mja.com.au | The Medical Journal of Australia

Home | Issues | MJA shop | MJA Careers | Contact | Topics | Search | RSS  | Login | Buy full access

Subtle societal changes have been proposed as a reason for the demise of white-coated doctors -- modern-day patients may find the use of a white coat to be an inappropriate status symbol or a barrier to effective communication. In particular, in paediatric practice it has been suggested that white coats may be an impediment, although studies have failed to confirm this.^3,4

I investigated the phenomenon of the disappearing white coat doctors in my environment by asking oncology patients about their attitudes to doctors and white coats. I was prompted to do this by remarks from patients indicating that identification of doctors and nurses in hospitals was an issue of concern.

Asking the patients

Patients' responses

Junior doctors

• 106 respondents (59%; 95% CI, 52.8%-67.2%) agreed that junior doctors should wear white coats; 17 disagreed (9%; 95% CI, 4.8%-13.2%), and 57 patients (32%; 95% CI, 25.2%-38.8%) responded " I don't care". The same general pattern was seen for both men and women.

• Reasons for agreeing (46 respondents): "for identification purposes"(41); "looks more professional" (36); and "reasons of hygiene" (6).

• Reasons for disagreeing (31 respondents): white coat a barrier to communication between doctor and patient (10); wearing a coat was a choice for the individual doctor (6); and avoiding additional cost.

Senior doctors

• 61 respondents (40%; 95% CI, 32.2%-47.8%) answered that senior doctors should wear white coats; 32 disagreed (21%; 95% CI, 14.5%-27.5%) and 60 (39%; 95% CI, 31.3%-46.7%) said "I don't care".

• Reasons for agreeing (28 respondents): white coats look more professional or assist in identification (22); and hygiene (3).

• Reasons for disagreeing (34 respondents): not wearing white coats distinguishes senior doctors from junior doctors, and white coats distance doctors from patients (11).

Patients who preferred junior doctors to wear white coats were also likely to prefer senior doctors in white coats. The proportion of patients disagreeing with doctors' wearing white coats reduced significantly with advancing patient age (P = 0.01, by logistic regression analysis).

Discussion

Many respondents who supported the wearing of white coats for junior and senior doctors agreed that white coats looked more professional or assisted in identification. Interestingly, reasons related to infection control or hygiene were uncommon. Of the 20% of respondents who disagreed with white coats for senior doctors, most referred to white coats as being some sort of a barrier.

As with all questionnaires, the data are potentially subject to bias. The number of questionnaires distributed was not recorded, making it impossible to exclude bias from an unbalanced sample. Patients who declined to complete the survey may have had a preference for, or against, the wearing of white coats. However, anecdotal evidence from hospital staff is that patient refusal to participate was rare.

That the doctors at the hospitals surveyed do not wear white coats could influence patient responses. Perhaps patients did not express stronger support for senior doctors' wearing white coats for fear of displeasing their attending doctor. If so, our data would underestimate patients' preferences for senior doctors' wearing white coats.

Many patients raised the issue of white coats with their doctor after completing the questionnaire. This feedback indicates that identification of hospital staff is a significant problem for patients, magnified by degrees of debility and dependence. Patients often have difficulty distinguishing the relative roles of staff wearing corporate uniforms (ie, nurses, clerical staff, kitchen staff, etc); name tags were difficult to read and insufficient for identification. Similar studies of patients' views of non-medical apparel in hospitals may be instructive.

If, from the patients' perspective, the greatest usefulness of the white coat is its value as a rapid means of staff identification, then to simply recommend reintroduction of white coats may be premature, especially if an alternative, effective means of staff identification can be implemented.

I do not believe that the results would be greatly different in other Australian settings, and recent reports from international clinical settings suggest qualitatively similar results.^5,6 Our findings confirm that the clinical environment and medical interaction are complex, and that individual patients hold differing views. However, our data do not suggest that the clinical environment has changed to one that favours extinction of white-coated doctors.

Acknowledgements

Competing interests: None.

References

1. Branch WT Jr. Deconstructing the white coat [editorial]. Ann Intern Med 1998; 129: 740-742.
2. Wear D. On white coats and professional development: the formal and the hidden curricula. Ann Intern Med 1998; 129: 734-737.
3. McCarthy JJ, McCarthy MC, Eilert RE. Children's and parents' visual perception of physicians. Clin Pediatr (Phila) 1999; 38: 145-152.
4. Matsui D, Cho M, Rieder MJ. Physicians' attire as perceived by young children and their parents: the myth of the white coat syndrome. Pediatr Emerg Care 1998; 14: 198-201.
5. Menahem S, Shvartzman P. Is our appearance important to our patients? Fam Pract 1998; 15: 391-397.
6. Ikusaka M, Kamegai M, Sunaga T, et al. Patients' attitudes toward consultations by a physician without a white coat in Japan. Intern Med 1999; 38: 533-536.

Authors' details

Reprints will not be available from the author.
Correspondence: Dr P R Harnett, Department of Medical Oncology and Palliative Care, Westmead Hospital, Westmead, NSW 2145.
harnettprATwestgate.wh.usyd.edu.au

©MJA 2001
Make a comment