Should doctors give up their white coats?

Photo by NEC Corporation of America
Photo by NEC Corporation of America

When you google ‘doctor,’ virtually every image shows a person in a long-sleeved white coat. The crisp white coat with a stethoscope around the neck has long symbolized the profession. However, there is currently controversy about whether doctors should give up their classic uniform, as described in a recent story in the Boston Globe.

Britain’s National Health Service banned white coats back in 2008, requiring doctors to be bare below the elbows to avoid spreading infections. Many clinical departments in the United States have done the same. The argument goes something like this:

  • The sleeves of white coats are germ magnets.
  • Doctor’s don’t launder their white coats very often, so deadly infections can be spread from one patient to another.
  • Therefore, doctors shouldn’t wear long-sleeved white coats.

As a pediatric infectious disease specialist at Stanford, Charles Prober, MD, supports this theory:

In terms of the infectious disease risk, there is little question that one can carry bacteria or viruses on your clothing — whether it’s a white coat or the sleeve of your shirt. And one way to lessen that is to wash up to the elbows, especially when you’re going into high-risk environments like the ICU or nursery. Obviously you can only wash up to your elbows if they aren’t covered with something.

William Benitz, MD, division chief of neonatal and developmental medicine, agrees:

I find the summary reports highly credible and accept the contention that the long sleeves of white coats harbor infectious agents and carry them from patient to patient. We banned white coats in our NICU about 5 years ago, along with a mandate for baring arms to the elbow and hand cleansing upon entering any patient room. Part of the reason for the former is to reinforce and provide active visual evidence of the latter. We used to hear ‘but I won’t touch anything’ a lot, but that was often not so. Not an issue now.

However, there are some practical reasons for wearing white coats and not even Prober has given his up. He explains:

When I go to the hospital, I wear my white coat over there because it allows me to carry a bunch of stuff in my pockets. Otherwise, I’d have to carry it in my hands. But I usually take the coat off when I’m seeing patients. It’s said that some children are frightened when they see the white coat. I normally just wear a long-sleeved shirt, tie and pants so I roll my sleeves up to my elbows when I go into the nursery. I wear bow ties and argue that they are less likely to have bacteria than straight ties, plus a child can’t easily grab a bow tie and soil it.

Many doctors aren’t ready to give up there white coats though, so the debate is likely to continue. Prober estimates, “Walking up and down the hall, the number of people wearing white coats at Stanford hospital is probably about 50 percent.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

A tiny fish helps solve how genes influence longevity

Photograph of the Nothobranchiius furzeri killifish, by Ugua
Photograph of the Nothobranchiius furzeri killifish, by Ugua

A tiny, short-lived fish may help solve one of the largest mysteries: how do genes influence longevity?

The African turquoise killifish has evolved as the shortest-lived known vertebrate — driven by its survival in the hot climate of Mozambique and Zimbabwe in seasonal ponds that only exist for a few months during the wet season. This compressed life span makes the killifish an ideal organism for genetic studies on aging and longevity.

To help researchers study this intriguing animal model, Stanford geneticist Anne Brunet, PhD, and her colleagues have now fully mapped the genome of the African turquoise killifish. Their initial insights into the genetic determinants of the killifish’s life span were published today in Cell.

Brunet’s team sequenced short segments of the killifish DNA and then assembled them using specialized software to create a complete map of the turquoise killifish genome.

Brunet explains in a news release:

The range of life spans seen in nature is truly astonishing, and really we have very little insight into how this has evolved or how this works. By having the genome of this fish and comparing it to other species, we start seeing differences that could underlie life span differences both between species and also within a species.

In the article, the researchers report on their initial study of genes unique to the short-lived killifish, which were identified by comparison to longer-lived species, such as killifish that were mated with longer-lived fish. Surprisingly, they found that the genes associated with life span differences between various killifish strains are clustered on the sex chromosomes, so its short life span likely co-evolved with sex determination. They also identified some unusual aging genes in both killifish and other long-lived fish, raising the question of what role these aging genes play in the determination of life span.

To uncover all of the killifish’s traits, Brunet’s group will have help: They have created a user-friendly website, which provides other researchers with free access to the data.

Brunet explained in the news release, “They can go to our website, enter their favorite gene of interest, and then zoom in on the killifish equivalent.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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