AN ODE TO THE WHITE COAT…
Please enjoy our fascinating guest blog on the life, times and subsequent demise of the white coat from Lee Taylor, Orthopaedic surgeon from Chichester, West Sussex. Do share your thoughts about the white coat, and it’s departure from our wards…
An Ode to The White Coat…
I came in different lengths and many sizes and sometimes I had different colours on my collars. I began my life as fluffy balls of cotton harvested in far off lands and was refined and processed into fine white thread that was weaved by an intricate system of automated needles on a large mechanically operated loom into sheets. I was then wound onto large reels and was packed into cartons and lifted into containers before being lifted by a forklift truck onto lorries and then into containers and transported to a far off destination where I would be transformed into my final form.
I was cut into various shapes by large scissors and then a machine anastomosed (a medical term used for joining blood vessels or pieces of bowel) my various cut outs by countless punctures of my tightly weaved substance with the same white cotton from which I was initially conceived. My body had two appendages attached near the top, one on each side and my dorsal spine was a neat line of stitches from the top to near the bottom where I split to allow movement, in my long form. In my short model I was stitched from top to bottom. At the front I was open with my edges neatly folded over and held back by more stitches to stop me from fraying and looking untidy.
Down my front were neatly formed horizontal orifices to receive the buttons secured on my other side with more cotton intertwined through my four perforations in a mechanically determined manner. With time my anchor chains would fray with multiple cycles through the industrial washing machines and I would hang loosely before falling to floor completely unnoticed. Probably never to be replaced.
Every medical student through their first two years of pre clinical studies aspired to collecting me freshly starched and ironed from the hospital laundry. A name badge was secured through my weave with a sharp pin with a name under which were written the words ‘medical student’. I was a prized possession.
I was brilliant white when new, but my brilliance faded with endless cycles of use and washing. My starched whiteness dulled, my crispness sagged and I moved to an off white discolouration. The sharply defined angular lapels which clung to my body curled away, like ageing petals and I lost my shape. My one pocket initially carried the much coveted stethoscope whose ears peeped over my top edge while concealing the coils of treated rubber leading down to my diaphragm. My other pocket was forced forced full of the most recent ‘Lecture Notes……”, so my stitching strained under the distension. I never knew how my stitches held so long as I became the recipient of keys, wallets, packets of cigarettes, lighters and any other object that needed a home. But I survived and carried many of the basic tools of the trade, a patella hammer, tape measure and a tourniquet to facilitate taking blood.
I assumed an even greater importance and self of pride in my occupant when my plain short with form was changed to a long one with a green and white (surgical) or blue and white (medical) gingham collar. I was proudly worn by the student locum houseman, who nervously strutted his or her new position as my occupant. Of course as political interference took over I became no longer the professional identity of the house officer, senior registrar……..or…..!
My demise was only to continue as I faded into oblivion as my occupants were no longer allowed to wear me. I never understood why the educationalist’s took my young doctors in training out of locum service as students, when manpower is so short. Common sense seems to have disappeared and the graduated practical apprenticeship my inhabitants had in learning how to talk to and examine patients has disappeared. I heard my trainee doctors saying they and I were being taken out of service for medical defence reasons and they would be taught more in the classroom in ‘Reality Examinations’, so more boxes could be ticked. I know those who were lucky enough to wear me gained great clinical experience under supervision which gave them great insight into how a newly qualified doctor worked and was expected to behave.
I was transported at times to places which now would quite rightly be frowned on and forbidden. Of course at quiet times in the evening I would be carried off the hospital premises to the local hostelry, mess or social club, where one of my pockets would be decompressed temporarily as my inhabitants wallet was retrieved to pay for a much earned and desired pint of beer. It was accepted then.
There were times I was discarded over the back of a chair and the bleep in my pocket was barely audible above the joyous medical chat and banter. Occasionally the bleep would sound much louder and faster indicating an emergency, usually a cardiac arrest. I was grabbed unceremoniously from my temporary resting place thrown over the occupants shoulders as he ran trying to adjust me. My collar was often turned in as there was not time to adjust me as the hands which would have repositioned me, clutched my pockets so their contents did not discharge in the corridor en route to our ultimate destination.
I graduated with my previous occupant to have a blue or green and white gingham collar while they had qualified as a doctor and had letters after their name, MB.BS (Batchelor of Medicine and Batchelor of Surgery). The badge on my lapel now read houseman. I represented the newly qualified doctor, whose real training was about to start as they steadily took more responsibility for their decisions.
The final stage of my development to the plain long white coat which signified my occupant was a fully registered medical practitioner with the General Medical Council (GMC). More about them later.
I am now extinct and obsolete. Why when I stood for so much? I was worn with pride. I represented professionalism and reassurance for patients but my name was unfairly tarnished and became the political scapegoat for rising infection rates. I understand that the reality was that bed occupancy was too high and cleaning inadequate. The truth was that it was not me at all.
“How was I any different to a nurse’s or physiotherapist’s uniform. Were the phlebotomist’s and ecg technicians who moved between wards not as likely to spread any infection?”
I often saw nurses coming to work dressed in their uniforms and into the hospital. My owner might even have seen them there! I am told this still happens.
“Surely they came into contact with patients and patient’s beds as often as I did?”
“I covered the sleeves that supported the cuff links and the watches, who shared in the blame for causing infection”
The government was becoming desperate to deflect the blame from any of their own interventions and the evidence was manipulated and distorted to support the cause of those in power. The Blair government dramatically reduced the numbers of hospital beds despite the increasing age of the population, so bed occupancy and utilisation increased well above 100%, when it known that that occupancy rates of 85% were optimal for reducing infection risk.
The segregation of emergency patients and elective patients became increasingly difficult. The numbers of trained nurses reduced significantly and were replaced with untrained staff. Antibiotics were injudiciously prescribed in the community and food industry. All of these were evidence based reasons to support increasing infection rates but remained relatively out of the spotlight.
So has the removal of the white coat contributed to the cause of patient safety by reducing infection rates. The evidence suggests not. If anything infection rates have continued to increase.
The ‘White Coat’ like a nurses uniform was most importantly a symbol to patients of reassurance and professionalism. A sign to them that they were being treated by trained doctors and nurses who would care for them and show compassion.
Lee Taylor, Orthopaedic Surgeon,
Chichester, West Sussex.