More patients could wear regular clothing in hospital: study

By Kathryn Doyle NEW YORK (Reuters Health) - Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don’t, according to a small Canadian study. That could have an important effect on patient dignity, the authors suggest. Dr. Todd C. Lee, who participated in the research, said he was struck by how bizarre it was to see one of his patients leave the ward briefly to attend to business wearing a suit, and then return and don an undignified open-backed hospital gown again. “Clearly he was capable of wearing normal clothes - it was our system and its expectations (and perhaps his preconceived notion of them) that led to him awkwardly strutting down the hall in that fashion,” Lee told Reuters Health in an email. “Since then, I have always believed that patients should be encouraged to wear their own clothing if it is appropriate,” he said. “It is interesting in that most times I have ever suggested it to my patients, they usually take to the idea quite quickly.” Lee is a doctor in the division of general internal medicine at McGill University Health Center in Montreal, Quebec. For the study, he and his colleagues noted whether or not patients entering six clinical teaching units at five hospitals in Canada on the same day were wearing any garments below the waist, other than underwear or a diaper. They also asked the attending doctors if each patient would be allowed to wear garments like pants if they wanted to. Of the 127 patients entering the units that day, doctors said that 57 would be eligible to wear pants, but only 14 of those were doing so, Lee and his team reported in a research letter in JAMA Internal Medicine. Some patients weren’t eligible to wear regular clothes below the waist because they had wounds or catheters. In other cases, patients were too immobile, too incontinent, too confused, or too ill to wear such attire, given the available nursing resources. At one center, researchers also asked 17 patients who were eligible to wear pants but were not doing so if they would like to, and 13 said yes. “Our study, which was small, suggested that probably more than one in two patients could have been wearing their own clothing, but were not,” Lee said. “On some units that proportion will be higher, on others lower.” In certain circumstances, gowns do have practical advantages, making physical examinations easier for doctors, and making laundering and disinfecting easier for those caring for patients with frequent urinary or fecal incontinence, he said. But as others have suggested, taking away a patient’s clothes and forcing them to adopt the familiar hospital gown may cause additional emotional trauma to some patients, he said. “I think all patients should therefore have the option to wear their own clothing if it is clinically reasonable to do so,” Lee said. “Clothing worn needs to be hygienic, able to be laundered, and shouldn't preclude the examination of patients or the performing of medically necessary acts.” Patients should be prepared to change into the hospital gown for procedures or examinations, which require them, he said. One way to address the problem would be for a Canadian or American company to design updated ‘functional fashions’ for the hospital that are easy to put on, easy to take off, easy to launder, and that facilitated examinations and tests, but preserve more dignity for the patient, he said. Until then, the base option may be for patients to ask for their own clothes and see if it would be an option. “Much as I think patients should politely ask all health care practitioners who see them in the hospital to wash their hands, I think they should also ask, if they are interested in doing so, if they can wear their own clothing,” Lee said. “To my mind, there is no harm in asking politely.” SOURCE: JAMA Internal Medicine, September 22, 2014.