Interesting discussion..
Where I did my undergraduate medical training ( several moons ago, the
size of the sleeve and the length of the white coat indicated the level
of your training and whether you were a student, resident or consultant.
The pockets of the white coats were used to stuff all kinds of papers,
notes and Washington manual ( and many other things) . The color of the
coat was no longer white after a while and the coat was usually
crumpled, and sometimes ( usually of the medical students) had serious
evidence of wear and tear. A starched coat was more in line with one's
sense for style and a sign of good allowance from their parents rather
than a measure of genuine concern for patients.
The white coat was however conferred a sense of power , though in
different degrees based on the length of the sleeve ( half, versus full)
and length of the coat ( upto the waist or below to the knee). The
evidence have been limited but I must admit there is always a hush of
silence when you patient's a person with a white coat and stethoscope
enter the room. This is especially true when the poor patient is waiting
with 50 others crowded for a hour to see their doctor. For the initial
visit patients still want their doctors to look like doctors. Does a
white coat make someone look more professorial? Of course, this honor
and privilege that is abused by some.
Evidence or not we love tradition ( graduation caps , etc.). And like
many things that persists in spite of evidence, the white coat will
probably hang on for a while before it becomes a things of the
past(like the nurses caps and gowns).Many things still exist because of
tradition and inability to act despite evidence due to inertia.
In the case of Pranab's Professor this might be considered a challenge
of core of medicine and authority and I agree may not fly well.
We need to learn how in the days of ancient master healing was done
without the paraphernalia of recent times.
Cheers,
Amit
Amit K. Ghosh, MD, FACP, FASN
Associate Professor of Medicine
Division of General Internal Medicine
Mayo Clinic
200 First Street SW
Rochester, MN 55905
Phone : 507-538-1128
Fax: 507-284-4959
www.mayoclinic.org
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of James Osborne
Sent: Tuesday, April 21, 2009 10:47 AM
To: [log in to unmask]
Subject: Re: Evidence on White Coat
Hi,
I'm afraid I don't have any real evidence to disable Pranab's Professor,
but I
think the following paper might make be of interest ;-)
Nair BR, Attia JR, Mears SR, Hitchcock KI. Evidence-based physicians'
dressing: a crossover trial. Med J Aust 2002; 177(11-12):681-682.
http://www.mja.com.au/public/issues/177_11_021202/nai10445_fm.html
I particularly love the way the authors developed the concept of NND.
This study was picked up by the media, such as the BBC
http://news.bbc.co.uk/1/hi/health/2667851.stm
Because the original article was continually being quoted and referred
to, the
authors felt the need to update
http://www.pubmedcentral.nih.gov/articlerender.fcgi?
tool=pubmed&pubmedid=12907509
Overall a lovely commentary on the perils of something...just don't know
quite
what!
Locally of course the entire NHS is bare from the elbow....so no more
white
coats.
James Osborne
Clinical Effectiveness Coordinator
Trust Headquarters
University Hospitals Bristol NHS Foundation Trust
Bristol UK
Tel 0117 342 3753
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