The White Coat: The Contamination Controversy

Every year a new class of students start their medical training with a white coat ceremony.  The white coat is so synonymous with "Doctor," it seems they have been the medical uniform for centuries. In fact, the coat that carries with it so much prestige (and, it turns out, bacteria) has only been around for about 100 years. Is it time to let the white coat go?

Doctors weren't always physicians.

We see the vestiges of the more archaic use of the word in our use of "Dr." for anyone who has reached the highest levels of education, a doctorate degree. For centuries, the use of the word connoted a learned person, and the root of the word doctor, from the Latin for "teach", demonstrates the role these individuals often played, passing on their knowledge in any field to future generations. 

Physicians weren’t always scientists.

In fact, up until about the 1800s, going to a medical doctor rarely helped your condition. Until the Enlightenment, when the scientific method, reason, and proof became the goal of research, doctors relied on a body of lore, myth, mysticism, herbalism, and old wives’ tales to help their patients, along with a heavy dose of prayer. They dressed in the formal wear of other serious professions - the clergy, judges, professors – they wore formal black suits.

When doctors became scientists, they dressed as scientists.

As the views of the Enlightenment spread to medical care, illnesses and diseases were systematically described, categorized, and researched. The origins of the germ theory were explored. Treatments and protocols were tested against control groups. Doctors became scientists. So they hung up their formal dress jackets and dressed in the scientist’s uniform of the day, a clean, white coat. The clean, white coat captured the newly accepted need for sterile environments.  This transition can be seen in these two paintings, completed only a decade apart.

When a student becomes a doctor, she or he puts on the white coat.

Fast forward 100 years to today, and the white coat is the single most iconic symbol of the medical doctor. Almost all medical schools induct their students in solemn “white coat ceremonies,” where graduates don their first white coat, embroidered with their full name and “Dr.” honorific. And unlike the graduation cap and gown, this symbolic article of clothing is worn for the rest of one’s career, a clear identification of status, achievement, and dedication.

But the white coat carries more than prestige.

So just how is this iconic symbol of the medical professional controversial? It turns out that it can become contaminated with pathogens that lead to hospital-acquired infections. Any article of clothing – ties, shoes, shirts – can become contaminated. But the white coat, with wide sleeves and long length, not only comes into contact with the patient more frequently, it is also laundered less often. In one study, S. aureus was found on 29% of tested white coats. The contamination increased if the coat had been worn longer than one shift, if the wearer had been working in an inpatient setting, or if certain parts of the coat were tested (sleeves, in particular).

When doctors take off the white coat, science wins.

Sure, the white coat presents an image of trust and confidence to patients (most prefer their doctors to wear white coats). Sure, the white coat represents years and years of study and dedication to patients and their health. But doctors are still doctors, even if they are wearing scrubs. And if being “Bare Below the Elbow,” or BBE, helps reduce the bacterial contamination around patients, isn’t that best for everyone? Even the obstacle of patient preference can be eradicated: In one study, individuals who preferred their doctors wear a formal white coat changed their minds when the issue of possible contamination was presented to them. In a way, the discovery of bacteria ushered in the clean, white coats. But many researchers believe it is time for bacteria to usher the iconic symbol out of the patient room.

In an ironic twist, “white coat ceremonies” were first championed by Dr. Arnold Gold, who believed that the recitation of the Hippocratic Oath at a student’s graduation was too late to make those famous promises to patients. But let’s not forget the very first line of the Hippocratic Oath: “First, do no harm.” And if there is the potential for harm in your white coat, Doctor, why not leave it hanging next to your diploma?