Mere symbolism and wearing white coats does not itself confer status or professionalism. Dressing presentably and sporting a smile are more important than white coats. To ensure we remain visible to patients, institutions should provide the medical students and doctors with recognisable name badge to wear”- Edmond Fernandes, a Postgraduate at Yenepoya Medical College, Mangaluru

Mangaluru: This article is in favour of the report titled “Doctors and medical students in India should stop wearing white coats” published by Edmond Fernandes – a postgraduate at Yenepoya Medical College, Mangaluru in his book ” Small Things That Matter Much”. Edmond’s views that doctors wearing long-sleeved white coats in India facilitate the transmission of infection in hospitals, was published in the British Medical Journal (BMJ). I fully agree with Edmond’s views on this matter, and I compliment him for bringing it to the awareness of the medicos and public.

According to Edmond Fernandes there is evidence to show that that long-sleeved coats facilitate the transmission of infection in hospitals, leading to avoidable harm and cost to patients. Fernandes says it is a fact that white coats “harbour potential contaminants and contribute considerably to the burden of disease acquired in hospital by spreading infection. In India, changing areas in hospitals are rare because of space constraints, so white coats are commonly worn by students coming from college and outside the hospital. They are also often left on chairs, tables, and in corridors. In many cities in India, some junior doctors are also now seen wearing white coats in shopping malls and cinemas too; they enter sterile zones in the hospital in the same attire. Given India’s tropical climate, common sense indicates that we should discourage wearing white coats that are washed perhaps only every few weeks.”

Fernandes also says that to reduce hospital infections, better hand washing compliance is required – Every hospital should have a committee to check and respond to hospital-acquired infections. But an easy solution would be for the ministry of health to ban doctors and medical students from wearing white coats, to reduce the harm and cost that results from hospital acquired infections. Doctors should be trained or taught in handling themselves better. If they are wearing it in malls, they should be educated not to unless they want to show off that they are medical students,” Edmond adds.

I have noticed that apart from medicos wearing white coats and moving around in the public, there is yet another diagnostic tool that medicos wear around their neck in the public. For nearly 200 years stethoscopes have been one of the most important diagnostic tools in the medical profession. The medical stethoscope has become so common a symbol of the medical profession that nothing else identifies a health- care professional more than a medical stethoscope draped around the neck. But that’s okay if medicos wear stethoscope inside the hospital/operation room or clinic, but having it around the neck or holding it in hands in the public is not a good idea, when it comes to safety and hygienic standards.

Infection can spread from patient to patient, not only on hands, but also via stethoscopes. Antimicrobial stethoscope covers, including those impregnated with silver ions, do not decrease bacterial colonization; evidence suggests that their use may actually increase it. Studies indicate that rubbing alcohol pads on stethoscope diaphragms can reduce bacterial colonization, and it has been suggested that cleansing of stethoscopes daily may be as effective as more frequent cleaning. Unfortunately, many clinicians do not clean their stethoscopes on a regular basis. In addition, alcohol pads are not always available, and using them requires an extra step and produces waste.

But through this article I want to ask one question is that, “Is it really necessary for doctors to wear stethoscopes when they move around in the public?”. Some may say that through stethoscope public could identify that person as a doctor, so in case of someone needs medical attention, they can approach them. But if that’s the case, I have witnessed couple of incidents right here in the city, where these persons wearing stethoscopes had simply ignored victims who needed medical care. It was the good Samaritans, ” the public” who came to the rescue of the victims, and brought them back to consciousness. On the other hand, those persons wearing white coats and stethoscopes around their necks simply walked away. So my question is, “Being a medical professional, why wear a stethoscope or a white coat in the public, if you are not ready to help someone in need of medical assistance”.

I am not trying to be prejudice towards doctors, but I am talking sense. I am not blaming every doctors either -there are many doctors who don’t walk around in the public with their stethoscopes in their hands or draped around their necks- but still you will see quite a few in that habit (white coat), especially the young medics. To be frank, being in USA for the last 23 years I have never seen a medical professional in the public in their white coats or wearing a stethoscope-The only persons you see in white coats walking around in the malls or shopping areas are the employees who work in the cosmetic departments of mega stores.

But look around in the city here-medical professionals, lab technicians, medical students and other hospital staff, simply walk to the fast food shacks/restaurants, go for a smoke and so on, and then they return back to their medical care duties or practical -just look at the germs that they carry back into the medical facilities through their white clothing or stethoscopes. Medical laws clearly states that uniforms, stethoscopes and other medical equipment should be kept inside the hospital room and never taken out or worn outside.

The white coat (or length of it) doesn’t mean much to the average non-medical person these days. I’ve been to a lot of clinics, private practices, etc., where docs are just dressed in business attire, and the only people who wear scrubs or white coats are lab techs, NP’s, and PA’s. It seems to me the lower on the proverbial totem pole people are, the more they want to advertise their status. I don’t think, however, that this holds true in hospitals. I think there the length of the white coat and the ‘white coat hierarchy’ (ie, the longer your white coat, the more senior you are) still holds for the most part. I sometimes laugh at people that wear scrubs or white coats outside the hospital- If you feel the need to advertise your status, I think it means you are compensating for something.

Admitted in the hospital for any health reason? Be cautious of not acquiring another health problem while trying to get rid of the one already suffering! With a number of patients, with different health problems, getting admitted for treatment in the hospitals and a number of health professionals using the same apparatus to check all the patients, hospitals are not totally a safe place.When a doctor places the stethoscope on your chest and at the same time carries a cell phone, and his soiled/infected white coat chances of infectious microorganisms infecting the patient increases.

Having learned through these vital sources, I myself have noticed quite a many times professionals in medical, PG medical students and others clad in their white coats or draped with stethoscopes around their necks or in their hands come to restaurants -sometimes they even place their coats or stethoscopes on the dining table or seats-and later they go back to their duties, could it be a testing room or surgery room or clinical, they carry germs/bacteria from outside. I think that’s not hygiene and safe for patients.

We have heard doctors preaching us to be clean, advise us to wash our hands always, to be hygiene etc etc, but it seems like what they preach, they themselves don’t practice. That’s sad! In conclusion, all I have to say is that doctors or any medical staff when they leave their hospital or clinic premises, they should leave their doctor’s coat/white coat/stethoscope back at their respective offices/clinic/examination or surgery rooms. Period. Now, for those patients NOT informed, we might have a problem. Some people associate the white coat with medical doctors, and might be seeing a nurse practitioner and think they’re seeing a doc. That’s a valid concern.