Wearing your white coat – and perhaps your ego and patient’s bacteria – in public

White coat in public place edited

People can wear what they want in America. Whether you want to debut the latest vogue or your midriff rife with adiposity, you are free to do so. But just because you can, doesn’t mean you should. In the span of one week, I found two people – on two separate occasions – wearing white coats, each eliciting a different reaction from me.

In the past few months, I have made a conscientious choice to buy more of my groceries in the form of fruits and vegetables – and less in the form of boxes, cans, containers, and cartons, and you may want to do the same. Although Winn-Dixie does not sit at the pinnacle of grocer quality – like perhaps Whole Foods, it does offer a reasonable produce selection at a reasonable price. As I happened to be picking out nectarines, I glanced up and felt that I was hallucinating. In escaping the hospital, I found it inescapably in front of me: a man in his white coat. In one of those moments where you realize something is wrong but don’t know what, I thought maybe I had not seen him correctly – maybe he was a chef and was wearing a white apron? Or maybe I was still in the hospital and this was normal? Snapping to reality, I realized he was at Winn-Dixie, and I was too. He was wearing a white coat, but I was not. I took out my camera and snapped away.

My first reaction was: What the hell? This is gross. First, I don’t even leave the hospital without washing my hands. This guy brought 20 square feet of a microbiological zoo to buy fried chicken! Maybe he has a really good excuse. Maybe he got fired from the hospital (and couldn’t leave his white coat at the hospital), his car got stolen (so he couldn’t leave the white coat in the car), and was so busy talking on the cell phone that he didn’t realize he could disrobe and fold his white coat for placement in a shopping cart or basket. Maybe he also didn’t realize that he had committed a more heinous oversight: wearing sandals with his white coat – the coup de grâce. I was apoplectic that more people were not pausing their purchasing activities to gawk at this unfathomable fashion faux pas.

White coats are dirty. In one Israeli study, more than half of physician’s white coats harbored pathogenic bacteria, like Pseudomonas, Acinetobacter, Staphylococcus aureus, Enterobacter – even some with antibiotic resistance1. The concern over the transmission of disease had led Britain’s National Health Service to ban doctors wearing white coats in the hospital, and the United Arab Emirates’ Ministry of Health to ban it outside the hospital. Washing your white coat doesn’t help – unless if you’re washing it several times a day. According to one study, white coats worn just 8 hours after washing have as much contamination as one that is washed “infrequently” 2. Wearing your white coat for just 3 hours gets you to the 50% level of contamination.

No one has shown that doctors wearing white coats outside the hospital increases illness in the general public, but one study showed transfer of multidrug-resistant organism from cloth to pigskin was possible 3. In theory, transfer from cloth to human skin should also be possible. Whether that translates into morbidity and mortality remains to be seen, but why risk smearing methicillin-resistant Staphylococcus aureus (MRSA) on every surface in Winn-Dixie?

I myself have worn scrubs, albeit begrudgingly, outside of the hospital, but never a white-coat. Doctors, like everyone else, have lives to live and errands to perform. Sometimes, I’ve had to pick up dinner or go to the ATM on the way home. But, I don’t wear my white coat. I’ve never even thought of wearing it out of the hospital, let alone with sandals. To me, it is so unorthodox it rivals opening an umbrella indoors. When I do wear scrubs out, I sometimes take off my scrub top and wear my plain and completely unfashionable T-shirt to minimize any possible bacterial trail and, more importantly, to avoid signaling to the rest of America that I work in a hospital.

The second time it happened, I was again not prepared. I was driving home, listening to the BBC on the radio, when I had reached the tail of a line of cars waiting on a red light. As I waited, I listened to the latest headlines being rattled off. And then I saw it, less than a week’s passing from the first sighting. Again, I thought, It couldn’t be. But it was! A white coat on a person outside of the hospital! I stared at her and wondered, What the hell? Again, I snapped away (see above picture on the right). Not only are you wearing a white coat outside the hospital, but you are really wearing it outside! In the middle of summer, the heat and humidity in Miami is unbearable. Even if you forgot you were wearing a white coat as you sat in your car and turned on the air conditioner, you would definitely remember wearing it as you opened your car door and the sauna-like environs slapped your face. You would definitely remember you were wearing a white coat as your core temperature rose, your back started to sweat, and your thalamus went into overdrive to keep your body cool.

The only way a person would wear a white coat in such a setting is if they actively chose to do so. There is no excuse as she could have easily laid her white coat down in the back seat or trunk. The most logical explanation for a person to elect to wear a white coat in public is to signal that they are in the health care profession and, more specifically, are a doctor, whether they are or aren’t. White coats are associated with doctors as toque blanches are associated with chefs. One could easily wear a white coat in public to signal to others that they are not just any “Joe” or “Jane.” If being doctor confers special treatment in public, then one could use it for such a purpose. I don’t know if any such promotional sale or treatment by the major gas stations for physicians, but maybe I am wrong. Chefs don’t wear their hats in public. Neither do judges wear their robes in public. Imagine if they did – what a farce! Doctors, and anyone else possessing a white coat, should follow suit and refrain from using the white coat in a personal situation.

White coats are easily removable, unlike scrubs, which is what makes it a point of contention. Even though I consider scrubs being barely socially acceptable, many do not4. I am actually not even the first to post about someone wearing a white coat at the gas station. I found a medical student posting about another instance of the exact same situation5. In his/her blog, they write that perhaps this white-coat wearer was attempting to signal their perceived lofty status as a doctor. However, any attempt to do so backfires as it more blatantly reveals the “doctor’s” lack of awareness.

The use of the white coat for secondary gain is actually a violation of the medical professions’ ethos. Doctors are doctors to be doctors. The only time it might – barely – be appropriate to wear a white coat out is if one was making a house call. When I was a medical student, one of my family medicine attendings did make house calls – something of a rarity these days – and he didn’t even wear a white coat. I assume if you’re knocking at someone’s house, the tenants already know you are their doctor. Second, doctors are human – just like our patients. Wearing a white coat does not separate us from disease, emotion, or people. Although the white coat signifies our profession, it shouldn’t be used to distance ourselves from those around us – whether we are inside or outside the hospital.

But maybe all of these out-of-place doctors had valid reasons. I don’t know. I am curious to know what you think. Maybe if this keeps up, people will start saying, “You can take him out of the hospital, but you can’t take the hospital out of him.”

Or not.

References:

1 Wiener-Well, Yonit, et al. “Nursing and physician attire as possible source of nosocomial infections.” American journal of infection control 39.7 (2011): 555-559.

2 Burden, Marisha, et al. “Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8‐hour workday: A randomized controlled trial.” Journal of Hospital Medicine 6.4 (2011): 177-182.

3 Butler, D. L., et al. “Transmission of nosocomial pathogens by white coats: an in-vitro model.” Journal of Hospital Infection 75.2 (2010): 137-138.

4 http://www.physiciansweekly.com/scrubs-wearing-in-public/

5 https://medschooltrap.wordpress.com/2013/09/06/wearing-your-white-coat-in-public-is-not-cool/

10 thoughts on “Wearing your white coat – and perhaps your ego and patient’s bacteria – in public

  1. Great post! I saw this on Kevin MD and had to come hither.

    I saw a white coat last Friday. I’m no doctor, I’m a long haul trucker that happens to have rheumatoid arthritis… call me an experienced patient. So I had just loaded in Sparks, NV last Friday when I noticed a slice in the side wall of my trailer tire. Off to Tyres International for a new recap (oxymoron alert). As I pulled to the side to wait my turn I saw a woman outside of her car at the Tyres office entrance. She not only had a white coat, she still had her stethoscope around her neck!

    Later, as I was signing off my own issue, I asked the tire tech what he thought about a stethoscope wearing doctor at a tire repair shop. Turns out she was his wife. She also wasn’t an MD, but an NP.
    She had come by for something minor, from Renown Regional Medical Center. The tech, her husband, told me proudly that his wife assisted in surgeries- often closing- after the surgeon.

    I’m guessing I don’t need to tell you how inappropriate this was. I know next time I’m getting any surgery at Renown I’ll be doing my best NOT to have this person anywhere near me.

    Like

    • Thanks for reading and commenting, Lisa! I agree that it is inappropriate to wear a white coat in a tire shop. I also think that many other people would assume that a person wearing a white coat with a stethoscope would be a doctor and not a nurse. Regardless, there is no need for a white coat to be worn outside the hospital/clinic. How did you end up on KevinMD as a trucker?

      Like

      • I have a second job, what I refer to as my ‘professional patient job’. I was dx’d with RA early in 2010. I’m on my fourth biologic, Cimzia, combined with an sDMARD, leflunomide. So far this combo works really well.
        Because of this nasty disease I like to stay on top of treatments, research etc. I expect I stumbled across KevinMD when a google alert flagged something with “rheumatoid” in it. I subscribe to certain things that strike a chord in me. Your blog most certainly does!

        Like

  2. Would this be acceptable? ANTIMICROBIAL LAB COATS
    https://www.medline.com/products/patient-and-professional-apparel/silvertouch-antimicrobial-lab-coat

    What’s the difference than hospital employees going to the cafeteria in their scrubs and lab coats in the hospital?

    I am unclear on your point. Are you saying it’s unprofessional to wear your “White Coat” outside the work place or is it just not safe for sanitary reasons?

    How do you mitigate the risk of infection to the patient? How many patients have become sick due to a dirty “white coat”? I need some data to make a valid opinion.
    Let’s not forget all the people who visit a hospital everyday and the stuff they drag in.

    Analogy 1. I have seen mechanics wear their grease monkey overalls into a grocery store and I don’t see anyone complaining.

    My point is if a physician wears his/her “white coat” outside of work, that means free healthcare for me.
    Your next experiment should be, ask the person in their “white coat”, “Are you doctor?, Because I have this horrible rash. Could you take a look at it?”

    We all have egos some more than others. I could care less if you are in a “white coat” or not. I see a human who went to school and studied real hard to help humanity.

    Analogy 2, When you see a person in military uniform do you look at them with more respect or less? Hug a doctor in the supermarket and tell them thank you for saving lives.

    Analogy 3, Firefighters, police officers, EMTs, they have their uniforms. They don’t always change before they go to the store.

    Last point:
    Someone should create a antibacterial mist when you walk in and out of a hospital and a hospital room. Problem solved.

    Thanks,

    ST

    Like

  3. I agree you look like a putz wearing a lab coat outside the hospital. I hate wearing them period, probably an overreaction to some perceived deleterious consequences from the public and colleagues. In a world where anyone can wear white coats, it is hardly a status symbol. You are more likely to be mistaken for housekeeping or a lab tech with one on than a physician or PA. While I agree with the data about microbial risk, unless you wear a protective gown as though you were scrubbing in, by the logic of the above reasoning scrubs-or street clothes if that is what you wear-should be changed mid-shift to protect the patients and public at large. It is not as if Pseudomonas says, “hey, that’s not a lab coat, everyone stay put!” I think the far more compelling argument against wearing a white coat in public is that you look like an ass clown.

    Like

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