I’ve just spent one day at Leicester General Hospital. I worked there in 1980, my first SHO job in general surgery. 105 appendicectomies performed by myself in six months. Those were the days! I did not recognise the hospital at all. So much building and development. My father was having some scans so I went to the postgraduate medical centre and spent some time in the library and then had a very pleasant lunch in the canteen, a very upmarket affair, “Margaret’s restaurant.” But true enough I did not see a single white coat in the hospital. People were rushing to and fro with scrubs and stethoscopes and pens, but I did not have a clue whether they were doctors or nurses or students or what. Yes, white coats in the NHS are an issue.
Last weekend I went to a fascinating advanced wound technology meeting in Seoul, Korea. The meeting was held in the Asan Medical Centre. This is an incredible place, and the website is well worth a visit.
The meeting was being held in a research building, and for lunch we were given vouchers to take meals in the basement of the main hospital. I did not have overly high expectations as I walked across the campus and entered the main hospital building, but then I took the escalator to the basement. Wow! What an amazing place. Just like a very upmarket shopping mall. A plentiful selection of restaurants, a bakery, travel goods shop, a professional massage parlor, a financial shop, book shops, mini-markets, flower shops. And among these retail outlets were Japanese water features and plenty of chairs for relaxing. The entire facility was obviously the result of some very smart business thinking which you would expect from a hospital founded by the owner of Hyundai.
But what struck me in this true international centre of medical excellence is that the patients all walked around in very smart designer pajamas and the doctors all went around wearing green scrubs and white coats.
I just could not resist the opportunity so I approached one young lady (pictured) drinking her coffee at one of the coffee shops: “Do you speak English?” What an opening gambit, but what followed was a fascinating experience in cross cultural communication. I explained to her that I would like to take her photograph and tried to explain why. Well that is paraphrasing the communication but I ended up writing the URL for the BMJ blogs and gave her my professional card, and she insisted that I take her photograph, but I forgot to ask her name.
What I did find out was that she was a pharmacist who worked in a clean room, hence the scrubs, but when she moved around the hospital , for example to buy a coffee for lunch she would wear a white coat. So I asked her why? She explained that pharmacists wear white coats in high street pharmacy shops. It is a sign of status, of professionalism, and so she wears a white coat in the hospital.
Walking back to the meeting I followed a few small groups of medical staff. They all wore green scrubs and white coats. At the close of the meeting I asked our local host if I could take a picture of him with two of his resident medical staff. They all gave a witnessed verbal agreement that I could take their picture and put them in the BMJ blogsite. Again such was my excitement at taking the picture that I did not get the names of the two residents but the boss, standing in the middle is Joon Pio Hong, an absolutely superb supra-microsurgeon.
So I have to ask myself; why do they ban white coats in the NHS hospitals and yet, insist on them in what must be one of the most advanced private medical complexes in the world? What does evidence based medicine and management have to say about that?!
Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.