The white coat of the ophthalmologist: what is the patient's opinion?

Abstract

The white coat is commonly used by physicians all around the world, and it is unmistakably associated with the medical profession. Nevertheless, it seems that the white coat is losing popularity. To evaluate what patients think of the white coat worn by ophthalmologists, last year a study was conducted at the two sites of the Diakonessenhuis, one of which is based in Utrecht and the other in Zeist (both in the Netherlands). Patients and their companions visiting the outpatient ophthalmology clinic anonymously filled out a questionnaire on the white coat of the ophthalmologist. An answer was sought for the following questions: does the patient prefer their ophthalmologist to wear a white coat or not and what are the advantages and disadvantages of a white coat according to patients? Four hundred and seventy-three of the returned 482 forms were suitable for analysis. Two hundred and ten participants were males and 255 females (eight participants did not answer this question) and they all had an average age of 64.1 years (range 16–92 years). Two hundred and ninety-nine (63%) did not care whether the ophthalmologist wears a white coat or not; 126 (27%) preferred their ophthalmologist in a white coat; and 48 (10%) liked to see the ophthalmologist without a white coat. The advantages and disadvantages of the white coat are presented in Table 1. The major limitation of the present study is the fact that it is not known how many questionnaires were actually handed out; only those returned were counted. The preference of 27% seems significantly lower than the patient's preference for white coats in other studies – mostly involving internists (Gallagher et al. 2008; Kazory 2008; Gherardi et al. 2009; Sotgiu et al. 2012). The single most important reason contributing to this difference is the study object: the ophthalmologist versus the internist. This implies that the preferences of patients for a white coat cannot be extrapolated to other medical specialists. Nevertheless, in the present study the white coat of the ophthalmologist does not seem to be a ‘must’ for the majority of patients in the Netherlands. The advantages and disadvantages might be extrapolated to other medical specialists. For 41% of the participants, the major advantage of the white coat was that it leaves no doubt over identification of the physician. Naturally, the white coat should then not be worn by anyone other than physicians. Of the participants, 12% presumed that a white coat was protective against infections: this is not a reflection of reality as studies suggest that white coats can act as vehicles for different kinds of potentially lethal microbes (Wong et al. 1991; Kazory 2008). Although bacterial contamination of the white coat does not equal an increased risk of infection, the implication could be that two percent of the participants were correct in their assumption that a white coat has a negative influence on protection against infection. In conclusion, a majority of the Dutch patients seem not to care whether their ophthalmologist wears a white coat or not. The most frequently reported advantages of the white coat were recognizability and professionalism, but also, erroneously, a reduced infection risk. The most frequently reported disadvantages of the white coat were that it was outdated and created too much distance.