Is it time for doctors to abandon the white lab coat?

The doctor’s white lab coat has a long-standing tradition. Some medical schools have created the ‘white coat ceremony’ to welcome new students into the profession. I think it’s time we got rid of these coats.

I used to wear one.  When I started clinical work I was proud of mine because it made me feel like a ‘real doctor’.  My lab coat was like most of my colleagues’: pockets overflowing with notes, the Washington Manual of Medical Therapeutics^TM (our on-call bible), and my stethoscope. During my residency, I decided to throw my lab coat away.

When I was a child, my mum used to read to me, sitting on my bed, leaning her back against the wall, my head snuggled into her.  Occasionally, I had the treat of my dad being home and not having work, and we’d read in his big chair. When I got a bit older, I’d read to myself before bed. My favorite books were a children’s book about famous detectives, and its companion about famous physicians. These two books fuelled my desire to become a police detective or a doctor. I recently found my book about detectives and have been reading it with my boys, but I couldn’t find my book about physicians. However, it made me pause and remember some of the stories from this book.

This child’s book, included chapters about Hippocrates, Galen, Vesalius, Harvey, van Leeuwenhoek, Jenner, Pasteur, Koch, Morton, Curie, and Fleming.  One I remember the best is the chapter about 19^th Century English physician, Joseph Lister. Its illustration was of an elegant but severe looking man, removing his top hat and cloak, and putting on the surgeon’s black frock.

The story described the surgeon’s frock, black or blue in colour, as being proudly worn and never washed. The skill and experience of the surgeon was judged by the blood and pus crusted on the front.  The story described how surgical infections were then believed as caused by ‘miasma’ or ‘bad air’. Yet Lister, fluent in French and German, read the writings of Pasteur, and how surgical infections were probably caused by germs, or micro-organisms, and that chemicals might prevent infections.

The chapter told of his experiments with carbolic acid. The story captivated me as a young boy, because it related Lister’s treatment of one of his patients, also a young boy, who had suffered a broken leg and wound when he was run over by a cart. Lister initially planned to amputate the leg (an operation which often resulted in the patient’s death), but he decided to try a new treatment: dressings soaked in carbolic acid. To his amazement, no suppuration or gangrene occurred, and the boy’s leg was saved.

Lister went on to recommend that hands and instruments be washed before surgery with carbolic acid, gloves be worn, wound and incisions be sprayed and dressing applied all with the addition of carbolic acid. He is credited with pioneering antiseptic surgery.  And of course, the surgeon’s old surgical frock was thrown away.

Since then, the lab coat, usually made of plain white cotton, easy to wash and clean, became the unofficial uniform of doctors and hospitals.  Today, these lab coats are often decorated with crests and embroidered with the name of the program, hospital, physician, or perhaps all three.  (We haven’t yet seen sponsor’s names added like European hockey or football teams). As a resident, I started looking closer at the lab coats being worn and didn’t like what I saw; then, or now.

Today, in the ICU during rounds, I’ll often ask the residents if they know about Joseph Lister (usually they don’t). Then, I ask them to show me their lab coats.  Often, though not always, the coats are dirty with deep grime around the cuffs, and stains on the front, the most common being pen marks, coffee stains, or body fluids.   When asked when the coat was last washed, the answer, “Oh, a few weeks ago”, and then the qualification “But it is usually washed more frequently.”  Some might say this is ‘shame based learning’, but we should all be ashamed (and the appearance of the coats of staff physicians and others are no different: perhaps take a minute and look at your own).  Amazingly, we focus so much on nosocomial infections, and yet ignore the simplest actions like washing our hands, and wearing clean lab coats.

Please, wash your hands, abandon your ties and lanyards, clean your stethoscope, and wear a clean lab coat.  If we can’t adopt these simple measures then maybe we should abandon the white coat ceremony, or perhaps find a sponsor for the lab coats: I’d recommend Javex.