Rites of Passage: A University Hospital White Coat Ceremony - A Century Old Garment, A Decades Old Tradition, A Lifetime Profession

2018 ◽  
Vol 2 (1) ◽  
pp. 237-241
Author(s):  
Marcellus Francis L Ramirez
2011 ◽  
pp. 60-64
Author(s):  
Van Tam Le ◽  
Van Minh Huynh

Objectives: To determine the prevalence of dipper and non-dipper blood pressure by using 24 hour ambulatory blood pressure monitoring (ABPM) and to assess the correlation between target organ damage with white coat hypertension and real hypertension. Patients and method: Data from 60 hypertensives including 38 males and 22 females, ages from 25 to 75 yrs were analysed. The 24h ABPM made by German Tonoport’s were used for the measurement of blood pressure with the program 30 minutes per time and ECG and Echocardiography were used to assess the changes in left ventricular structure. Results: - White coat hypertensive group: The prevalence of dipper blood pressure was 43,75% and non-dipper was 56,25%.- real hypertensive group: The prevalence of dipper was 38,64% and non-dipper was 61,36%. There hadn’t the left ventricular hypertropy and lession of ocular fundus in patients who had white coat hypertension. Conclusions: By using the 24 hour ambulatory blood pressure monitoring (ABPM) we can detect the dipper and non-dipper phenomenon of blood pressure


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tine Lass Klitgaard ◽  
Diana Stentoft ◽  
Mads Skipper ◽  
Mette Grønkjær ◽  
Susanne Backman Nøhr

Abstract Background Despite increased focus on improving the transition from being a medical student to working as a junior doctor, many newly graduated doctors (NGD) report the process of fitting the white coat as stressful, and burnout levels indicate that they might face bigger challenges than they can handle. During this period, the NGDs are in a process of learning how to be doctors, and this takes place in an organisation where the workflow and different priorities set the scene. However, little is known about how the hospital organisation influences this process. Thus, we aimed to explore how the NGDs experience their first months of work in order to understand 1) which struggles they are facing, and 2) which contextual factors within the hospital organisation that might be essential in this transition. Methods An ethnographic study was conducted at a university hospital in Denmark including 135 h of participant observations of the NGDs (n = 11). Six semi-structured interviews (four group interviews and two individual interviews) were conducted (n = 21). The analysis was divided into two steps: Firstly, we carried out a “close-to-data” analysis with focus on the struggles faced by the NGDs. Secondly, we reviewed the struggles by using the theoretical lens of Cultural Historical Activity Theory (CHAT) to help us explore, which contextual factors within the hospital organisation that seem to have an impact on the NGDs’ experiences. Results The NGDs’ struggles fall into four themes: Responsibility, local knowhow, time management and collaborators. By using the CHAT lens, we were able to identify significant contextual factors, including a physically remote placement, a missing overlap between new and experienced NGDs, a time limited introduction period, and the affiliation to several departments. These struggles and factors were highly intertwined and influenced by one another. Conclusion Contextual factors within the hospital organisation may aggravate the struggles experienced by the NGDs, and this study points to possible elements that could be addressed to make the transition less challenging and overwhelming.


2021 ◽  
Vol 2 (6) ◽  
pp. 1515-1529
Author(s):  
Silvia Helena Oliveira Da Cunha ◽  
Eliane Ramos Pereira ◽  
Rose Mary Costa Rosa Andrade Silva ◽  
Daniela Chaves Costa ◽  
Vivian Moreira Mencari

O momento na hospitalização da criança gera uma mudança brusca na vida de uma família, pois envolvem circunstâncias, como a interrupção do cotidiano, onde ela se vê longe de seus irmãos, do pai e amigos; de seu lar e de seus hábitos. É um evento social que mobiliza todos, tem seu caráter segregante, pois afasta  a criança e sua família da vida em sociedade, mas por outro lado, tem-se o desafio de conhecer novos ambientes, outras pessoas e por que não dizer, a possibilidade de fazer amizades e de retornar ao lar com a saúde restaurada. A criança hospitalizada passa por todo este processo e precisa do suporte familiar e educativo, a fim de que entenda aos poucos o processo no qual está inserida. Objetivos: descrever o fenômeno de extremo medo apresentado pela criança quando está na presença do jaleco branco. Visa também, apontar contribuições na minimização de manifestações de medo extremo e da síndrome do jaleco branco em crianças. Método: Estudo descritivo, com abordagem qualitativa e adotando conceitos da visão fenomenológica desenvolvido no setor de emergência pediátrica de um hospital universitário. Utilizou-se a técnica da entrevista semiestruturada, evocações livres e observação participante com treze familiares, a fim de produzir dados acerca da cultura do medo reproduzida pela família nas crianças hospitalizadas. Resultados: Os dados foram submetidos à análise de Bardin, onde se estabeleceram cinco categorias: Profissionais de saúde; objetos estranhos; evento indesejável; infecções e bactérias hospitalares e medo da morte da criança. Detectou-se o fenômeno de intenso medo pela criança comparado à “síndrome do jaleco branco em adultos” no qual foi interpretado sob o ponto de vista fenomenológico. Conclusão: Concluiu-se que a articulação de estratégias terapêuticas, é ferramenta indispensável tanto na prevenção da síndrome do jaleco branco em crianças, quanto no fortalecimento do estado de resiliência e no enfrentamento do medo pela criança e família.   The moment a child is hospitalized generates an abrupt change in the life of a family, because it involves circumstances, such as the interruption of daily life, where the child is far from his/her siblings, father and friends; from his/her home and habits. It is a social event that mobilizes everyone; it has its segregating character, as it distances the child and his family from life in society, but on the other hand, there is the challenge of getting to know new environments, other people, and why not say, the possibility of making friends and returning home with his health restored. The hospitalized child goes through this whole process and needs family and educational support, so that he/she can gradually understand the process in which he/she is inserted. Objectives: to describe the phenomenon of extreme fear presented by the child when in the presence of the white coat. It also aims to point out contributions to minimize manifestations of extreme fear and the white coat syndrome in children. Method: A descriptive study, with a qualitative approach and adopting concepts from the phenomenological view, developed in the pediatric emergency department of a university hospital. We used the technique of semi-structured interview, free evocations and participant observation with thirteen family members, in order to produce data about the culture of fear reproduced by the family in hospitalized children. Results: The data were submitted to Bardin analysis, where five categories were established: health professionals; foreign objects; undesirable event; hospital infections and bacteria and fear of the child's death. The phenomenon of intense fear for the child was detected, compared to the "white coat syndrome in adults", which was interpreted from a phenomenological point of view. Conclusion: It was concluded that the articulation of therapeutic strategies is an indispensable tool both in the prevention of white coat syndrome in children and in the strengthening of the state of resilience and coping with fear by the child and the family.  


BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026009 ◽  
Author(s):  
Marc Zollinger ◽  
Nathan Houchens ◽  
Vineet Chopra ◽  
Lauren Clack ◽  
Peter Werner Schreiber ◽  
...  

ObjectivesWe explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician–patient relationship.SettingThe 900-bed University Hospital Zurich, Switzerland.ParticipantsA convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey.Primary and secondary outcome measuresThe survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents’ ratings of how the physician’s attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided.ResultsOf 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively).ConclusionsOutpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takaharu Matsuhisa ◽  
Noriyuki Takahashi ◽  
Kunihiko Takahashi ◽  
Yuki Yoshikawa ◽  
Muneyoshi Aomatsu ◽  
...  

Abstract Background There is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy. Methods This was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy. Results A total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000). Conclusions This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully. Trial registration Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.


Author(s):  
Atsushi Shimizu ◽  
Mitsue Takeuchi ◽  
Fumio Kurosaki ◽  
Kaichiro Tamba ◽  
Naohiro Sata ◽  
...  

Background: Physician attire influences perceptions of care. This study was conducted to evaluate the impact of physician attire on perceptions of care by patients and families in a Japanese palliative care unit. Methods: From November 2018 to February 2020, patients and family members admitted to the Palliative Care Unit at Jichi Medical University Hospital were recruited and completed a survey consisting of 4 demographic questions and 15 questions regarding perceptions of care. A 7-point Likert scale (1 = strongly agree, 4 = neutral, 7 = strongly disagree) was used to judge attire (name tag, long sleeve white coat, short sleeve white coat, scrubs, scrub color, jeans, sneakers) addressing patient and overall impact on perception of care. Results: Of 203 patients admitted, 79 were enrolled. Surveys were received from 23 patients and 52 family members. Patients and families want physicians to wear name tags (median, interquartile range) (2, 1-2) and white coats (3, 2-4). Patients want to be addressed by surnames (2, 1.5-4). Patients and family members have neutral opinions about short sleeve white coats (4, 4-4) and scrubs (4, 4-4). Jeans were not liked (4, 4-6) while sneakers are acceptable (3, 2-4). The impact of attire on perceptions of care is significantly (p = .04) greater for patients (3, 2-4) than family members (4, 3-4). Conclusion: Patients and family members prefer their physicians to wear name tags and white coats and address patients by surnames. Physician attire has a significantly greater impact on perceptions of care for patients than family members in a palliative care unit.


Author(s):  
Takanori Sohda ◽  
Hiroshi Saito ◽  
Goro Asano ◽  
Katsunari Fukushi ◽  
Katsuya Suzuki ◽  
...  

Recently, the functional aspect as well as morphological aspect of the reserve cells in the cervix uteri drew much attention in view of the carcinogenesis in squamocolumunar junction. In this communication, the authors elucidate the ultrastructural features of the reserve cells in patients of various age groups visiting our university hospital and affiliated hospital.From conventional light microscopic point of view, the reserve cells tend to be pronounced in various pathological conditions, such as the persisting inflammation, proliferative disorders and irritation of hormones. The morphological patterns of the reserve cells from various stage and degree of irritation were observed.


Sign in / Sign up

Export Citation Format

Share Document