Should Doctors Ditch Their White Coats?

A Boston infectious disease doctor says yes, and he’s started a petition to make it happen.

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Doctors can get dirty. They spend their days poking and prodding their way through rounds, visiting with patients who may be coughing or puking or pooping or peeing or bleeding. Microscopic organisms are flung around hospitals, and it stands to reason that some of these infectious particles end up on doctors’ coats.

That’s why Philip Lederer, an infectious disease doctor at Massachusetts General Hospital and Brigham and Women’s Hospital, wants his colleagues to give up the iconic attire. Last month he launched a petition, calling on doctors to voluntarily stop wearing white coats. By doing so, Lederer hopes they can cut into the astronomical number of healthcare-associated infections that occur each year in the United States.

According to the CDC, in 2011 roughly 75,000 hospital patients with healthcare-acquired infections died. That same year, more than 700,000 healthcare-associated infections were logged nationally.

Hospitals are a particularly challenging environment for patients whose immune systems are suppressed; they face the unfortunate reality of requiring treatment in a building that is crawling with potentially lethal pathogens, be they in the air or on a stethoscope—or a doctor’s coat.

It turns out that doctors’ coats are kind of gross. A study of 149 healthcare workers found that 64 percent hadn’t washed their coats within a week. Worse, 17 percent hadn’t washed them within a month. The study also found that nearly a quarter of all the coats studied were contaminated with the bacterium that causes staph infections. Among those, some were the nasty drug-resistant variety known as MRSA.

There’s no doubt that doctor coats can harbor bacteria, but it’s less clear whether they are actually a source of healthcare-associated infections. “Where is transmission occurring?” Lederer asks. “Is it objects? Keyboards and bedpans? Neckties? White coats? We just don’t know.”

Given the uncertainty, Lederer reasons, why not just lose the coat?

It’s a symbolic target, and Lederer knows he isn’t just attacking coats: He’s attacking the aura of authority they represent. For many medical students, the “White Coat Ceremony”—a relatively recently adopted tradition during which doctors-to-be are draped in medicine’s chosen cloth—is a memorable milestone.

“It’s kind of like a religious ceremony,” Lederer says. “And eventually, when you become an independent doctor, you’ve had seven to 10 years of socialization and habit forming where you’re taught that the garment you’re supposed to wear is the white coat.”

Habits are hard to break for anyone, and not all clinicians are enthusiastic about sartorial shifts. While Lederer’s petition is aimed at doctors, he encourages patients to bring the issue up with their physicians. “If they start hearing it from patients, that might make them feel nervous about wearing it,” he says.

As for Lederer’s white coat? “It’s in my closet at home.”