The white coat has remained a traditional symbol of the medical profession for as long as we know. However, its relevance stands questioned today. A recent report by Dr Edmond Fernandes in the BMJ suggests that Indian doctors should ban the use of white coats as the long sleeved coats spread infection and lead to avoidable harm and cost to patients. Arguing about the perils of the white coat, Dr Fernandes told TOI Health, "The biggest worry of the white coat is the spread of hospital acquired infection, which in turn leads to drug resistance. Hospital administrators, without appropriate research and review enforce white coats on medical students, residents which is wrong and more authoritarian by its very nature. I think those who do not wish to wear the white coat should not be forced to, and patient care should be put before ego and symbolism." Dr Fernandes added in the report that changing areas in Indian hospitals are rare because of space constraints, so white coats are commonly worn by students coming from college and outside the hospital. They are also often left on chairs, tables, and in corridors. In many cities in India, some junior doctors are also seen wearing white coats in shopping malls and cinemas. And then they enter sterile zones in the hospital in the same attire. "Given India's tropical climate, common sense indicates that we should discourage wearing white coats that are washed perhaps only every few weeks," he added. Dr Bishnu Panigrahi, group head, medical operations, Fortis Healthcare explains, "I agree that white coats are often left on the chairs, tables or sometimes even corridors. And doctors put hands in their pockets after checking the patient. Yes, there are risks involved in long-sleeved coats. And that is the reason we use 3/4th or 1/4th sleeves white coats in OPD. Even OPD doctors and nursing staff strictly follow hand hygiene. Before and after checking patients, they all use antiseptic hand gel or scrub. And when it comes to sensitive areas such as Operation Theater (OT) and ICUs, doctors cannot enter without scrubbing, even if it is a consulting faculty." While some of the city doctors argued that the long-sleeved coats don't pose any threat if hand hygiene is followed, Dr Fernandes banishes the claim. He reiterates, "Studies have proven that sides of the long sleeve coat contain infections, and therefore UK made a landmark decision to ban the white coat in 2007. In India, we need to bring it to the notice of the health ministers in order to combat the problem. Hospital acquired infection is like a ticking time bomb, waiting to explode." Recommending some of the ways that infection can be reduced, Dr Fernandes suggests that while hand washing, short sleeved coats can help, the ultimate solution is rejecting the white coat, with name badge being a more feasible alternative. Source
