Death of the doctor's white coat

By Clare Murphy
Health reporter, BBC News

The long-sleeved white coat has been a symbol of the medical profession for more than a century. But the death knell has been sounded.

They may look spotless but are their cuffs really clean?

Now condemned as a harbinger of infection, some NHS trusts have already banned the garment on the wards and the government expects all to follow suit by January.

The irony is that the white coat was first introduced in the 19th Century in part to prevent cross-contamination.

But borrowed from the scientists who were making breakthroughs in laboratories, the white coat was also seen as a way of giving credibility to a profession regarded by some as dominated by cultish quacks.

And its arrival on the ward also co-incided with a new era in medicine. Rather than hospitals being centres of death, a greater understanding of illness and hygiene meant more and more people were emerging alive.

So the gleaming white coat - in many respects an entirely impractical colour - became a symbol of authority and of a profession which was able to give life instead of just preside over its ebbing away.

Everyone's got one

But even before this latest government initiative, it has already started to slip from the shoulders of doctors.

GPs are actively discouraged from wearing them, in part to bring down the barriers between doctor and patient, while it is far from the garment of choice for a psychiatrist - given the old fear of "the men in white coats".

I've seen people turn up to work in the same shirt every day. How clean is that? Coats are no more and no less hygienic than anything else people wear Professor Colin Brown

At the same time, Dr Ayan Panja, a GP in London, notes, the number of non-doctors who wear white coats has increased exponentially.

"Go into any hospital and there'll be people from pharmacists to blood porters in white coats," he says. "This idea that it confers a special status and sets doctors apart from other professions just doesn't really hold up."

"Coats carry infection, they're hot and they can be a hassle if you are tearing down the corridor in an emergency.

"I for one am not going to mourn their demise."

Heading to the pub

But Dr Panja admits that while it can be seen as being a barrier to communication, some patients like to see the person treating them in a white coat.

Several surveys over the last few years have backed this up, with older patients particularly keen that their doctors look the part.

"I wouldn't want to see a pilot turning up to fly a plane in shorts and flip-flops, and patients don't want to see a doctor dressed in the kind of thing he or she might wear down to the pub," says Professor Colin Brown, a retired renal consultant from Sheffield.

"I think the authority issue is an important one. And on the hygiene front - well, I've seen people turn up to work in the same shirt every day. How clean is that? Coats are no more and no less hygienic than anything else people wear."

One doctor wrote to the BBC News website complaining that the problem was not the white coat per se, "but the inability to provide clean ones".

"When I started in the NHS 25 years ago the first thing you did when you started at a new hospital was to go and meet the lady in charge at the hospitals' laundry," said Mr Simon Marsh.

"Sadly hospitals no longer have their own laundries."

But while the white coat may have had its day, for those keen on a uniform all may not be lost.

From next month, all junior doctors starting work at West Middlesex hospital will be provided with tunic-style uniforms in bright blue - made of an "infection fighting" material.

It is apparently sleeveless, roomy, and the large pockets within it are trumpeted as a particular boon for the female staff.

"I won't have to carry my handbag around all day," said one.