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Whose Coat Is It Anyway?

Vazquez, Thomas; Nham, Fong

doi: 10.1097/ACM.0000000000002578
Letters to the Editor
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SDC

Second-year medical student, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida; tvazq020@med.fiu.edu.

Second-year medical student, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.

Disclosures: None reported.

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To the Editor:

Navigating any public space in a hospital can feel like swimming through a sea of white coats, but a closer look reveals that many of these white coats belong to nonphysicians. Identifying a physician can be quite a challenge for patients when social workers, nursing administrators, care managers, and other nonphysicians frequently don white coats. With rising patient safety concerns, should white coats be permitted among nonphysician health care professionals?

A quick survey of the medical blogosphere revealed passionate debate on the subject; yet, there is a paucity of dialogue in the scientific literature on the issue. In a time where nearly every health-care-related professional school holds a white coat ceremony for its students, physicians are hanging up their white coat over safety concerns and bringing a new level of scrutiny to the practice. One study demonstrated that 16% of physician white coats grew methicillin-resistant Staphylococcus aureus colonies, and coats worn only eight hours after cleaning showed no difference from the infrequently washed coat.1 The white coat strikes out again with the well-known case of “white coat hypertension.”2 When, then, should hospitals permit the proliferation of white coats despite the risks to patient safety?

Patients often expect this uniform from their doctor, but there is little constructive discussion on white coats among other health professions. This has surely raised tension between doctors and other hospital employees, while leaving patients hanging out to dry.

We are not indicting health care professionals, but merely calling for further discussion. More research should be conducted on the safety and patient preferences of white coats for nonphysicians. Any policy regarding hospital attire should not be rooted in biases, history, or any hierarchical structure but, instead, the primacy of patient welfare above all. It is time for the discussion to transition from breakroom conversations and bellicose blog posts to the peer-reviewed literature. We can all agree that health care decisions should be rooted in evidence. Hospital attire should be no exception.

Thomas Vazquez

Second-year medical student, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida; tvazq020@med.fiu.edu.

Fong Nham

Second-year medical student, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.

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References

1. Burden M, Cervantes L, Weed D, Keniston A, Price CS, Albert RK. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: A randomized controlled trial. J Hosp Med. 2011;6:177–182.
2. Cuspidi C, Tadic M, Mancia G, Grassi G. White-coat hypertension: The neglected subgroup in hypertension. Korean Circ J. 2018;48:552–564.
© 2019 by the Association of American Medical Colleges