Question

I remember being handed a white coat during my first year of medical school. It came crisply folded in a cellophane bag. I was told to wear it anytime we were in the hospital or with patients as a sign of respect.

There was no pomp about it. I took it home and tried it on. It was like putting on a costume and pretending to play doctor. The white coat continued to feel that way to me for a long time.

Over the years, the costume has become second nature and part of my clinical identity. I slip it on when I'm seeing patients, because when I've asked, most of them tell me they prefer it. The coat provides a mutual comfort to us both.

My, how times have changed. Now the vast majority of the nation's medical schools (along with more than 700 nursing schools and physician assistant programs) host special white coat ceremonies, in which new students are welcomed into their profession with a solemn ceremony invoking commitment to the healing arts. White coats are formally offered to students, and put on them by their school's leadership.

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These ceremonies present an opportunity for the students and their families to mark the beginning of health careers in an educational and professional crucible that will challenge their ideals, empathy and compassion. "The iconography, the ritual of holding up members of the profession in this time of change must be maintained," says Dr. Richard Levin, president and CEO of the Arnold P. Gold Foundation, whose mission is to promote and maintain humanism in health care.

Now in the role of medical educator myself, I find anything that helps students stay connected with their highest ideals valuable in imparting a sense of professionalism. That's why it's disconcerting to think that our white coats are being challenged as possible vectors of infection.

A group of doctors in the field of infectious diseases has begun to rally around a mantra of "bare below the elbows," suggesting that health professionals avoid wearing white coats altogether, as is the custom in the U.K.

It turns out we don't wash the things nearly enough.

In a piece titled "It's Time for Doctors to Hang up their White Coats for Good," Boston-based infectious diseases specialist Philip Lederer argues that white coats have outlived their usefulness, both as guardians of cleanliness and as symbols of the profession.

Studies demonstrate the presence of harmful bacteria on our white coats, though evidence of direct harm to patients is lacking.

"We don't need a randomized trial to prove that parachutes save lives," Lederer told me. He prefers wearing khakis and dress shirts with the sleeves rolled up; no tie. He mentioned other docs who favor vests for their pockets and warmth, a trend some hope will catch on. And while Lederer supports the idea of a humanism-themed ceremony to welcome students into the profession, he and others suggest that even as a symbol white coats are more of a barrier than a conduit to strong doctor-patient relationships.

Levin counters that with all of the changes in health care, people in the field feel a tremendous sense of dislocation. "The idea of taking away [professional status] rather than elevating it is a problem for health care," he said. But taking away the coats wouldn't necessarily be a blow, he said, pointing to a study that challenges the notion that white coats are fundamentally elitist.

The debate over white coats has forced me to consider my own practice. In the end, I think the issue is as much about generational change as it is about infection control. I'd give up my white coat instantly if I knew it was spreading harmful bacteria. But colonization with bacteria is different from transmitting them to another person.

Bacteria live on all of us, so are white coats necessarily worse than our other garments or even our own skin?

It's likely that this debate will continue, unless patients were to somehow come to consensus on what they want doctors to wear. And that's not likely to happen anytime soon.

Until then, I vow to wash my white coat more frequently.

1. Does the White Coat Ceremony give a false impression to the participants and the public that these students are now full-fledged physicians? Can you see where this might encourage elitism?

2. Rather than being initiated into a “patient-centered ethos” through the process of the ceremony as reported by the Arnold P. Gold Foundation (Wiley and Allen 2015:53), could these first year students be party to appropriation of a prestigious image they are totally ill equipped to claim at this point in their education? Can you identify how this might be harmful to both student and others?

3. Is the “coat” a case of elitism or something more ominous and mistakenly mundane like the spread of microorganisms to sick and sicker people?

4. Does this ceremony further cultivate a defining line between patient and power? Is the patient disadvantaged by the symbolic nature of the “white coat?”

Answer 1

If a person or class of persons are considered superior by others or by themselves, as in intellect, talent, power, wealth, or position in society it is called elitism.

White Coat Ceremony is a ritual that often takes place during the initial days of orientation. It serves to welcome students to healthcare practice and elevate the value of humanism which is the core of healthcare.

Positive aspects of white coat ceremony

• The White Coat Ceremony sets a standard among nurses by highlighting the goals of a clinical caretaker.
• Since they  play a large role in the clinical setting and acknowledging them with a wonderful ceremony, will be an unforgettable experience. It provide sense of pride,responsibility and commitment to service .
• a sense of honor and accomplishment, and a sense of being welcomed into this prestigious and rewarding profession.
• A new rite of passage 'The White Coat Ceremony' honors the important  role nurses play in health care and recognizes their parity with their medical counterparts.
• the ceremony symbolize nurses recognition as significant member in in health care industry
• easy to recognize and identify as health professional by others in the society as dress code

Above mentioned points definitely promote elitism. To create a sense of responsible and serious nature of work it is important that the ceremony should be there for first years. It will be a thought provoking moment for each of budding professional.It reminds them of the noble and ethical aspects of profession.

Since adage that white coat bring credibility and dignity to profession.  However, white coats harbour potential contaminants and so these may play role in the nosocomial infection or hospital acquired infections. The high rates of infection is due to following 2 facts:

1. patients continuously carry  infectious microorganisms in the hospital environment, and the nurses  are in constant contact with these patients.
2. Secondly, microbes can survive between 10 and 98 days on cotton, cotton and polyester, or polyester materials.

A systematic review reported that white coats are frequently contaminated with strains of harmful and sometimes drug-resistant bacteria associated with hospital-acquired infections. About 16 percent of white coats tested positive for MRSA, and up to 42 percent for the bacterial class Gram-negative rods. IF we abandon coat whatever dress we wear will harbour organism.Staphylococcus aureus, Coagulase negative Staphylococci,Pseudomonas aeruginosa are commonly found in pockets,collars,side and lapel.

The main reason for microorganism is due less frequent wash or washing coat once in a weekand lack of hand hygiene .

The following points can keep infections under control

• a yearly purchase of white coats and more white coats at any point of time should be made compulsory.
• The wearers should be encouraged to change their white coats daily.
• daily wasing and cleaning system
• Strict hand hygiene or scrupulous hand washing before and after nurses attended to patients
• promote alternatives to the white coats, such as  universal use of protective gowns which are disposable. But whether cost effective or not that has to be analyzed .