Doctors and medical students in India should stop wearing white coats

Doctors and medical students in India should stop wearing white coats, argues a doctor in The BMJ this week.

Edmond Fernandes, a postgraduate at Yenepoya Medical College in Mangalore, says evidence shows that long sleeved coats spread infection and lead to avoidable harm and cost to patients.

Although long sleeved white coats have traditionally been worn by doctors since the 19th century, we now know that white coats "harbour potential contaminants and contribute considerably to the burden of disease acquired in hospital by spreading infection," writes Fernandes.

He explains that in India, changing areas in hospitals are rare because of space constraints, so white coats are commonly worn by students coming from college and outside the hospital. They are also often left on chairs, tables, and in corridors.

In many cities in India some junior doctors are also now seen wearing white coats in shopping malls and cinemas too, and then they enter sterile zones in the hospital in the same attire, he adds.

"Given India's tropical climate, common sense indicates that we should discourage wearing white coats that are washed perhaps only every few weeks," he suggests.

He points out that in 2007, the United Kingdom took the landmark decision to ban long sleeved white coats - and that in 2009, the American Medical Association wanted to follow suit and dump the white coats, "but the proposal was dismissed because clinicians wanted to keep their traditional gowns."

Some may argue that white coats are a badge of honour, says Fernandes, "but they are mere symbolism and wearing them does not itself confer status or professionalism."

He believes that "dressing presentably and sporting a smile are more important than white coats" and that institutions "should give every medical student and doctor a recognisable name badge to wear."

And he points out that we can do other things to reduce hospital acquired infections, such as better hand washing compliance.

"Every hospital should have a committee to check and respond to hospital acquired infections," he says. "But an easy win would be for India's ministry of health to ban doctors and medical students from wearing white coats, to reduce the harm and cost that results from hospital acquired infections."