If you want to be rebellious, to mark yourself as someone really important, to show that you give not a hoot to whatever management may say in our hospital then there is no finer way to do all these things than by wearing a white coat. Preferably a vintage white coat which bears your name, a long lost relic from the good old days. Since 2008 the white coat has been outlawed and we now have a uniform policy of “smart attire” and the faintly smutty sounding “bare below the elbows”. We are also not allowed to have our hair down or wear rings other than a plain wedding band and other dull rules and regulations relating to closed toe footwear and not having ones tits or tatts out. Clearly there is some wisdom in this, no rings at all would be better, no watches makes sense, sleeves rolled up ready for work and rigorous hand washing all seems clear enough to me.
Two of my great leaders frequently flaunt the laws of the NHS that dictate thou must not wear a white coat. A number of not so great leaders also try this tactic in a bid to make themselves seem more senior but they always look nervous about it, this other pair can do what they like whilst the rest of us admire their audacity. I must admit that I have on occasion worn one at night, when the infection control police are in bed and it’s freezing and I am under cover of darkness but it’s just like a cardigan really, I wash it after every wear. I have been around long enough not to be accosted about this and not to care if I am.
David Cameron was recently in trouble whilst visiting a hospital, he was tieless, had his sleeves up and was adhering to policy for the public yet his cameraman was not. A wonderfully brave surgeon stormed into his ward and interrupted the interview, he booted out the team flaunting the rules. A video of it here shows Dave flapping and faffing and realising his faux pas.
A white coat was a joyous and wondrous piece of clothing, it carried all your shit, it made you look thinner, it hid sweaty armpit marks post cardiac arrest, it made you look like a doctor, it made you feel like a doctor, it was warm over scrubs and it even played a part in on call room sexual antics. Not many people dry clean their clothes or even wash their clothes after every wear, especially not surgeons who spend most of the working day in scrubs and so I wonder if we are really less infectious in our own clothes.
NHS management have many stupid ideas, they frequently don’t get what is really going on and are whipped by their political masters who are even more removed from patient care. I was rather impressed with Gary Walker, ex NHS chief executive of a trust in England who was interviewed on the Today program on BBC Radio 4 on Thursday, he seemed to have more of a clue than most and was commenting that we must be able to speak out publicly about patient safety. The Francis report into the Mid Staffs scandal is according to the BMA “essential reading for all doctors” but with 290 recommendations who can really find the time. Handily they can be distilled into 18 key points and can be summed up by saying that patient care should come first and that we must be accountable and transparent. The full report is two volumes long and makes grim reading, account after account of poor care, poor communication and poor hospitals. It is terrible, but sadly not unimaginable to those of us who are in this system, the huge volume is dispiriting.
This is just one of the witness statements:
“After a five-hour wait and pressure from his son, who worked as a doctor
in another hospital, the patient who had been admitted to Stafford
Hospital with pneumonia was assessed. He was treated on a general
ward where his family found mouldy sandwiches in the bedside cabinet
and needles and syringes being kept in an open box on the windowsill.
On one occasion, the patient found the lavatory covered in blood, which
he cleaned himself. When the patient was transferred staff asked his wife,
who suffered with back problems, to push her husband’s bedside cabinet
to the new ward. When the patient was discharged he was made to wait
in the ambulance area wearing only pyjamas until his wife arrived to
collect him. Some months later at an outpatient appointment it was found he had been suffering from Legionnaires’ disease and not pneumonia.”
As yet we haven’t been subjected to a uniform, but no doubt we will be at some point. As you can see they have already designed some lovely ones for the professions allied to medicine. In the light of the Francis report though, one has to wonder if we haven’t got our priorities a little mixed up.