Friday, July 14, 2006

Preferences

I had a pen explode in my lab coat pocket yesterday -- a tragedy, I know. At the end of the day, as I was leaving the office carrying my lab coat home to be washed, one of the other docs said, "I don't know why you still wear that thing. None of us feel the need to wear lab coats anymore. Do you think you're still a resident?"

He was joking, of course, and then we had a short discussion on the the philosophy of a doctor wearing a lab coat while seeing patients in the office. From my perspective, I like my lab coat. Not only is it fashionable, it is practical. I'm able to carry my stethoscope, my prescription pad, a couple of pocket-sized reference books, and a pen (when it doesn't explode).

His points were that the lab coat can make a physical and emotional barrier between you and the patient which can hinder communication. And, it's difficult to continually keep a long white coat clean (I conceded that point).

I'm kind of curious, what do you think? What's your preference? Lab coat or no?

(Notice the new blog title? Why? Leave a comment to find out...)

31 comments:

Hoping4more said...

i like the lab coat. it depends i guess, personability is good to lesson the discomfort of the amount of personal information about us as patients, but the lab coat seems more professional, and a sense of a boundary can be a good thing! i vote lab coat, but not essential all the time (and there is nothing that bothers me about a doctor not having one, but i just like the lab coat myself)

Dr. A said...

Why the change? The original title was "Does it matter." Well, in the big picture, the whole lab coat thing probably doesn't matter.

There's probably more important things to discuss, but I thought this would be a fun Friday debate.

So, take a side an give me your best points!

Pattie said...

Well I can certainly see both sides to this preference. I was a Pediatric nurse. I remember a study that was done, suggesting that white coats cause children unnecessary anxiety. So, at our hospital, the physicians did not wear them. However, my husband is a surgeon.
He wears a white coat, even to office hours for a few reasons. First of all, to carry the necessary "stuff'....stethescope, script pad, etc. But also, to keep "stuff" off his clothes...an extra protective barrier, if you will. As a pateint, I honestly do not have a preference.

difficult patient said...

I vote for the lab coat. It helps establish appropriate boundries with your patients. It's nice to know your doctor is your friend, but the lab coat is a reminder that the doctor is the doctor and the patient is there for a reason. The reason isn't to shoot the breeze with a buddy.

Lea said...

I vote for the lab coat. I am kind of a freak about cleanliness and to see a stark white lab coat shows me that my doc does not have other patient's "stuff" on her. After all of those years of schooling, a person deserves to wear the coat with their name embroidered on it. ;)

On the other hand....for children, I think doctors should not wear the white coats. Instead, maybe a coat with kid-friendly prints on it. Keep the anxiety at bay with something for the children to focus on besides a stranger poking and prodding them.

And that's my two-cents worth. Happy Friday!!

ladybug said...

the formalness of the labcoat is a good thing, in my opinion. you earned the right to 'look' like a doc, and it should command respect from your patients and coworkers...

besides, a labcoat, or lack of one, in no way makes you an effective communicator with your patients. being a good communicator does. my primary doc always has a labcoat on, and he is able to put me at such ease, i never feel worried i cant approach him. you have to make your spirit approachable, and that lab coat barrier isnt even an issue.

a little story about 'looking the part' which is why i vote for the labcoat:

i worked for a catholic nursing home for some years after college, and it was run by nuns [sisters of mercy]. they do not wear habits, and in fact, dress very business-professional. there was one nun, who i swear to heaven had a wardrobe comparable to a hospital CEO, etc... she always looked impecable, hair done, nails done, jewelry coordinating, high heels, etc... someone musta called her "miss" or not "sister" and she got all offended. and she was like "I Am A Sister of Mercy" and the person fussed back and said, well, if you looked like a sister, i would have called you sister!

i do not expect nuns in this day and age to be in the full garb of a habit. but i have an aunt who is a nun, and when she is working or on official business, she wears a white blouse and black or navy skirt. it is uniform enough to mak eher stand out....and you know she isnt some fortune 500 ceo.

just a ladybugs sleepy opinion... off to work!

Dr. A said...

Hmmmm.... This is really intersting today. I look forward to reading more.

Sarebear said...

I think different is good. And being able to carry your "tools" with you. Imagine the looks you'd get if you wore a toolbelt, instead, and had your stethoscope "holstered" at your hip like an old 45.

Stick em up!! I mean, out, as in, your tongue, and say AHHhhhhhh. Lol. Wait, you don't need a stethoscope for that . . .

Me, I like the authority, confidence, and capability the image projects, with lab coat on.

But then, I also have a thing for guys in uniforms, lol.

Jordan said...

I always wear my coat.....I like the fact that it creates a certain seperation between Doctor and patient....How else will patient's feel comfortable telling you things they wouldn't tell their family and friends

Dream Mom said...

Personally, I like the lab coat with the name embroidered. I think it conveys professionalism. I prefer the starched white ones the best (some hospitals use blue).

When I am in the hospital with Dear Son, there are at a minimum of 50 different people that enter his room on a daily basis. I would much prefer to go back to a standard uniform for each level (std uniform for nurses, nurse's aides, etc.). It makes them easier to identify. As for the white coats, I notice everyone from doctors, nurses, dieticians, case managers (yes I know they are nurses) wearing them. The white coats should be reserved for docs only, in my opinion. I'd love it to go even further and identify residents, fellows and attendings. You have to remember at Big Acadmemic Medical Center, there might be four neuro residents, six ped residents, etc, etc, let alone if other specialities are called into the room. The name embroidered also helps me figure out who these people are; there are a lot of people who enter the room and who don't identify themselves (one of my pet peeves). Yes, I know his regular docs but there are a heck of a lot of docs that come in the room.

Also, I still like it when the docs wear a tie to work-doesn't matter if it's a bow tie or regular tie. Call me old fashioned, but I like it. As for the female docs, it wouldn't hurt to put a little make up on from time to time; some of the female docs look liked they just got out of bed.

As for communication, I don't ever feel like I have a problem communicating with the doctors so whether or not they have a lab coat on would not affect me either way.

ipanema said...

Since no one wears it in my workplace, I prefer a lab coat. Personally, I think it sets them apart and as a patient, it sets the tone.

Dr. A, with permission, I'm blog rolling you. Honestly, I've been to other med blogs but there are a few who really write, you're one of them. One more thing, you really respond to your readers, hope you'll stay this way. This is refreshing to read.


Thanks.

Dr. A said...

Ipanema, Thanks for your kind words. I'm on my way to reading you blog. I suspect I'll like what I read.

Dreaming again said...

Our first family doctor insisted on wearing a coat, but thought the white was intimidating to kids. So he wore blue.

Some of my doctor's I don't even notice if they wear one or not. I get thrown off in the hospital when my neuro comes in with one, because I dont' think he wears on in the office. Never seen my pulmonologist in one at all.

My primary care doc didn't have hers on last friday and it just seemed strange. She needed the coat. She also looked like she was missing an appendage, she kept grabbing at the non existant edges to pull them together.

So, I guess .. it depends on the doctor.

may said...

dr. A...with your permission, i just hosted the BA meeting. i hope you can come, and you can bring all your "patients" with you :)

Cathy said...

Dr. A., I think you should wear your lab coat. As you said it allows you to carry your supplies. I think Doc's look sharp in white coats. Very professional!

I'm probably strange but it's the "shoes" that matter to me. I always look at the shoes..I like to see a doctor wearing nice sharp looking shoes. But as I said i'm weird....:)

Dr. A said...

I highly recommend you see Dr. Anonymous, the owner of the official unofficial site of BA. he is highly respected in this field of specialty, and a recovering blogaholic himself. needless to say, he knows what you are going through. or, what WE are going through.

May, you're KILLING me! That's funny. Hope you have a great turnout for the meeting. Thanks!

Artemis said...

Interesting timing ... I don't wear a lab coat now, and don't even have one in the office. I do wear a white coat while consulting in the hospital. I mention the timing, because only this a.m., I was thinking about storing a white coat at the office to wear on occasion (only to free up some wardrobe choices). My partner and I have chosen to NOT wear white coats to promote communication with our patients (as a tertiary referral center, most patients are pretty freaked out to be there anyway), and for the most part have succeeded ... we do occasionally run into an old codger who complains that we must not be "real" doctors, due to lack of said coat. Regarding "tools" -- we have stethoscope, tuning fork, reflex hammer, safety pins, ophthalmascope, etc., in each exam room (or in my trusty black bag), so no need to carry.

Alcohol works well to eliminate ink (hairspray is good in a pinch, mostly d/t the alcohol content). Try rubbing alcohol, not your trusty Corona or similar...
A

Hans G. Engel, M.D. said...

A rebelrouser since my teens, I haven't worn a formal white coat since internship. White shirt and tie, short white jacket for a while, and then I thought my comfort was more important to me than formailty. When I moved to California, sport shirts and jackets became my rule and before long, I got barber-supply colored jackets. My patients supported me: less anxious, more comfortable, particularly with children.
On rounds, only civilian jackets, and sport shirt only in summer.
Other docs followed me quite rapidly and today (in many Los Angeles areas, at least the majority no longer wear white coats - at least in my limited circle).

healthpsych said...

I don't think I've even see a doctor here who wears a lab coat.

I personally like it. It looks professional, it has all the benefits everyone has described...does it put up unhelpful barriers? In my experience, that depends more on the doctor...good bedside manner is not lab coat dependent.

For kids, colourful, patterned fun lab coats could be the way to go....still identifies the doctor and creates a talking point to break the ice.

Moof said...

Interesting question. I do believe that the lab coat intimidates me ...

... I'm already intimidated enough! *LOL*

You know, I'm thinking back on the nearly one dozen people I've had to see in the last 3 years or so, and I can only remember one white coat ... a hematologist at the Lahey clinic.

Just a wee note about extra layers in your office ... if your thermostat is set to accommodate your lab coat, could be your patient's rash is really goose bumps! ;o)

RNrealnurse said...

Hello Dr A,
I was in heaven when I got a job where I could wear "real clothes" until I realized that I didn't have any! and the ones I did have didn't look all that great on me. So, I got some nice crisp white lab jackets and voila! ...problem solved...it covers up the fat rolls I don't want anyone to see. That's what I like about the white lab coat.

Fat Doctor said...

I don't wear a lab coat because it's too hot. If I could wear a short coat or a short sleeved coat, I would, but in our clinic I would be mistaken for other professionals (medical student or nurse). As a consequence, I have ripped all the pockets in all of my pants by shoving too much stuff in them. I've considered the fanny pack, but I hesitate to come across as the fat and DWEEBY doctor.

Dinah said...

Did you want the psychiatrist's input here?
For a hands on doc with all those body fluids oozing all over the place, I vote yes (just wash the thing, and after the pen explosion, it may be doomed).
What about for the psychiatrist? As a medical student, I did my psychiatry clerkship in an institution known for it's psychoanalytic bent (Payne Whitney, if anyone cares)--interestingly, it was policy there for the residents and attendings (and of course the med students) to wear long white coats, even though this was psychiatry. I then did my residency at a program with a much stronger research bent, smaller emphasis placed on psychotherapy, and few psychoanalysts affiliated; here too, long white coats were mandated (I've commented on the length because in every other training program in both those hospitals, Residents wore short white coats, only the psychiatry residents wore long coats like the attendings--why? I've no clue). I thought it was interesting that two programs which were so different, both had psychiatrists wear lab coats, different philosophies, different states. I've visited many other psych programs, none of them had psychiatrists in white coats.

I don't own one, but I do so wish I had a job where I could wear sweats or surgical scrubs.

Aren't you glad you asked??
Dinah of Shrink Rap
http://psychiatrist-blog.blogspot.com/

TheTundraPA said...

In our hospital, all medical staff are strongly strongly encouraged by the clinical director to wear white coats. Most of us do. All the outpatient clinics are located within the hospital, and she believes the identification issue is important as we move about from one area to another. Also, many of our Eskimo patients are pretty "old school" and expect and want us to wear them. I would do so anyway, just because of the convenience--pockets for the tools, and protection from the occasional errant fluid. And they cover a host of wardrobe ills; I don't worry so much about my shirts being ironed. (You have to understand that the dress code up here in frontier Alaska is a bit more relaxed; "dressed up" means that your jeans are clean and there are no holes in your shirt.) Our only wardrobe proscription is blue jeans; black, green, brown, or any other color is fine, just not blue.

Sarah said...

I don't work in the medical field...yet (soon to be nursing student) but I think it depends on who your patients are.

As a child I was pretty sick and had seen many different doctors when mine was not available. Many of them were not pleasant and some of them were pretty scary and rude.

I remember one experince when I was about 11 yrs old. I was really really sick and my PPC was not available, I was in the exam room waiting for Dr. Stump (yes, that was his real name). In walked a 6'5 300lb man with a mustach and beard, wearing blue jeans, a plaid shirt, and suspenders - I almost laughed. I was immediately at ease. He looked like a lumber jack. He was a kind and friendly as a teddy bear. He became my PPC.

First impressions are everything. I guess it depends on if you're trying to appear "professional" or approchable.

Roy said...

I just ran into this whitecoat post from NeoNurseChic's blog.

I quickly scanned the comments, and it seems that the pro-whitecoats have it. I agree with many of the commenters, for mostly the same reasons.

-There's the practical, lots o' pockets reason, and cheaper to replace than a sportcoat.

-It can reduce infection transmission. The germs stay on the white coat, whereas most sport coat wearers probably come home with it on.

-You don't get as upset about getting blood (or worse) on your lab coat as you do on your sport coat or shirt.

-Serves to identify you as a health professional. This is particularly useful in hospital settings where one sees older folks, who may have cognitive problems (like delirium or dementia) or visual impairment. Giving them as many cues as possible (like clocks, one-a-day calendars, and moderately bright rooms) help to keep them oriented.

What is interesting is that, during my psychiatric residency, I was one of the few who bucked the trend of *not* wearing lab coats. Most of my peers did not wear them, I think to help differentiate themselves from their medical colleagues, or to feel that they've put medical school days behind them.

Anonymous said...

hinder communication? thats a good one. when i went to an insurance required follow up visit with my pcp, he walked in the exam room talking about himself, talked about himself for five minutes and then left, asking me nothing, leaving me with a rx for a colonscopy. i had just had aortic valve surgery three weeks prior!
-san diego gp in a lab coat everyday, listening to patients

Patient Anonymous said...

I was looking for this entry.

I guess there are two angles from which you can approach this: the patient and the health care provider.

As a patient (who is also not coincidentally a HCP) I guess it doesn't really matter but my personal preference is no lab coat.

I kind of have this freaky weird issue of doctors as "Almighty Authority Figures" and not that the lab coat really *does* create a barrier but it's just a further symbol of POWER. You can be intelligent and efficient and do your job well without having to "look the part." Although I do understand the more practical aspects of the coat. I just don't like it.

Hey, maybe patients can get something fun to wear in exchange (NO, not those AWFUL gowns that expose everything...talk about feeling vulnerable...) Okay, I know that may not go over well as some docs want to remain "distinct" from their patients.

*rolls eyes*

I'm in Canada Dr. A (just because I read that you like to know who's reading from where) and I've noticed a bit of a "uniform shift" up here--even in hospitals. A lot of health care providers are pretty casual here--or at least in my part of the country. I was in the ER of one hospital and the nurses had these really cool T-shirts and regular pants...docs were in scrubs or maybe the odd Attending had a shirt and tie. I think I saw two lab coats?

I don't think a lot of doctors are wearing lab coats in offices but I don't have a concrete number of course. I just know what I see/have seen and currently none of my physicians do. I have a couple of referrals to specialists coming up so I'll see if they'll be wearing them. I'll put money on the table that they won't be.

Anonymous said...

For those who don't wear a lab coat, where DO you put all the stuff? I find I leave RX pads in exam rooms if I am not in a lab coat.
rubyred

Anonymous said...

To wear or not to wear....as long as the lab coat is checked daily to assure that it is clean, I do not see a problem. Please, do remember to clean those ties if you feel you the need to wear them.

rojan said...

I don't see any problem with wearing lab coat. Perhaps, it creates some kind of barrier, somehow. But every patient knows doctors will help them with their health conditions no one else, no matter what is the outfit. And I love embroidered lab coats ever since, besides their many uses, of course.