Pronovost weighs in on the white coat

Peter Pronovost, arguably the nation's leading expert in patient safety, gave us his thoughts on the white coat debate yesterday on The Armstrong Institute's blog Voices for Safer Care. His conclusion: there's enough evidence to ditch the white coat.

Here is the core of his argument (in his words):

We could voluntarily ditch the white coats without needing a clinical trial to tell us it’s OK. We know that white coats can carry pathogens, and it is logical to think that germs could be transmitted from physician to patient. Given that confirming this theory could be prohibitively expensive, we can look at the implications of acting and not acting. While the risks of maintaining the white coat tradition are clear — potentially more infections and preventable deaths — the risks of removing this potent symbol of professionalism would be less significant, though certainly real for some clinicians. How would patients react? Studies disagree on whether they prefer the white coats — some may find them reassuring, but others may see them as elitist. 

Some experts may argue that we should instead focus on proven infection control practices, such as hand hygiene. Yet it's hard to see how voluntarily giving up your white coat would distract from that. It may even raise awareness in general about the importance of hand hygiene once clinicians consider the pervasiveness of germs on their attire, stethoscopes and keyboards. The risks of doing nothing seem much greater than of making the change.

As we have said for several years, mandates should be reserved for interventions with the highest level of evidence to support them. Neither banning the white coat nor mandating flu vaccine for healthcare workers are backed by evidence at that level. But there's enough evidence to suggest that hanging up your white coat and getting a flu shot are probably the right things to do. And to get a flu shot you have to take your white coat off anyway. So do both and leave the coat behind!