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• The state of affairs in United Kingdom
  Hussain Sarwar
  Published on: 24 January 2019
• Advice that has stood the Test of Time
  Benjamin S Vipler
  Published on: 6 July 2018
• President & Medical Director - Golden State MD Health & Wellness A Professional Corporation
  Ahimsa P Sumchai MD
  Published on: 15 June 2018

• Published on: 24 January 2019

  The state of affairs in United Kingdom

  • Hussain Sarwar, Emergency Medicine Physican Ipswich Hospital

  After reading the study thoroughly it comes as a surprise that patients would be actually assessing about there treating physicians and surgeon's knowledge and competence also on basis of there attire rather than handling of affairs, discussions and discourse. The high percentage of preference for White Coats was also indeed refreshing to see in US. Even though in United Kingdom, NHS has embraced the concept of bare elbow for many years now and almost completely let go of the white coat culture, which once used to be a sense of identification and source of pride for doctors everywhere. I believe if such a study is carried out across trusts in United Kingdom the results would be convincingly different. Especially because use of Caucasian models would result in significant bias for the study since NHS is multicultural and not just consisting of Caucasian doctors.. It would be interesting if the same study model is repeated with doctors representing the BAME(Black Asian Minority Ethnicity) as patients preferences regarding there attire would be a stark difference from Caucasian fellow doctors. Also effect of attire would have much greater influence on patients perceiving there doctor as being knowledgeable or not.

  Conflict of Interest:
  None declared.

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• Published on: 6 July 2018

  Advice that has stood the Test of Time

  • Benjamin S Vipler, Internist Naval Medical Center Portsmouth

  In their manuscript, Petrilli et al. reference an abundance of literature showing that bacteria and other pathogens can be isolated from physician attire, including items that are typically not laundered after a single use, such as white coats and neckties. Despite this, they claim an absence of literature linking said contamination to source or transmission of disease. I caution the authors not to dismiss lower levels of evidence for clinical studies, such as case series. In his essay, which was later published in The New England Quarterly Journal of Medicine and Surgery, Oliver Wendell Holmes Sr. describes what can be interpreted as a clinical demonstration of early germ theory related to the contagiousness of postpartum infections and subsequent maternal death.(1) Holmes references multiple cases where physicians performing obstetrical duties in clothes worn in the care of (or performance of autopsy on) patients who succumbed to puerperal fever, would have similar outcomes on future patients with whom they came in contact. He references a similar case report published by Brodie in the Lancet where a provider, after destroying his entire wardrobe, had no recurrent cases of puerperal peritonitis.(2) He finishes with a list of recommendations, which instructs physicians to change “every article of dress” after post-mortem contact with patients who died of puerperal fever. In the absence of convincing evidence refuting the now common sense nature of Holmes’ recommendat...

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  In their manuscript, Petrilli et al. reference an abundance of literature showing that bacteria and other pathogens can be isolated from physician attire, including items that are typically not laundered after a single use, such as white coats and neckties. Despite this, they claim an absence of literature linking said contamination to source or transmission of disease. I caution the authors not to dismiss lower levels of evidence for clinical studies, such as case series. In his essay, which was later published in The New England Quarterly Journal of Medicine and Surgery, Oliver Wendell Holmes Sr. describes what can be interpreted as a clinical demonstration of early germ theory related to the contagiousness of postpartum infections and subsequent maternal death.(1) Holmes references multiple cases where physicians performing obstetrical duties in clothes worn in the care of (or performance of autopsy on) patients who succumbed to puerperal fever, would have similar outcomes on future patients with whom they came in contact. He references a similar case report published by Brodie in the Lancet where a provider, after destroying his entire wardrobe, had no recurrent cases of puerperal peritonitis.(2) He finishes with a list of recommendations, which instructs physicians to change “every article of dress” after post-mortem contact with patients who died of puerperal fever. In the absence of convincing evidence refuting the now common sense nature of Holmes’ recommendation over a 175 year period, it is imperative that we heed his remarks. Present-day providers must minimize the amount of unlaundered attire worn, particularly in settings where the spread of infectious diseases is conceivable, even at the expense of patient satisfaction.

  1. Holmes, O. W. The contagiousness of puerperal fever. New England Quarterly Journal of Medical Surgery. 1843. 503 – 530.
  2. Brodie, B. C. Royal Medical and Chirurgical Society. The Lancet. April 14, 1840. Volume 2. 193 – 194.

  Disclaimer: The views expressed in this letter are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.
  The author is a military service member. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that “copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a US government work as a work prepared by a military service member or employee of the United States Government as part of those person's official duties.

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  Conflict of Interest:
  None declared.

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• Published on: 15 June 2018

  President & Medical Director - Golden State MD Health & Wellness A Professional Corporation

  • Ahimsa P Sumchai MD, Sports Medicine/Emergency Medicine/Fitness & Nutrition Golden State MD Health & Wellness

  As an African American female physician and practice owner with a 37 year professional history I fully concur with the findings of this article. I have commented on other writings on Doximity around the issues of professional attire and efforts to restrict wearing white coats. As a practice owner with locations in San Francisco and Sacramento I travel weekly by Amtrak and this experiences reinforces my opinion that professional attire for a physician can improve patient and public interactions. In the course of my career I have experienced numerous incidents in which I was demeaned, harassed or disrespected as a physician because of my race and gender in areas dominated traditionally by white males. I have authored numerous writings about my experience as the first African American female to train in neurological surgery in the University of California system and my experiences as a flight physician and post doctoral fellow for Stanford Life Flight. I have been mistaken for a custodian, a "girl" and on a good day a pediatrician in my years of training. My white coat and my professional attire make all the difference in the world in how patients relate to me. When I appear without it I am called Miss or Ms. When I have it on I am called Doctor.I will never give up wearing my white coat!

  Conflict of Interest:
  None declared.

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