What is an a white coat?
Efficiency, not attire, decides the worth of a doctor
Srinagar, Publish Date: Dec 19 2017 9:22PM | Updated Date: Dec 19 2017 9:22PM
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File Photo
What to wear
The subject of what to wear isn’t covered directly in medical school but majority of students still adhere to some sort of dress code, befitting the profession. Why do doctors wear white apron? A question that has always baffled me. The truth is that during my career, frankly, most of my colleagues didn’t know the exact answer. Was it keeping with the centuries-old ritual of a traditional hierarchy inherited from our seniors as what is appropriate to wear at workplace; Medical council’s policy code of ethics was not clear to me, if at all there was any institutional or Government regulation on dress code it was not known to most of us. Dress code for care providers assumed legitimacy recently when state issued a circular on this issue, the medical staff are expected to know and abide strictly by these rules regulations the minimum acceptable standards of conduct expected of all employees .
And Why?
Everything is supposed to be evidence-based in medicine. I am for a dress code in hospitals of course with some strict guidelines reviewed on scientific evidence fitting the professional responsibilities assigned to care provider in different settings of hospital, with due considerations to local climatic changes and cultural values as has been done in mnay hospitals of south India. What to wear in workplace, the father of medicine, Hippocrates, had a clear idea of what a doctor should look like - "clean in person, well dressed, and anointed with sweet-smelling unguents”. Hippocrates would probably approve of modern hospitals, which offer "unguents" at every turn in the form of hand sanitizer for hand wash to prevent infection - but he might take issue with the standard of doctors' dress.
For any quality improvement planner, like me, the recommendation/regulation for any healthcare organization(HCO) is based on the principles of best practice scientific evidence, standards from accreditation bodies, productivity, efficiency and effectiveness. At the top of our priority list is attention on improving quality of patient care and safety as this is fundamental to achieving better health outcomes. Does distinction of attire ,have any relevance to the patient care, safety or productivity, ? The latest editions of NABH, JCI,CBAHI accreditation standards for hospitals focuses mainly on quality of care, safety , dress code is not included in these standards nor it figures in Quality assessors list of key performance indicators. Selecting, testing, implementing and monitoring changes is a core element of the model for improvement in HCO . Institute for healthcare improvement says, “While all changes do not lead to improvement, all improvement requires change”. In HCO’s performance is based on compliance of a care provider on his/her assigned job description, competence and professionalism , adherence to quality and safety standards . But in terms of productivity, we find the main driver is job satisfaction, organized total quality management system. If an employee is motivated at work, they are more likely to work harder, and more effectively in a team spirit.What dress code means to a Clinical auditor like me , should set out what attire is expected from a care provider in different settings of hospital rather than a strict code for everyday/everywhere to be in “white apron” . A care provider working in operation theater appropriate attire is different from the staff involved in any interventional /invasive procedure, radiology bay , high dependency units the recommendations on attire are different, obligatory wearing of PPE –personal protective equipment, sterile gowns etc not always a white apron and any noncompliance on these is a violation.. For improving patient care monitoring physicians /organizational accountability on more serious matters of quality and safety like essential safety requirements,international patient safety goals and key performance indicators in a hospital setting , I leave it to healthcare planners and leadership who is the the best person to be privileged for this professional task ?
Do clothes make any difference?
Dress is uniform, and instills discipline everyone, including patients say it is easy to identify. Whether part of the medical community or not, If no white coat, can’t be a doctor - this stereotypical image of the anyone wearing white apron quintessential symbol for Doctor holds no more true today as many others engaged in non-medical jobs like hairdresser, meat sellers and bartenders, use white coat during their work. Thus, from the patient’s perspective, “one size fits all” approach may not work in a hospital setting where different jobs are to be done in different settings using different attires other than white coat. A Clinical auditor would always vouch for employee’s photo ID bearing name, designation ,specialty ,place of work,etc be made mandatory for staff in all hospital settings so that right person at right place at right time is assured.
Effect of doctor's attire on the trust and confidence of patients’;
Won’t you trust a doctor who is not wearing a white coat? Trust me, I'm same doctor, committed to my patient/client/profession, whether I am in white or black coat. A public perception of Doctor or trust is not based on particular attire. Doctors are valued for their professional knowledge, competency along with some personality traits of mannerism, empathy, altruism and communication skills .Do we really care what our doctor is wearing especially in his /her private clinic.? For measuring KPIS in hospitals the physician’s attire isn’t necessarily a reliable major indicator of his or her professional competence, but some elderly patients do notice what docs are wearing and often judge them for personality traits accordingly. In a cross-sectional questionnaire survey on the recognition, symbolism, and formality afforded by a white coat may enhance communication and facilitate the doctor-patient relationship, only 33 % patients reported feeling more confident and better able to communicate with doctors who wore white coats while most would likely agree with something along the lines of “it doesn’t really matter, as long as they are competent ,empathetic and do a good job the preferences on particular attire”.
White coat risk infection
Although long sleeved white coats have traditionally been used by doctors since the days of Semmelweis (19thcentury). Many hospital based studies have suggested that physicians' attire especially white coat, ties and, stethos are frequently colonized with bacteria associated with resistant pathogens and we should do away with white coats at least .This is in a place where the uniforms like white aprons were regularly laundered by the hospital laundry and regularly monitored by infection control department. With this emerging clinical evidence many hospitals in west have banned white apron for hospital staff, and some of our clinical staff wear scrub suits dress now , and we would never criticize them for this. The decision to be resilient in the dress code is one that Quality auditors have not regretted and we trust that care providers will continue to act with the utmost professionalism whether they are wearing white apron or a scrub suit. Most(90%) of the differences erupt in work place due to our wrong tone of voice, only a few of them are due to differences in opinion there is always scope for improvement for that I need to learn and practice the use of right communication skills having a sense of respect and privacy towards especially the other non compliant professionals to bring successful organizational change in quality.
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(Dr Fiaz Fazili is Clinical auditor and works as Quality improvement consultant in healthcare organizations.)
read more on http://www.greaterkashmir.com/news/opinion/what-is-an-a-white-coat/269485.html
read more on http://www.greaterkashmir.com/news/opinion/what-is-an-a-white-coat/269485.html
