The hospital white coat may be consigned to history after doctors backed a move to update their uniform to combat the threat from superbugs.
Operating theatre scrubs, familiar to patients from television dramas such as ER, which can be laundered daily by hospitals, should become standard issue for all medical staff, the British Medical Association's annual conference said.
White coats are already disappearing after becoming victims of the fashion for informal dress. A survey last year found that only one in eight doctors said they still wore one.
Patients, however - especially those aged over 70 - preferred them to be worn, according to the survey conducted at the Royal Free Hospital in north London. It made doctors easier to spot, they said.
Yesterday, representatives at the BMA conference said white coats were now part of the problem of escalating hospital infections and should be dispensed with. Andrew Butterworth, a junior doctor from Salford, said: "We should take responsibility ourselves. Watches, rings, ties and white coats all harbour bacteria that can cause infections. My teaching hospital banned white coats. They used to be laundered by the hospital but that no longer happens. I believe we should lead the way by wearing scrubs that would be laundered by the hospital."
White coats have traditionally been worn as a uniform inside and outside the hospital and keeping them clean has been left to the doctor. Scrubs are worn only in clinical areas and are the property and responsibility of the hospital.
But Andrew Davies, from Cardiff, told the meeting that patients would not appreciate doctors abandoning white coats. "Scrubs look less professional. Patients would rather see us in shirts and ties than walking round in ill-fitting pyjamas." Surgeons and gynaecologists have always been more attached to their white coats than paediatricians and psychiatrists, who are more anxious to put patients at their ease. The Royal Free survey found big differences in attitude to white coats among the specialties. The conference passed a motion condemning high bed occupancy rates and the contracting out of cleaning services to private companies for contributing to the lack of cleanliness in hospitals and the high rates of infections.
Doctors also voted for scrubs to be provided by hospitals as "the only clothing they are permitted to wear in clinical environments, other than garments necessary for religious observance." But after warnings from senior officials that the proposal could be impractical, the conference referred the decision back to the BMA council.
James Johnson, chairman of the BMA and a vascular surgeon at Halton hospital in Merseyside, said: "The white coat in many places has disappeared. But this proposal would be difficult to implement. You would have to treat a hospital like an airport with a landside and an airside. Staff would have to change every time they crossed over into a clinical area and then you would have to do the same for visitors."
Some hospitals have already banned white coats. East Kent NHS Trust has warned doctors that anybody caught wearing one would be disciplined, according to the Health Service Journal.
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