Is It Time for Doctors to Ditch the White Coat? First Impressions in Health Care
You go to the doctor and he or she walks into the room with that clinical white coat. How does that effect their first impression? And how does that effect you as the patient. You may know that I speak on body language and patient care so I particularly interested in the latest research on doctors white coats.
Is it time for doctors to ditch the white coat?
The traditional uniform is causing more problems than you think
By Andrew Park | December 17, 2013
Anyone who has considered medicine as a career imagines walking into a white, clean exam room with the power to comfort and heal the sick. To add to this angelic fantasy, we do not forget to imagine ourselves wearing a freshly laundered white coat bearing what only many years of arduous education and sleepless nights can provide: First name, last name, M.D.
The white coat is a badge of perseverance, intelligence, empowerment, and authority — for new interns, a reassurance that they have what it takes to take care of the life of another. But this Victorian symbol of purity and sanitation may soon go the way of the lobotomy.
I recently returned from an interview at Mayo Clinic, where I was surprised to see so many business suits. As one of the world's meccas for medicine and health care, I expected a place that resembled, well, a hospital. Instead I encountered what appeared to be a fancy hotel with a curiously large number of wheelchairs.
The rationale behind the white coat restriction makes sense given Mayo's dedication to providing the best for patient care and comfort. The organization's philosophy: The white coat builds a barrier between patient and physician, increasing the chances for the patient to feel anxious.
And Mayo patients seem to like it. Surveys have found that patients felt most comfortable when physicians wore scrubs, followed by semi-formal/business attire, then followed last by white coats. In order to maintain its high standards of professionalism, Mayo went with the suit and eschewed the white coat. (The only ones who can wear white coats in public are those in scrubs coming from or going to the OR.)
In a separate 2005 report published in the
British Medical Journal,
researchers found that patients preferred doctors wearing semiformal attire — defined as dark pants and long-sleeved shirt with a tie for men, and dark-colored skirts or pants with a blouse for women. Those ensembles beat out the white coat, formal wear, and casual attire.
Mayo is not alone in recognizing the symbolic power of the white coat. As Jean-Phillip Okhovat, a UCLA medical student, puts it, "I think the white coat creates an immediate sense of hierarchy. Not wearing a white coat makes it less intimidating for the parent and child."
In psychiatry, the white coat can not only add to this patient-physician barrier, but also become a target of aggression for patients with a history of troubled visits to the doctor. Yang Yu, a University of California, Irvine, medical student, recalls, "Mentally ill patients can perceive the white coat as a threat. There have been instances of people in white coats who were attacked."
Inevitably, when the topic of white coats comes up, the issue of spreading infections is never far away. Even as someone who works in health care, the white coat can sometimes make me cringe. I have no idea how many hundreds of patients that coat rubbed up against, and sometimes I can tell that the coat has not been washed in weeks. The gloves get changed, the paper on the examination bed gets rolled out, and copious amounts of hand sanitizer are used, but none of that may matter if the biggest culprit is right on the doctor's clothes.
In
one study, researchers found that doctor's white coats were contaminated with all kinds of bacteria, including
Staphylococci resistant to penicillin, erythromycin, and clindamycin. The worst areas were the sides of the white coat, the cuffs, collars, and pockets.
The National Health Service in the U.K. has already banned the use of long-sleeved white coats, and instead adopted a "bare below the elbows" rule to reduce unnecessary infections. The NHS also requires that doctors leave their uniforms at the workplace, where it is regularly laundered to reduce cross-contamination. This policy has already shown a marked reduction in infections. (I should mention, however, that despite evidence showing that white coats harbor bacteria, many professionals remain unconvinced that this makes a difference in terms of nosocomial infections.)
Every July and August of each year, recently admitted medical students don fresh white coats to symbolize the beginnings of this arduous yet rewarding journey toward becoming a physician. But the tone is changing as physicians continuously ask themselves how best to serve their patients. As Don Berwick, a Harvard Medical School professor and former Administrator of the Center for Medicare and Medicaid Services, put it at the commencement for the Yale School of Medicine in 2010:
Those who suffer need you to be something more than a doctor; they need you to be a healer. And to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off.
When you take off that white coat in the sacred presence of those for whom you will care — in the sacred presence of people just like you — when you take off that white coat, and tower not over them, but join those you serve, you become a healer in the world of fear and fragmentation.
Is it time for doctors to ditch the white coat?
The traditional uniform is causing more problems than you think
By Andrew Park | December 17, 2013
Patti Wood, MA, Certified Speaking Professional - The Body Language Expert. For more body language insights go to her website at www.PattiWood.net. Check out Patti's website for her new book "SNAP, Making the Most of First Impressions, Body Language and Charisma" at www.snapfirstimpressions.com. Also check out Patti's YouTube channel at http://youtube.com/user/bodylanguageexpert.
In 2010, neuroscientists at the Zanvyl Krieger Mind/Brain Institute at Johns Hopkins University joined forces with the Walters Art Museum in Baltimore to conduct an experiment. What shapes are most pleasing, the group wondered, and what exactly is happening in our brains when we look at them? They had three hypotheses. It is possible, they thought, that the shapes we most prefer are more visually exciting, meaning that they spark intense brain activity. At the same time, it could be that our favorite shapes are serene and calm brain activity. Or, they surmised, we very well might gravitate to shapes that spur a pattern of alternating strong and weak activity.
To investigate, the scientists created ten sets of images, which they hung on a wall at the Walters Art Museum in 2010. Each set included 25 shapes, all variations on a laser scan of a sculpture by artist Jean Arp. Arp's work was chosen, in this case, because his sculptures are abstract forms that are not meant to represent any recognizable objects. Upon entering the exhibition, called "Beauty and the Brain," visitors put on a pair of 3D glasses and then, for each image set, noted the their "most preferred" and "least preferred" shape on a ballot. The shapes were basically blobs with various appendages. The neuroscientists then reviewed the museum-goers' responses in conjunction with fMRI scans taken on lab study participants looking at the very same images.
"We wanted to be rigorous about it, quantitative, that is, try to really understand what kind of information neurons are encoding and…why some things would seem more pleasing or preferable to human observers than other things. I have found it to be almost universally true in data and also in audiences that the vast majority have a specific set of preferences," says Charles E. Connor, director of the Zanvyl KriegerMind/Brain Institute.
"Beauty and the Brain Revealed," an exhibition now on display at the AAAS Art Gallery in Washington, D.C., allows others to participate in the exercise, while also reporting the original experiment's results. Ultimately, the scientists found that visitors like shapes with gentle curves as opposed to sharp points. And the magnetic brain imaging scans of the lab participants prove the team's first hypothesis to be true: these preferred shapes produce stronger responses and increased activity in the brain.
As Johns Hopkins Magazine so eloquently put it, "Beauty is in the brain of the beholder."
Now, you might expect, as the neuroscientists did, that sharp objects incite more of a reaction, given that they can signal danger. But the exhibition offers up some pretty sound reasoning for why the opposite may be true.
"One could speculate that the way we perceive sculpture relates to how the human brain is adapted for optimal information processing in the natural world," reads the display. "Shallow convex surface curvature is characteristic of living organisms, because it is naturally produced by the fluid pressure of healthy tissue (e.g. muscle) against outer membranes (e.g. skin). The brain may have evolved to process information about such smoothly rounded shapes in order to guide survival behaviors like eating, mating, and predator evasion. In contrast, the brain may devote less processing to high curvature, jagged forms, which tend to be inorganic (e.g. rocks) and thus less important."
Another group of neuroscientists, this time at the University of Toronto at Scarborough, actually found similar results when looking at people's preferences in architecture. In a study published in the Proceedings of the National Academy of Sciences earlier this year, they reported that test subjects shown 200 images — of rooms with round columns and oval ottomans and others with boxy couches and coffee tables — were much more likely to call the former "beautiful" than the latter. Brain scans taken while these participants were evaluating the interior designs showed that rounded decor prompted significantly more brain activity, much like what the Johns Hopkins group discovered.
"It's worth noting this isn't a men-love-curves thing: Twice as many women as men took part in the study. Roundness seems to be a universal human pleasure," writes Eric Jaffe on Co.Design.
Gary Vikan, former director of the Walters Art Museum and guest curator of the AAAS show, finds "Beauty and the Brain Revealed" to support Clive Bell's postulation on significant form as a universal basis for art, as well as the idea professed by some in the field of neuroaesthetics that artists have an intuitive sense for neuroscience. Maybe, he claims, the best artists are those that tap into shapes that stimulate the viewer's brain.
"Beauty and the Brain Revealed" is on display at the AAAS Art Gallery in Washington, D.C., through January 3, 2014.
More from Smithsonian...
Tweet