What residents and medical students should wear in the hospital

At a recent meeting I attended, a vigorous discussion broke out about what medical students, residents and attendings should wear, and more importantly what they should not wear.

Interestingly, patients have been asked to weigh in on this discussion. What to wear is also on the mind of many current second year medical students who may find themselves trying to take study breaks from USMLE 1 to go buy clothes for the wards. I also remember doing this as a rising third year student and wondering what to get.

1. Don’t break the bank. Stores like Target, Marshalls, Sears or JCPenney are all fine places to get clothes for the hospital. You’ll be wearing your white coat over your clothes. Save your money for your fourth year interview suit.

2. The hospital is a messy place. Buy clothes which you wouldn’t mind throwing out if you were drenched in body fluids. (Not likely to happen but would be devastating if you’re wearing Prada or Valentino).

3. Buy comfortable shoes. You’ll be on your feet most of the day. There are actually studies that demonstrate that residents (who you’ll be following around) may walk up to 6 miles when on call! It’s hard to answer “pimp” questions if you’re developing bunions and wondering when the heck you can take off those shoes. You’re feet will thank you.

4. Get a waterproof, inexpensive watch. You’re going to be washing your hands a lot. Being late to rounds is never good, but you may also lose your watch after you take it off to scrub in. A watch with an alarm can be very handy when you have to get up at 4 in the morning to pre-round for surgery.

5. Scrubs are for the hospital not for home. As a New York Times article pointed out, no one wants to sit next to someone on the subway wearing scrubs, particularly those with uncharacterizable stains on them. Scrubs are there, in part, to keep you from taking hospital germs into the community. It’s also hospital policy. Unless a resident or student is staying overnight or involved with procedures, scrubs are a ‘dressed down’ look. So plan to change from scrubs to regular clothes before you wander around outside the hospital.

6. Stock up on detergent, soap and deodorant. You’re going to be getting up close with your patients and if your clothes (or you) smell, they will feel even sicker than they already do.

7. Buy a bleach pen. This is very helpful for spot cleaning blood stains until you can get your coat back to your house for laundering. Peroxide works too.

8. White coats (and ties for men) are still part of the uniform. Yes, there are studies showing white coats and ties spreading infection. In the UK, they are already banning white coats. However, for now in the US, they are considered part of the standard attire for physicians and medical trainees and what patients have come to expect. In addition to washing your coat often, washing your hands is the #1 thing you can do to prevent infection.

9. Wash that white coat. Those aforementioned uncharacterizable stains are really gross on white coats. Not a great way to instill confidence in your abilities with patients or attendings.

10. No perfume or cologne. Remember the triggers for asthma? Perfume is one of them. Stick to “eau de soap and water.” Beware the overly scented deodorant too. Unscented soaps are typically the best for combating malodors while avoiding elicitation of bronchospasm.

And some more tips especially for women

1. Save the ‘Hospital Honey’ look for Halloween. Buy clothes for the hospital, not for going out: cover your cleavage, make sure your skirts reach at least mid-knee when you sit; shirts and pants/skirts should cover your midriff even when you raise your arms above your head. Remember, you are not dressed to kill, but dressed to heal. A patient actually called one of our attendings out for wearing loud, high heeled boots. An embarrassing reminder that we’re dressing for our patients not for each other.

2. Minimize jewelry. Make sure you don’t wear anything too expensive to work especially if you know you’ll have to take it off (e.g. engagement ring gets taken off whenever you put on gloves). Get a safety deposit box if you’re worried about leaving your jewelry at home. Stay away from hoop or dangling earrings. Your stethoscope will pull off the hoops and kids will pull off the danglers. Besides, you’ll get germs on anything that’s not attached closely to your body (e.g. stud earrings).

3. Wear OSHA compliant shoes (no open toe). We know this is especially hard in the summer, when all the high fashion sandals and pedicured feet aching to show themselves. Do everyone a favor and keep your toes covered and save your fashion forward footwear for an evening out with friends.

One of us actually took care of a female healthcare worker who had an IV pole run over their foot and contracted a MRSA foot infection – not fun! As a result, every summer, we are on the hunt for comfortable but good looking pair of “OSHA shoes”- it’s harder to find that it looks! DSW shoe warehouse is a good bet and won’t break the bank. Dansko clogs are also a safe bet and Crocs are now making comfy shoes without holes. Stay away from Crocs with holes which just provide pores for body fluids and needles to get to your feet.

4. Hold off on the fancy manicures. Your nails have to be short and you’ll be washing your hands often. Nail polish does not stand up well to frequent hand washing/Purell.

Vineet Arora is an internal medicine physician who blogs at FutureDocs, and Shalini Reddy is an internal medicine physician.

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  • anonymous

    I have been annoyed by the open-toe ban ever since an attending criticized my tasteful low-heeled sandals while she was wearing huraches (sure, her toes were covered but fluids and needles could have slipped into the spaces between the leather weave). We work so hard trying to follow the letter of this rule that we forget its spirit. Heck, if we are serious about protecting feet against needles, we should ban pumps and loafers too; the thin material will not stop a falling needle, and some pumps cover only the small portion where the toes are while leaving a large area of the foot uncovered. Maybe we should all wear steel-toed or steel-footed boots!

  • Karin

    As a medical student in Sweden I must admit that I am pretty chocked at the clothes that physicians in the US wear in the hospital. Sweden has long ago banned all personal clothes in the hospital (everybody wears scrubs), white coats when doing anything involving patient-contact, as well as any ornaments that goes on your wrist/hands such as watches, rings, bracelets and nail-polish; all in an effort to cut down on infections. You are also definitely not allowed to take anything home from the hospital – everything is washed on site. I understand that the white coat is strongly tied to physician-identity, but it seems to me that patient safety should be more important, and these are such simple steps towards curbing infectious disease. When I hear horror stories about the rates of MRSA etc. in the US I cannot help but wonder to what extent the dress code contributes…

  • Maddie

    I haven’t worn a watch since I was 9 and I hope I don’t need to start. So far my iPhone has satisfied all my time needs. And it doesn’t tear through the wrists if gloves.

    • Anon EM doc

      Cool. Do you use something to clean off all the iGerms, or do you spread them to friends and family?

  • stargirl65

    I believe all hospital employees that have patient contact should wear scrubs. These should be put on when you arrive at the hospital and they should be removed before leaving the hospital. The hospital should launder all the scrubs to make sure they are adequately clean. Shoes should be a clog or loafer or similar and not anything fluids can easily pass through or a needle easily puncture. Ties won’t be an issue in scrubs. If you are concerned about identity then assign certain colors to different staff members in the hospital. The USA is so backwards on so many things.

    • Anon EM doc

      Agree highly. Color-coded scrubs should absolutely be the standard for numerous reasons.

  • Dan

    Ditto Maddie. Who wears watches? Unless you’re a scuba diver, watches are jewelry, mere adornment, and nothing more.

    • Anon EM doc

      I use mine to check pulses when a clock with a second hand isn’t close by. Radical idea, huh?

    • William Ott

      You obviously are not a pilot. Pilots operating large aircraft or most any type of jet depend on watches, typically the Breitling or Rolex watches with sweep second hands, stop watch function, rotating slide rule for fuel burn ratios and display of two or more time zones. Anon EM doc is right, what a concept, checking pulses, calculating drip rates, etc.. where a clock isn’t available, radical indeed..Jewelry, right, get a clue

  • ninguem

    The best is one of those Ben Casey shirts that button down the side. That way if something vile is splattered on your shirt you don’t have to drag it over your head like a pull-on scrub shirt:

    http://www.mirandauniforms.com.au/images/Ben%20Casey.jpg

  • Dr. J

    I’m with the person from Sweden. Who wears street clothes in the hospital? YUCK!? Lots of the stuff that gets on it (like C. diff) can’t even be properly removed by a home washing machine. Wear hospital scrubs when you are in the hospital it’s the only way to go.

  • Xerxes1729

    Something doesn’t add up. I can only wear scrubs when I’m in the hospital. I have to change into them there and out of them before going home. Then why is it okay for me to wear my shirt and tie from home, to the hospital, and back home?

  • just a patient

    One nit-pick with this… Bleach sets in all iron-based stains, which includes blood. A bleach pen will only make the stain permanent, and if you don’t rinse it out the bleach may eat a hole in the fabric you’ve used it on. Better are the stain-wipes that several of the laundry product manufacturers produce, as they are non-chlorine bleach, so they don’t set the iron into the fabric and shouldn’t damage the fabric.

  • DKV

    Watch, yes.
    Comfortable shoes, yes.
    Cleavage, no.
    Agreed.

    But we (Americans) have to ditch the ties and white coats, symbols at best and vectors of disease at worst.

  • Fernando Moreno

    Ties are a vestige of a class system who’s days should long be past us (not to mention breeding grounds for all sorts of harmful pathogens). I work in a very diverse community hospital where most patients hover at or below the poverty line, and a tie to me represents some archaic notion that somehow, perhaps, I am better than them. This is not who I want to be and clearly not the impression I ever want to portray.

    If you want to know what a doctor looks like, look at me. I’m a doctor, and therefore, this is what a doctor looks like. I can assure you, it doesn’t include a tie.

  • tamoroso

    I’m with the folks who think we should ditch the tie. I wear Hawaii shirts at work (I’m an ER doc), and I have since I worked in Hawaii (where Hawaii shirts are business wear for all except stockbrokers serving clients from the mainland).

    We need to step away from the idea that a doctor should dress a certain way, and like Karin, step towards the idea that clothing is first to protect the worker, and second to protect the patient. Fashion, respectability, all the reasons we wear ties, jewelry, and all the other whatnot of modern society, do not finish.

  • Cospo

    Forty years ago when I was in nursing school and then when I graduated and worked in hospital there were very clear rules one had to follow re: what could be worn in/out of hospital. Women’s hair was to be up off their collars at all times. No garish makeup, no hoops/dangle earrings (studs only), no nail color, no jewellry on hands, a water resistant watch only with sweep second hand. No perfumes of any sort were allowed. Fingernails were short, smooth, clean; your dress hem was below the knee and your cap was immaculately starched, your pinafore and Clinic shoes were sparkling white – even down to the laces(!). Each morning we gathered in the “Fishbowl” for muster where the instructors examined your person and clothes head to toe. If everything wasn’t perfect and in place you were not permitted to go to the wards until it was – even to the point of returning home until you could meet the standards of proper dress. Oh, and your time out was naturally docked from your clinic time which you had to make up on Saturdays. No one wore scrubs in those days other than surgical, nursery, or isolation ward nurses and doctors – and those were owned and laundered by the hospital. When you worked those areas you had an assigned locker within the unit itself, changed your clothing, put on scrubs, cap and shoe covers. If you left that space you removed cap and covers and put on a CLEAN white lab coat and stayed gone only the shortest amount of time. Your space to wander was strictly limited and you had to return post haste to your assigned area when your business was concluded. At the end of your shift, you took off all the outer wear that you’d worn, deposited it in a laundry bag, took a shower right there in the locker rooms and redressed in your street clothes and went home. One NEVER saw scrubs in public or even nurses’ uniforms in public as the scrubs were hospital property and nursing uniforms were considered inappropriate in public as it only brought thoughts of Typhoid Mary in those days – TB was still a widespread public health concern in those days when one might not even spit on the sidewalk! And one thing you rarely heard of then were nosocomial infections that were out of hand. Not only health care individuals but the public at large were more careful about possible vectors then. What a difference these days!! Perhaps if we went back to some of those education and infection control practices there would be less MRSA, C. Diff. etc. around now. Of course, I’ve pretty much dated myself here, but I wonder when did we get so careless about things such as this? Perhaps the false security of all those new antibiotics made us think that precautions weren’t so necessary anymore??