Not lily-white, doc

Call to ban familiar medical coats

By G.S. Mudur
  • Published 23.07.15

New Delhi, July 22: An Indian doctor has issued a call for a ban on the ubiquitous medical white coats, warning that the symbolic attire adopted by the medical profession in the 19th century can spread lethal infections.

Edmond Fernandes, a community medicine specialist at the Yenepoya University, Mangalore, says there is sufficient research evidence to show that the long-sleeved coats may spread infections and cause avoidable harm to patients.

In a paper published today in the British Medical Journal, Fernandes has called on India's health ministry to ban doctors and medical students from wearing white coats, saying such a move would reduce harm and costs that come from hospital-acquired infections that patients pick up during their stay in hospitals.

"The coats are nothing but symbolism over substance, but they continue to be used either under rules or through a misplaced sense of pride - they should go," Fernandes told The Telegraph over phone from Mangalore. "Pride for doctors should come from how they treat their patients and the respect they give to their patients."

His paper cites several earlier medical studies that suggest that long-sleeved coats can serve as vehicles ferrying infections across a hospital.

A study by microbiologists at the Bangalore Medical College and Research Institute had three years ago found that a disease-causing bacteria called Staphylococcus aueurus was the most common organism on medical coats, accounting for 64 per cent of bacteria isolated from coats worn by medical students.

In the US, doctors at the University of Maryland Medical Center had five years ago documented how healthcare workers' coats may be contaminated with drug-resistant versions of Staphylococcus aueurus. An independent study from Nigeria that examined the pockets and cuffs of doctors' white coats found nine out of 10 coats contaminated with bacteria.

Doctors who have examined the history of medicine say the medical profession adopted the white coats - traditionally used by scientists in chemical laboratories - in the 19th century as a symbol of "purity and goodness".

Sections of doctors appear loath to drop their coats.

"It has been a symbol for decades - patients are happy to see us in a white coat," said Harish Gupta, a surgeon in New Delhi who is joint secretary of the Indian Medical Association, a non-government body of doctors. "Some professions have symbolic clothes, lawyers have black coats, doctors have white," said Gupta, who mostly wears surgical gowns.

The UK government banned long-sleeved coats in 2007 as part of a set of measures to reduce hospital infections. The American Medical Association had in 2009 wanted to follow suit, but the move was blocked by sections of doctors who wanted to keep their traditional gowns, Fernandes said.

The Indian Medical Association, Gupta said, has not discussed the issue of white coats.

Some doctors believe there are medical reasons to justify the use of the coats - although with a ban on their use outside the healthcare workplace.

"The coats should be exclusive workplace attire," said Asima Banu, an associate professor of microbiology at the Bangalore Medical College who had conducted the 2012 study. "Instead, we found medical students indiscriminately wearing them outside hospitals, in cafeterias, in shopping centres, even in their homes."

But, Banu said, abandoning the coats may not be a good idea. "Whether a coat or an apron, there's a need for some barrier clothing to minimise the risk of healthcare workers carrying infections from hospitals into public places or their homes," she said.

Fernandes points out that the long-sleeves of the coats and their lengths, at times reaching down to the knees, increase the chances that the coats would pick up infections.

"During routine rounds of wards, the long sleeves, the cuffs, and the base of the coats are likely to come into contact with patients and their beds - and serve as conduits to carry microbes from patient to patient," he said.

Doctors concede the key problem is that most medical coats don't get washed daily. While daily-wear clothes may also pick up infections, they get washed every day.

The Bangalore study found that medical students washed their coats on average once a week - on their holidays. But even then, contamination levels ranged from 62 to 76 per cent.

However, some doctors have already dropped their coats. "I haven't worn the white coat since 2002," said Rashmi Kundapur, a community medicine expert at the K.S. Hegde Medical Academy, Mangalore. "It is possible those who make policy on such issues aren't aware of the research findings."