Doctors: It’s ok to shed the white coat and tie

Those of you who have followed our blog for the past few years probably know that one of my favorite topics in infection prevention is the role of clothing in transmission of pathogens. But I’m also fascinated by the sociologic aspects of clothing in medicine, which is usually framed around questions of professionalism (for example, is a doctor in a white coat more “professional” than a doctor wearing scrubs?).

So I was interested to see another paper on this topic in JAMA Internal Medicine. The study was a survey of family members of ICU patients in three Canadian ICUs. Over three hundred persons viewed photographs of physicians dressed in scrubs, business suits, white coats with neckties, or blue jeans. The study subjects were then asked to match the variously dressed doctors with certain attributes. In a nutshell, they found that families deemed the doctors in white coats to be most knowledgeable, most honest, and best overall. Doctors in scrubs and white coats were deemed equally most competent and most caring.

I’m always amused by these studies because I’ve never met a patient who chose their doctor on a sartorial basis. It would be like buying a red car because you love that color even though you know nothing else about the car and never took it for a test drive. These types of studies, in my opinion, sell patients short. Yes, all of us form rapid first opinions about those we encounter, but almost all of us are sophisticated enough to quickly move past superficial qualities to assess a person’s honesty, ability to communicate, and for physicians, his/her ability to demonstrate empathy. Lastly, the entire premise of the study seems strange–while you might choose your primary care doctor, it’s extremely unlikely that you will choose your intensivist. The accompanying editorial is congruent with my line of thinking and concludes that professional behavior is far more important to patients and families than professional appearance.

I stopped wearing a white coat a decade ago, but many physicians still cling to it. Some wear them for storage, which my wife (also a doctor) tells me is more important for women since their clothing has fewer pockets. Some wear white coats as a form of identification, which may have held true when doctors were the only people in the hospital wearing them. Some wear them for warmth. And some just need the ego boost.

I was an early adopter of bare below the elbows and have only worn scrubs when seeing inpatients for the last five years. Smart phones and cargo scrub pants have taken care of my storage needs. But the one downside of scrubs is feeling cold in the winter. My partners and I recently solved that problem. We found vests that are lined but are constructed of nylon on the exterior surface, which allows them to be easily wiped down. They fit snugly so they don’t drape onto the patient when performing an exam. And yes, they are warm! I’d like to take credit for the idea, but actually we copied our intensivists, most of whom are also bare below the elbows.

On April 1, we embark on a new policy at my hospital that no longer requires contact precautions for patients with MRSA and VRE. As we educate our staff on the change, we’re reminding them that it’s ok to shed the white coat and tie. If we’re not going to wrap ourselves in plastic, bare below the elbows seems even more important.

Michael Edmond is Professor of Internal Medicine and Chair, Division of Infectious Diseases, VCU Medical Center.  He blogs at Controversies in Hospital Infection Prevention.

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  • Suzi Q 38

    I don’t know, my MS neurology fellow does not wear a uniform, just professional pants, business shirt, and a tie. His teacher, the famous MS specialist, wears the official lab coat with his name inscribed.
    I think that they both look like very credible professionals.
    Of course, the fellow with the fancy clothes may not like it when a patient throws up or bleeds on his nice clothes.

  • Scott A. Bowser, OD

    You are so wrong about Doctors in a primary care environment. I switched to scrubs two years ago for comfort,
    and every other patients for six month, told me how much better and professional I looked with my shirt and tie and clinic jacket, and wished I would switch back. I wore this uniform for 35 years and served me well in my world. You have fun in your world, but don’t dictate to me in mine. Blessings and prayers, Scott A. Bowser, OD

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Dr. Scott,
      I am sorry that you think that the author was trying to dictate to you as to how you should dress for work everyday. He wasn’t trying to do that at all. He’s just saying that for those that would rather not wear the white coat and tie that it’s ok to do that, and there are still other ways to dress that make them look professional. I have some doctors that prefer to use the white coat and tie, I have another that wears scrubs most of the time, and I have yet another that dresses in a business casual style. To me it does not matter how my doctors dress when it comes to what they choose to wear that signifies being a professional because I am there to get help for the problems that won’t go away on their own. I know that it matters to some patients and even among some doctors themselves about the kind of dress style. That’s fine.

  • EmilyAnon

    I guess I’m old fashioned. I like the professional look of the doctor’s white lab coat. If they wore casual street clothes I might start calling them by their first name and dropping the Dr. title.

  • FemaleMD

    This argument while logical from an ID perspective misses the role the white coat plays for those of us who do not fit the patients’ mental stereotype of a doctor. Even with the coat I have been mistaken for an RN or PT. As have African-American friends of mine who have been mistaken for food service or hospital support staff. For us, the coat is an important symbol of our role. That should not be overlooked in this dialogue.

    • http://www.facebook.com/michael.edmond.9 Michael Edmond

      I am commonly mistaken for a nurse or respiratory therapist in my scrubs, but what’s so bad about that? I don’t find that demeaning.

      • FemaleMD

        I don’t find it demeaning – I usually thank the patients for seeing my youth, not my job. However, when counseling them – dealing with end of life decisions, discussing surgical complications, or offering consultation it is often easier if everyone in the room is aware of my role. I find it detracts from our conversation if they are apologizing for mistaking me for another type of provider and interferes with the discussion we should be having. Thus, I wear my white coat to redirect the conversation away from misperceptions of my role and to focus on the real topic – the patient.

      • buzzkillersmith

        I saw an image of a guy in scrubs from the UK NHS. Over the right chest it said “Doctor.” I think even the English could figure it out.

  • buzzkillersmith

    Dr. E has it right. Just say no to fomites.

  • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

    I haven’t worn a white coat or tie in 8 years (of course 6 of those were in the Army), but still. No need. I do occasionally throw on the white coat if the office is cold in the winter, but more often than not I am in a sweater and feel no need to.

    I do feel though that doctors in scrubbs in a clinical setting is unprofessional. If you are doing surgery or procedures its one thing but if not you have no business being in your pajamas.

  • CRT1981

    Speaking as someone who almost died from an hospital-acquired infection, I want all medical personnel in a hospital setting to wear whatever makes it easiest for them to keep from carrying germs around.

    I don’t automatically confer respect on people based on their dress anyway. And as for confusion over who’s whom, how hard is it for medical workers to introduce themselves? “Hi, I’m Mike Jones, I’m an NP and I’m here to [bla bla bla]” ….. “Hi, I’m Tim Smith, I’m the ENT doctor who’s going to have a look at your [bla bla bla]” … “Hi, I’m Jane Doe and I’m a Respiratory Therapist and today I’m going to help you with [bla bla bla]“.

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