By Isaac Ato MENSAH
Accra- 12 November, 2018.
‘Prof Paul K. Nyame, chairman of the Ghana Medical and Dental Council has advised medical students to wear their white coats while on study clerking or studying as students,’ myjoyonline.com has reported.
‘He noted that the wearing of the white coat onwards needs to be enforced by hospital authorities even when they have graduated as doctors and dental surgeons.
According to him, patients feel reassured to see a doctor who turns out in a professional look.’
The distinguished professor was speaking at the fifth White Coat Ceremony (WCC) of the School of Medicine and Dentistry held on Saturday at Korle Bu.
So let us look at the problems with what the chairman of the regulatory body for medical doctors and dentists said.
Many years ago when I asked why some health workers wore the white coats and others did not, I was told it was because they come directly in contact with patients, but I wasn’t convinced because in Ghana I have seen revenue collectors who sit inside the wards to bill clients.
This practice is pervasive in Ghana and is done with the approval of the hospital management, the head of which is usually a medical doctor.
That is why Prof Nyame’s admonition caught my attention.
It needs repeating: patients feel reassured to see a doctor who turns out in a professional look by wearing the white coat.
As usual my mentor’s mantra – “FACTS, EVIDENCE AND REASON” – which we have adopted as our method of work, came in handy.
There are several research studies published in international journals that link the white coat to the spread of infections.
The European Journal of Experimental Biology, Volume 3, in 2013, reported one such study.
‘Swabs were taken from 4 different areas of the white coat – collar, pocket, side and lapel….Although most of the white coats had been washed within the past 2 weeks, over 60% of the coats were contaminated especially the sides of the coats, the collar and pockets….Most of the germs were resistant to Penicillin, Erythromycin and Clindamycin…What was most dangerous was that these deadly hospital organisms could spread into the community if the students went home with their coats.’
The seriousness of poor infection control is revealed by the US Centers for Disease Control (CDC) which said there’re about 1.7million hospital related infections annually in America of which some 99 thousand people die each year as a result.
You can well imagine what the figures are for Ghana.
Has everyone forgotten that we have a perennial water shortage problem?
Clearly our infection control mechanisms still warrant significant improvement with respect to resources and training.
We should therefore see the white coat matter within this context.
Now for some reassurance on the matter.
In 2014, the Society for Healthcare Epidemiology of America (SHEA) published recommendations on white coats.
It partly states: ‘White coat- facilities that mandate or strongly recommend use of white coat for professional appearance should provide coat hooks that would allow removal of the white coat before contact with patients or a patient’s immediate environment’.
Now, do white coats improve the patients confidence or satisfaction in his doctor?
What is the evidence?
Do we have any studies from Ghana…..or West Africa?
If none have been done why is that so with all the tertiary institutions that we have?
A recent study at the University of Texas Branch at Galveston Obstetrics and Gynaecology Department published in the American Journal of Perinatology showed that whether or not physicians wear the white coat, it does not impact patient satisfaction.
‘Our study showed that not wearing a white coat by the physicians team didn’t impact the communication between patients and physicians nor patients’ satisfaction,’ said Dr Mauricio La Rosa, principal investigator of the study.
The website infectioncontroltoday.com which publicised the Texas research on 9 August, 2018 added: ‘The survey is the only national standardized survey used to assess patient satisfaction’.
In conclusion, it is difficult to support the distinguished professor’s reported recommendation with facts and evidence.
The reason for the recommendation especially in our national context is also not discernable.
We are of course as always open to further enlightenment on this issue since it clearly impacts on the mortality and well being of patients in Ghana and beyond.
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