'Undignified' 100-year-old hospital gown design in desperate need of redesign, doctor says
Current design allows staff to perform their duty of care, surgeon retorts
Originally published on March 6, 2020.
Likening the 100-year-old hospital gown to a prisoner's orange jumpsuit, a prominent British doctor says the "alien, open-at-the-back garment" is in desperate need of a redesign.
Dr. David Oliver, a consultant in geriatrics and acute general medicine at the Royal Berkshire Hospital in England, says the gown's terrible design, which opens in the back, is at the heart of the issue.
"It's very hard to do up — even for able-bodied people — and the back and the bottom are left exposed, which makes people feel very vulnerable. And if you're already frightened and sick in a strange environment, it's not dignified," Oliver told White Coat, Black Art's Dr. Brian Goldman.
Oliver, the former vice-president of the Royal College of Physicians, wrote an opinion piece about the gown's inadequacies last month after spending some time in a hospital following a minor surgery.
The hospital gown as it is known today is roughly a century old and arrived along with modern surgery and anesthesia, according to the U.K.'s largest health-care textile supplier InterWeave Healthcare. Back then, patients were so sedated prior to being wheeled to the operating room that they couldn't undress themselves. The idea was to cover patients with something easy enough to remove without the patient's help.
Celebrities including Jimmy Fallon and Ellen DeGeneres have made the gown's style the butt of jokes, describing it as "booty curtains," and commenting on a proposed redesign by Henry Ford Hospital, as "leave it to Ford to cover the junk in your trunk."
'You could have a better design'
But the traditional hospital gown is no joking matter for patients who are required to remove their day clothes, underwear and walk down breezy and cold hospital corridors, making it hard to "keep your dignity and keep covered up," Oliver said.
"We've got into a habit of putting people in gowns for the sake of it… And I think there's something about taking away people's personhood and their comfort."
Medical publication The Lancet published a survey in 2019 detailing the impact wearing gowns had on 928 adult patients in the U.K.. Fifty-eight per cent of the respondents reported wearing the gown despite feeling uncertain that it was necessary. Over 60 per cent considered its design inadequate and difficult to put on, while 72 per cent said they felt exposed while wearing it.
Patients are also often kept in the gowns "far beyond the period where they're really needed," Oliver added.
"Even though I'm a doctor and I know the health system, it certainly makes you realize, even for a day, how vulnerable those gowns can make patients feel."
"But even then, you could have a better design. And more to the point, when you're finished doing surgery, why are [patients] still in the gowns a week, two weeks later, when they could be in the day clothes, or pyjamas or something that makes them feel more dignified."
Customizable gowns
Over the years, there have been multiple attempts to redesign the hospital gown by big names like Diane von Furstenberg in the U.S. and Ben de Lisi in the U.K., but none have managed to replace the gown so far.
In Toronto, Jackie Moss is among the latest to attempt a redesign. After suffering a cardiac arrest five years ago at 49, she spent a long time recuperating wearing a traditional hospital gown.
The typical gown is either too small or too large, the fabric is "almost see-through" after the many washes it has to endure, and it shows "every single private part," she said.
That motivated Moss to start Giftgowns, which makes custom hospital gowns using a comfortable cotton fabric and metal snaps to close the opening in the back and the shoulders. The company mostly sells to individuals, but has previously done custom bulk orders for Sick Kids and Mt. Sinai hospitals in Toronto.
The gowns also come in multiple colours that can be customized with any image.
"It gives you your own personality back," she said.
Moss says the metal snaps address the need for privacy while allowing the patient to be hooked up to vital sign monitors.
However, Dr. Lesley Barron, a surgeon at Georgetown Hospital, west of Toronto, says gown redesigns, which included metal buttons, implemented in the past at her hospital caused significant issues.
While the snaps make IV access and taking blood pressure "much easier," they are unusable in the operating room because anaesthetized patients could potentially develop pressure sores from laying on them, she noted.
But Moss says she is not attempting to replace the gown worn in the emergency or operating room. Instead, people can wear her gown in a hospital bed or at home in order to make recovery easier.
"One of our taglines is, 'We've got you covered,' because it allows you your dignity when you're in the hospital."
Redesign at 'bottom of a very long priority list'
While Barron "absolutely believes" patients' dignity needs to be protected, the current design allows staff to perform their duty of care.
"Not only my job as a surgeon, but nursing staff need to be able to change patients, keep them clean, do their vitals, maintain their IVs, catheters, drains. And all of that is done best with the traditional hospital gown that opens at the back."
Dr. Barron contends that people in hospitals are generally "too sick to care" what they are wearing, adding that she hasn't had a "single patient complain about the gown" in the 12 years she has worked at Georgetown Hospital.
In her own experience, she says gowns are preferable to other attire because it' "tells people I'm the patient" and signals that treatment "is moving along and getting done."
"We have to make sure patients are safe first. And honestly, our health-care system is so starved for cash right now that [redesigning] hospital gowns are at the bottom of a very long priority list."
Does the open-back hospital gown need a revamp? Share your experiences in the comments section below.
Written by Adam Jacobson. Produced by Sujata Berry.
Clarifications
- The photo caption for Dr. Lesley Barron has been updated to reflect her full title.Mar 09, 2020 10:07 AM ET