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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 6; 335(7622): 684.
PMCID: PMC2001089
“Bare below the elbows”

A cheap soundbite

Adam Magos, consultant gynaecologist, Allan Maclean, professor of obstetrics and gynaecology, Daryll Baker, consultant vascular surgeon, Nicholas Goddard, consultant orthopaedic surgeon, and Olagunju Ogunbiyi, consultant colorectal surgeon

We were astounded to read that the Department of Health plans to ban doctors from wearing white coats because of the risk of cross infection.1 2 The package describes a “bare below the elbows” dress code (short sleeves, no wrist watch, no jewellery, no ties when carrying out clinical activity).

What is the evidence for this? It is impossible to say because this policy is based on two as yet unpublished reviews. Surely, they should have been made available first for discussion. We doubt that evidence is convincing as the working group's first conclusion is that there is no conclusive evidence that work clothes are a significant risk in terms of spreading infection, and the policy document ends with, “it seems unlikely that uniforms are a significant source of cross-infection.”

The document considers it good practice for medical staff to wear short sleeved garments and not white coats because “cuffs become heavily contaminated and are more likely to come into contact with patients.” Presumably this conclusion is based on bacteria such as Staphylococcus aureus being found on a quarter of white coats.3 But these coats were worn for up to eight weeks and not changed daily. Why? Because hospitals no longer provide clean white coats.

But maybe we should not be astounded. Dirty hospitals are expensive to sort out, whereas “bare below the elbows” is a cheap sound bite that saves money. But the policy ignores the advantages of white coats and name badges—ease of identification and cleaning, protection, and usefulness for carrying things. Most patients in the UK prefer doctors to wear white coats,4 and doctors wear white coats in most countries.5

White coats should not be banned. Yes, use plastic aprons when examining patients, but insist that you are provided with a clean white coat every day.


Competing interests: None declared.


1. White coats to go in cleanliness bid. BMJ 2007;335:582 (22 September.) Doi: 10.1136/bmj.39342.596979.AB [PMC free article] [PubMed]
2. Department of Health. An evidence base for developing local policy London: DOH, 2007
3. Wong D, Nue K, Hollis P. Microbial flora on doctors' white coats. BMJ 1991;303:1602-4. [PMC free article] [PubMed]
4. Tiwari A, Abesinghe N, Hall A, Perera P, Ackroyd JS. Should doctors wear white coats? The patient's perspective. J Eval Clin Pract 2001;7:343-5 [PubMed]
5. Major K, Hayase Y, Balderrama D, Lefor AT. Attitudes regarding surgeons' attire. Am J Surg 2005;190:103-9. [PubMed]

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