New British Hospital Dress Codes

[FFPM15]

Anyone read the article from Associated Press/Yahoo about British hospitals banning neckties, long sleeves, white coats, and jewelry for doctors? Seems like the pose very valid points about spread of disease. How long before our hospitals start enforcing similar rules?

Here's the Links:
http://news.yahoo.com/s/ap/20070917/ap_on_he_me/doctor_dress_code

http://www.gnn.gov.uk/environment/f...53&NewsAreaID=2&NavigatedFromDepartment=False

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[PeepshowJohnny]

Personally, I'm a huge fan of this except for the white coat thing. I *hate* my white coat as much as the next guy, but when I'm rocking scrubs or a more casual polo/khakis look, the white coat is the only thing that distinguishes my position. Maybe a short sleeved version would be in order...

 

[Slide]

Same as above poster. I agree with everything except the whole white coat thing. The white coat in society is sort of the distinguishing facet of a physician from the other staff and as my ethics professor once told me "that white coat is going to be your best friend and save your ass". When I asked about that, he told me patients feel more comfortable and more compliant when the coat is on, thus being more honest. I don't have the links or stuff to back that up either, so don't hold me down on that

 

[SemperJeff]

hmm.. That's interesting. It makes sense if they have found a lot of pathogens in ties... But white coats and those pockets are pretty practical for carrying around little books and notes...

 

[SemperJeff]

The white coat in society is sort of the distinguishing facet of a physician from the other staff and as my ethics professor once told me "that white coat is going to be your best friend and save your ass".

Well I think the white coat is more associated with the physician. But these days I've seen RNs, NPs, and PAs wearing white coats. (Granted, the RN I saw wearing a whitecoat was, I believe, in some higher administrative position or something like that. The other RNs weren't wearing coats.) And the patient has to squint at the badge to see that there is an NP instead of an MD after the person's name (unless the patient is paying close attention when the Nurse introduces himself/herself).

 

[cfdavid]

Personally, I'm a huge fan of this except for the white coat thing. I *hate* my white coat as much as the next guy, but when I'm rocking scrubs or a more casual polo/khakis look, the white coat is the only thing that distinguishes my position. Maybe a short sleeved version would be in order...

I hear your concerns, but not sure that would look so great.

Regarding the article, they DO make some very valid points.

 

[RockShox]

This is an effort in futility. Sure they found bugs on ties and stuff. But did they bother to mention the carrier rate of MRSA in the nares of hospital employees? Are they going to make them wear nose plugs too? I am all for not wearing ties, though (for reasons that have nothing to do with bacteria and everything to do with unobstructed breathing). I think its impractical to ban white coats...I need the pockets and everything else to prevent me from looking like a transport orderly.

My hospital now does MSRA screening of patients and if they have positive colonization they go into contact precautions. IMO complete waste of money considering that the medical workers are not residing in contact precautions. Getting workers to wash the hands and wear gloves...oh and then take said gloves off before touching charts, doors, etc would probably be more cost effective than isolation rooms...but what to I know

 

[keeping-it-real]

I always love it when people talk about how "distinguishing" the white coat is. Maybe we can let our work do the talking and not worry about what everyone's wearing to the prom?

If they did away with white coats, what would you guys change your facebook photos to?

 

[SemperJeff]

If they did away with white coats, what would you guys change your facebook photos to?

oh, there's always the classic stethoscope-around-the-neck picture...

 

[akpete]

Anyone read the article from Associated Press/Yahoo about British hospitals banning neckties, long sleeves, white coats, and jewelry for doctors? Seems like the pose very valid points about spread of disease. How long before our hospitals start enforcing similar rules?

The problem I've got with this is the long sleeve thing. I'm always freezing my ass off in the hospital and I know I can't be the only one.

 

[kronickm]

My problem with this would be the watch. I find that I use that more then anything else while working in the hosp. (pulses etc.) That and I feel naked without it.

As for the white coats I suppose you could always just wear embroidered scrubs.

 

[deleted77919]

My problem with this would be the watch. I find that I use that more then anything else while working in the hosp. (pulses etc.)

I forsee above the elbow watches becoming the newest physician fashion in the UK.

By the way, there aren't any studies (that I am aware of) that show health care workers have a higher rate of Staph colonization than the baseline 50% in the population.

 

[peace zealot]

I forsee above the elbow watches becoming the newest physician fashion in the UK.

By the way, there aren't any studies (that I am aware of) that show health care workers have a higher rate of Staph colonization than the baseline 50% in the population.

not actually elbow watches,but i think arm watch will not be a bad option.....all that half seleeve stuff and arm watches will make ladies more glamarous,men should worry....half selvees white coats are in fashion in ladies but not much in men......
well i personally think whitecoat is the honour of a physcian......if a doctor gets nothing much attractive in life let "whitecoat honour" be the attraction atleast......

 

[ms. a]

The problem I've got with this is the long sleeve thing. I'm always freezing my ass off in the hospital and I know I can't be the only one.

That was my first thought! Not a day goes by in the hospital that I don't need a sweater/long sleeve shirt/my white coat for some sort of warmth.

 

[GodoShingo]

I hear your concerns, but not sure that would look so great.

Regarding the article, they DO make some very valid points.

Are you sure? Well, Dr. Cox is not a real doctor, but still, it looks great on him.

I am personally for white coats. They should offer a service that, just like scrubs, you can get a new, clean, white coat every morning.

 

[kronickm]

I forsee above the elbow watches becoming the newest physician fashion in the UK.

Where will I wipe my nose then if not on my upper arm?

 

[Northerner]

I always love it when people talk about how "distinguishing" the white coat is. Maybe we can let our work do the talking and not worry about what everyone's wearing to the prom?

If they did away with white coats, what would you guys change your facebook photos to?

Likewise, we could ask every hippy "white-coats-don't-mean-jack" egalitarian how exactly wearing a white coat hurts anyone (in the absence of ? All of a sudden you can't distinguish yourself by the quality of your work because you're wearing a white coat? Let's be honest - you're doing pretty ****ty work if it's overshadowed by the distinctiveness of your white coat.

You make it sound like it's immature to have respect for what the white coat symbolizes (or used to, anyway). I assume you'll have your patients call you by your first name? I mean gosh, the title "Dr." separates you so much from your patients, you'll never be able to connect. I suppose you'll refuse to write "orders" for anyone, as we're all equal and all that. Maybe some suggestions would help, though.

(But if he was serious and there really are people out there with Facebook pictures of them in their white coat or with their stethoscope or some equally inane thing, PM me and I'll give you all the reasons you're an idiot too.)

 

[deleted77919]

I am personally for white coats. They should offer a service that, just like scrubs, you can get a new, clean, white coat every morning.

Our laundry service provides that. If you really want to exchange your coat everyday, you can. Admittedly what comes out of the laundry service is never the best looking, but it is at least, clean.

 

[JayneCobb]

we won't. Right now the evidence for supporting this action is extremely thin to non-existent. And the British publication which tries to claim that it is evidence based medicine is anything but.

That being said, I do think that our laundry habits of neck ties and lab coats leaves much to be desired.

 

[SoCuteMD]

If my hospital tries to take my long sleeves away from me, they're gonna have to up the temperature about 20 degrees.

 

[Llenroc]

Sounds like a badly thought out move. All doctors will look like nurses now.

Also, hospitals are damned cold. I hate scrubs, especially wearing them without a coat.

 

[deleted77919]

Sounds like a badly thought out move. All doctors will look like nurses now.

Also, hospitals are damned cold. I hate scrubs, especially wearing them without a coat.

Personally I'm suprised we haven't set hospital temperatures at 4 degrees C, you know, to help inhibit bacterial growth, pt and staff comfort be darned.

 

[JayneCobb]

Sounds like a badly thought out move. All doctors will look like nurses now.

so? And if you go quoting the studies which show that patients care that their docs dress up, i'll post just as many which show the converse.

Also, hospitals are damned cold. I hate scrubs, especially wearing them without a coat.

Perhaps they keep it cold because we physicians are over dressed?

 

[Llenroc]

so? And if you go quoting the studies which show that patients care that their docs dress up, i'll post just as many which show the converse.



Perhaps they keep it cold because we physicians are over dressed?

Maybe you can be the first to import an NHS tunic and sport it on the wards. I will be the one standing in the back, pointing and laughing at you for being a girly man.

 

[Cirrus83]

Well, it's official now but I used to work in London and I had noticed that the doctors usually weren't wearing anything that would give you a clue that they were doctors, lol. There was some kinda color code for their scrubs/uniforms in the hospital for the nurses and whatnot, but doctors usually just wore a shirt with pants, and no white coat or anything.

On the plus side I guess you can wear anything you want. On the downside? It was kinda hard to figure out who was a doctor if they didn't have their stethescopes on, because then they looked exactly like all the administrators, etc.

Still, wouldn't mind not wearing a tie, but don't expect that any such rule will mean that you can dress like a bum in the UK.

I do applaud the official banning of jewlery and watches for health reasons, but it's also a little sad that you have to take your watches and wedding/engagement rings off. Oh well, probably better not to wear your fancy watch and have it covered in MRSA anyway lol.

Hmm, just noticed they're actually banning all long sleeves...I guess that's a little more extreme, but hey, now you can roll in wearing your crazy punk rock tees and claim it's for patient safety hahahaha.

The pic they showed for the uniform is just one of the uniforms that "could" become something doctors there will wear, but I dunno if it'll really happen other than maybe when actually doing procedures or something. But who knows, anything's possible.

 

[JayneCobb]

I do applaud the official banning of jewlery and watches for health reasons,

Why? There have been no studies which show that rings or watches have any effect on nosocomial infection rates. And only a few poorly done studies which even hint that rings might carry bugs. The only half way convincing study showed that there was a marginally higher bacterial load present under rings after washing.

 

[Cirrus83]

so? And if you go quoting the studies which show that patients care that their docs dress up, i'll post just as many which show the converse.

Well, being mistaken for nurses could actually lower our malpractice rates since nurses don't get sued nearly as often!

But whether or not patients prefer docs dressed up or down, I think the docs that get sued are the ones who look incompetent, so looking like you're sloppy is probably more of a problem than what clothes you're wearing exactly. That is, even in scrubs you can look well groomed, confident, have a good sense of humor, etc. It's just a little bit harder to look totally incompetent when you're wearing a dress shirt and tie since people probably assume you're not a total idiot (so I notice when I'm taking patient histories anyway lol).

 

[JayneCobb]

Well, being mistaken for nurses could actually lower our malpractice rates since nurses don't get sued nearly as often!

so looking like you're sloppy is probably more of a problem .......It's just a little bit harder to look totally incompetent when you're wearing a dress shirt and tie since people probably assume you're not a total idiot (so I notice when I'm taking patient histories anyway lol).

You've hit the nail on the head. It has little to do with what you wear, but how you appear in it. I can easily make myself look like scruffy ***** in dress cloths with a tie. It doesn't take much to wear an unkempt shirt and a tie which doesn't match/doesn't fit, etc.

 

[Cirrus83]

Why? There have been no studies which show that rings or watches have any effect on nosocomial infection rates. And only a few poorly done studies which even hint that rings might carry bugs. The only half way convincing study showed that there was a marginally higher bacterial load present under rings after washing.

You have to realize that in the NHS system, MRSA is somewhat of a bigger problem than even in US hospitals, and they had had some success banning watches apparently (although it was at the same time as a bunch of other changes, so it's not really proof that the watches did anything). But while in US hospitals you do have some MRSA, I remember they had like...well, a LOT of special MRSA rooms all over the place when I was there. And they usually were almost all filled with people too. I haven't yet been to a US hospital where that many people seemed to get MRSA while there. MRSA was discovered in England anyways, so it's not entirely surprising that they have more hospital cases.
From wiki (which is an awful source, but still)

As of early 2005, the number of deaths in the United Kingdom attributed to MRSA has been estimated by various sources to lie in the area of 3000 per year.[42] Staphylococcus bacteria account for almost half of all UK hospital infections. The issue of MRSA infections in hospitals has recently been a major political issue in the UK, playing a significant role in the debates over health policy in the United Kingdom general election held in 2005.

It's actually hard to compare data with the USA because we have a lot more community based cases (the UK has almost none), where there's a breakout in a school or something, then people go to the hospital. But it seems like you're more likely to actually catch MRSA at the hospital in the UK, so it would make more sense that they're focusing more on controlling the spread at the hospital since that's the only disease vector over there.
It might also be largely political though, but all the extra care the NHS puts into MRSA patients apparently also makes it a financial issue for the government, so since it's pretty cheap to just ban rings I guess it was the cheapest way to look like you're at least doing something.

That said, I guess we'll know soon whether banning rings and ties helps in the fight against MRSA since there should be data in a couple of years.

 

[ChuckRock]

Likewise, we could ask every hippy "white-coats-don't-mean-jack" egalitarian how exactly wearing a white coat hurts anyone (in the absence of ? All of a sudden you can't distinguish yourself by the quality of your work because you're wearing a white coat? Let's be honest - you're doing pretty ****ty work if it's overshadowed by the distinctiveness of your white coat.

You make it sound like it's immature to have respect for what the white coat symbolizes (or used to, anyway). I assume you'll have your patients call you by your first name? I mean gosh, the title "Dr." separates you so much from your patients, you'll never be able to connect. I suppose you'll refuse to write "orders" for anyone, as we're all equal and all that. Maybe some suggestions would help, though.

(But if he was serious and there really are people out there with Facebook pictures of them in their white coat or with their stethoscope or some equally inane thing, PM me and I'll give you all the reasons you're an idiot too.)

Awesome. If I could, I'd digg this.

 

[Slide]

The white coat distinguishes physicians, not to separate them from the nurses and staff (though it is helpful), but as a person that can bypass social norms and be trusted with delicate personal information from that patient in order to treat him. One of the most unique workplace traits that only belong to physicians is the fact that patients will allow physicians to violate common social norms (eg. looking at the patient undressed, asking personal questions, touching the patient), and since physicians have been long associated with that white coat, people unconsciously assume that the physician is automatically a trustworthy person. When you take away that white coat, the patient feels a little uneasy at first and may not be willing to disclose information or allow procedures that could be vital in treating the patient. This distinguishment has nothing to do with pretentious attitudes or elitism.

 

[peace zealot]

Awesome. If I could, I'd digg this.

dont even try to dig into that.time seems much more worthwhile in front of such philosophical posts......hm.....philosophers among doctors.....

 

[Northerner]

The white coat distinguishes physicians, not to separate them from the nurses and staff (though it is helpful), but as a person that can bypass social norms and be trusted with delicate personal information from that patient in order to treat him. One of the most unique workplace traits that only belong to physicians is the fact that patients will allow physicians to violate common social norms (eg. looking at the patient undressed, asking personal questions, touching the patient), and since physicians have been long associated with that white coat, people unconsciously assume that the physician is automatically a trustworthy person. When you take away that white coat, the patient feels a little uneasy at first and may not be willing to disclose information or allow procedures that could be vital in treating the patient. This distinguishment has nothing to do with pretentious attitudes or elitism.

Good luck convincing the hippies.

 

[dilated]

I wouldn't mind banning ties. There's no escaping them in the hospital but I've found a number of community clinics where the attendings wear white coat/dress shirt/dress pants sans tie. And they never care if you ditch the tie too.

 

[GodoShingo]

Our laundry service provides that. If you really want to exchange your coat everyday, you can. Admittedly what comes out of the laundry service is never the best looking, but it is at least, clean.

Looks like they already have a solution there, then. Maybe it's just their hatred of the doctor's prestige that haunts them, making them to do these desicions.

 

[Winged Scapula]

Interesting aside on the "prestige" of the white coat: when I was training in Australia, we were told NOT to wear the white coat because it "scares" the patients and would add undo stress.

Frankly, I like the coat for the warmth and the pockets and when I've had too much to eat and need something to cover my gut.

 

[psymedicus]

Just as an interesting aside, it's extremely interesting to me the huge importance attached to white coats and their length. In Singapore, no doctor wears white coats; conversely, students are required to wear long white coats. So in essence the white coat becomes a distinguishing mark of the untrained student. We recognize senior doctors by their black nametags with white words, universal across hospitals. Nurses wear uniforms and techs wear short white coats. And probably because of our colonial history, we do have the bare-below-the-elbows rule as well. Although since it's hot and humid all the time, I guess nobody would really want to wear long-sleeved white coats in non-air-conditioned wards.

 

[M81AD]

Hi every one
my name is Mohamad , I wounder if any one can help me ?????

I am graduated from medical college of Basrah / Iraq and awarded M.B.Ch.B
I was born on london and I got the british passport ??
my question is that
I am consider as home student or not ?
Is the fee of postgraute study is lower for me if I am home student ?
If I want to go for australia did they consider me as home student and is the fee of study generally lower than UK ?
Must I do plab test if I am home student ? or can do postgraduate study directly ?
Can I Find any medical job before doing Plab to get many for study ?

Thank you

 

[MarieStockholm]

As for the white coats, french hygienists have solved the problems by getting everyone to cut their sleeves over the elbow and forbidding watches, rings, bracelets, etc. Besides, hospitals give some blue tops and trousers to junior and senior doctors to wear (the same that are worn in operating theaters) instead of their civil clothes. Not all of them wear the blue things (as a matter of fact, the majority doesn't), but the "naked forearms" rule is very well applied (you just have to put your watch in the white coat breast pocket).

But what I think is most significant about germ transmissions is that, unlike in the UK, there's no wards in France. Many patients are in single rooms (so it's very easy to make sure no multi-resistant germ is transmitted from the one to the other) and there's, at most, 2 patients per room.

I hope the white coat stays everywhere. As many said, it's what identifies the doctors. The patients sometimes hardly know who's who, so we shouldn't make the identification task harder by taking our coats off...

 

[JayneCobb]

As for the white coats, french hygienists have solved the problems

Do they have any data to support these acts?

 

[MarieStockholm]

Damn, I don't know if there's been two double-blind randomized studies... That's what I've been taught, anyway. Well, not that the nosocomial problem was solved (that would be too great !), but that the white-coat dilemna had been succesfully solved that way.
I've searched PubMed, and found that article, but I can't read it (no personal PubMed account, soooo...)
Here's the abstract of a descriptive epidiemiology study.

 

[JayneCobb]

Damn, I don't know if there's been two double-blind randomized studies... That's what I've been taught, anyway. Well, not that the nosocomial problem was solved (that would be too great !), but that the white-coat dilemna had been succesfully solved that way.
I've searched PubMed, and found that article, but I can't read it (no personal PubMed account, soooo...)
Here's the abstract of a descriptive epidiemiology study.

Long story short, there is no correlative studies that I'm aware of that white coats, stethoscopes, wedding rings, long sleeve shirts, or other fomites play a role in transmission of nosocomial infections, and more importantly, there is no data which supports the theory that removing those fomites will decrease nosocomial infections.