Do you care if your doctor wears a white coat? The Society for Healthcare Epidemiology of America (SHEA) wants doctors to ditch white coats, and while they are at it, their stethoscopes too. Why? SHEA's research has shown that these items may actually spread infections.

SHEA has reviewed 26 studies looking at patient's perceptions of health care workers and what they wear. The findings revealed that patients believe their doctor's appearance is important to their care. Most prefer medical professionals to wear a white coat or scrubs as it instills greater confidence in the care deliverer.

The tradition of doctors wearing white coats only goes back about 150 years. Prior to the 19th century, doctors wore black attire. A famous depiction of a surgeon wearing black (The Gross Clinic) hangs in the Philadelphia Museum of Art. The white coat became important in the 1870's when Dr. Lister suggested that doctors wash their hand and instruments before operating, and ushered in the era of sterility and good medical practice. In those days, it helped legitimize and define how physicians were different from the many practitioners of quackery.

Nurse's caps experienced a similar exit from hospital runways. In the 1800's, Florence Nightingale proudly wore her nurse's cap but today it has disappeared from sight. One of the reasons that caps originally became unpopular was the possible risk of infection.   The final straw leading to the caps extinction, though, was the fact that they got in the way of high tech medical equipment in the 1980's.

Now, it is time for the white coat to go the way of the nurse's cap. There are a number of reasons to abandon the white coat. It has been called an example of medical paternalism, further adding to the barrier between patient and physician. It may cause a heightened sense of anxiety — known as "white coat hypertension" — in some who fear medical offices, doctors, and procedures. It can also lead to misunderstandings. As the types of health care professionals expand, more health care workers are donning the white coat. This can be confusing to the patient, making it is hard to know if they are seeing a doctor, nurse, lab technician, dietitian, or medical student.

Above all, maintaining patient confidence is not worth increasing the risk of hospital acquired infections transmitted by a doctor going from room to room with a dirty coat.

The white coat is a tradition that has become outdated and no longer has the meaning that it did 100 years ago. Interestingly, younger doctors often do not like to wear a white coat, and younger patients seem to care less what their doctor wears.

Physicians, nurses, and other health care personnel will need to earn confidence and respect without this crisp white uniform. Professionalism, politeness, empathy and clinical competency will need to be presented without the iconic white coat. As for the stethoscope, we'll have to continue to auscultate carefully for ways to reduce its role as a reservoir of bacteria.

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Dr. David Becker is a board certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. and has been in practice for 25 years. In 1993, after extensive research, Dr. Becker launched Healthy Change of Heart™, an innovative 10-week program designed to reverse heart disease and improve quality of life through diet, exercise, and stress management. Since then, thousands of patients have participated in the program, achieving significant results in improving cardiac wellness.