What doctors wear: Do we care too much?

What doctors wear: Do we care too much?

What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of “it doesn’t really matter, as long as they are competent and do a good job.“

Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in publications studying this phenomenon – some of them hinting at the possibility that patients do care a great deal, even if they don’t consciously know it.

Let’s start off with the most commonly cited reason for getting rid of the traditional physician attire of the white coat and the neck tie: “Eww, it’s full of bugs! You’re spreading MRSA to everyone!” Based on a handful of studies that found many neckties were colonized with bacteria, there have been a tremendous push to shun these traditionally professional accessories (and by extension the white coat as well) from everyday practice. Many will recall how the U.K. banned neckties altogether in their hospitals, and centers around the world are contemplating similar action against white coats, long-sleeved shirts, and other items of clothing.

But hold on a minute. Is this truly evidence for neckties and white coats being inherently evil? Take a step back, and one might realize that the problem is not wearing neckties or white coats…or wearing any other traditional doctor’s attire, for that matter – the problem is that healthcare professionals have been lazy when it came to personal hygiene habits.

You are supposed to clean those neckties and white coats with the same regularity as you do your shirts and pants. I would argue that a physician who washes his necktie and white coat as often as another doctor does her scrubs, is as equally safe from an infectious diseases point of view. Wearing a scrub top and sneakers instead of a necktie and white coat does not magically make one less of a vector for transmissible diseases; I have seen many a doctor wearing the same personalized scrub top, with the same pair of pants and the same pair of shoes to work day after day – swab their attire and you’ll likely discover the workings of a Petri dish.

Banning sleeves is just as ridiculous. Will physicians magically improve their hand-to-elbow washing habits when wearing short-sleeved shirts? Evidence suggests otherwise: physicians are still among the worst offenders when it comes to hand hygiene, and bare skinned forearms are just as good a vector as a clean shirt sleeve. I doubt rolling up their sleeves will result in any significant improvement in preventing MRSA spread.

The focus, from an infectious diseases point of view, should have been on improving personal cleanliness and hand washing, and not so much on what a physician wears to work.

Regardless, the train as left the station and many have hopped onto the bandwagon of ditching the traditional doctor’s attire for something much more casual, and at times, I wonder if the pendulum has swung a little too far. Medical students wearing jeans (or what they would later defend as “fancy” jeans) to a clinical shift; residents showing up for work in what looks more like yoga outfits and pajamas; and staff losing the necktie and white coat for v-neck t-shirts.

What is happening to the professionalism of the profession of being a doctor? Even when not explicit, there is an unspoken standard when it comes to attire for every single other profession, be it a lawyer or a bank teller. Making the effort to dress professionally denotes respect for those you serve, and respect is of utmost importance in a doctor-patient relationship. This recent BMJ letter offers a refreshing take on the whole subject, concluding with a plea for physicians to don their ties once more.

And it matters more than you might think. Rehman et al enrolled over 400 individuals in their study, looking at the effect of physician attire on trust and confidence of patients. Their conclusion?

“Respondents overwhelmingly favor physicians in professional attire with a white coat. Wearing professional dress (ie. a white coat with more formal attire) while providing patient care by physicians may favorably influence trust and confidence-building in the medical encounter.”

This recent study by Au and Stelfox analyzed how patients and their family perceived ICU physicians wearing different types of attire. One of the most interesting things the authors found was that even though people would consciously claim that what the doctor was wearing didn’t matter – their ultimate responses showed “traditional attire was associated with perceptions of knowledge, honesty, and providing the best care” … even beating out those wearing scrubs. Such first impressions may be especially important in brief interactions such as those in the ER.

So where should we go from here? When it comes to life and death, what one wears probably has minimal effect in the grand scheme of things. Still, the focus need to shift away from individual clothing items, and more on personal hygiene habits overall. More studies need to be done to explore the effect of professional attire on perceptions, quality of communication and trust building between doctors and patients.

Until then, I think as a patient I would still appreciate a doctor who dresses professionally. Assuming that outfit’s fresh and clean, of course.

Edmund Kwok is an emergency physician in Canada who blogs at the Front Door to Healthcare.

Image credit: Shutterstock.com

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  • http://barefootmeds.wordpress.com/ Barefootmeds

    You have a strong argument, and this may be very selfish of me, but when I’m on 24 hour call (or, god forbid, 48 hours vascular call) the last thing I want to be wearing is a stiff dress suit. Those calls are exhausting enough.

    At my school, professional attire is encouraged but we are allowed to wear fancy jeans and modest shirts, because our course and living costs are already so expensive. I’ve done my past three years of clinical rotation in jeans, and now that I’m starting the big final 18 months, I am having some comfortable clothes tailored – for which I had to save for months.

    I’m not sure if I share the same perception about doctor’s attire, but then again I don’t usually think the same way as the majority. I guess I don’t want a scruffy looking doctor, but I’ve seen some very profession smart-casual wear.

    • penguin50

      I would never expect a doctor to wear a formal suit in order to look professional. Suits actually strike me as counterproductive for a doctor’s professional needs, and it’s not selfish at all for you to reject them. I think they are way too physically restrictive for the sort of movement a doctor potentially needs to be free to do. And aren’t they awful hot to wear as you hustle from patient to patient? Plus the dry cleaning bills would be outrageous!

      I do have one doctor who exclusively wears matched suit jackets and pants topped by the traditional white coat. He dresses this way even for weekend rounds at the hospital; I think it simply reflects his own exceedingly formal personality and sense of propriety. But I would be perfectly content with a doctor who wore a white coat over clean jeans, khakis, a dress that allowed free movement, or whatever other clean form of dress suited each doctor’s needs and style.

  • southerndoc1

    “a physician who washes his necktie” . . .
    Not recommended.

    • Suzi Q 38

      Physicians should buy their neckties at the discount stores.
      Just throw them away when they get really dirty.
      Professionally dry cleaning them is just too expensive.

  • Kristy Sokoloski

    It doesn’t matter to me whether the doctor is in a white coat and tie, scrubs, or business casual as long as they look professional. It’s their skill and knowledge at diagnosing and treating my medical problems that is going to help me feel better than what they wear. I think that patients and their families are expecting way too much without fully realizing what goes on in a doctor’s work day.

  • Suzi Q 38

    I don’t prefer a doctor that wears a tie and an expensive, monogramed shirt. It “screams” “Nordstrom.”
    If I get sick and throw up on you or urinate on you shoes accidentally, I am going to have to offer to replace whatever.

    I am that kind of person. Well, my husband is that kind of person.
    I would ask him to replace it with a gift card to a decent clothing store.

    Just wear something that looks professional.

    Jeans? Not sure. O.K., I guess under a white coat.
    I never understood why you have white coats. The stains endured on them throughout the day would be gross. Maybe red, brown, or black would be better.

    A tie? Optional. I wouldn’t notice under your coat.
    The pants? Dockers or other dark colored pants.

  • penguin50

    As a patient, my preference is for all healthcare professionals in a hospital setting to wear clothing that is both very clean and clearly denotes their particular, distinctive role within the institution. Those are the two aspects that strike me as most important. I myself like doctors to wear a white coat with an embroidered name followed by “MD” (cleaned every day by a hospital laundry service—is this practical?) on top of any reasonably professional clean garb. Ties seem very difficult to clean on a daily basis, so I can’t recommend them (plus they are associated with only the male gender). Many of my doctors wear immaculate coats at least sometimes; one wore a grubby, limp, yellowed one the very first time I met him, and it did not inspire confidence (although he turned out to be excellent).

    I have spent weeks in the hospital, and I found it stressful to rarely be able to identify the endless stream of people trooping into my room. (I had many doctors, plus, because I have a rare disease, it was not unusual for other doctors to want to speak with me out of an admirable dedication to enhancing their own education.) Probably the staff member who most “looked like” a doctor was the gentleman from the kitchen who regularly stopped by to review my menu choices.

    It distressed me to see the cuffs of overly long pant legs of scrubs often look grubby and to discover that many staff were commuting on crowded buses in work clothes that were supposed to be kept clean (in my city, tuberculosis has been found to circulate primarily on public transportation). Years ago, my mother was a hospital nurse when it was standard practice to change into her uniform only after arriving at the hospital in order to minimize dirt on it. Is it possible to revive that practice?

    I’m not asking for nurses to return to starched white outfits and caps, but surely there is some way to let patients know who is who at a glance. So very often I searched in vain for nametags with a professional designation, only to find them twisted backwards or covered by long hair or held within a smeary plastic case or covered with stickers or pins that obscured the essential information.

    At first I mistakenly thought that scrubs were worn only by surgical staff in the OR (I must not watch enough medical TV shows to keep up with these sartorial trends!), but I soon learned that almost everyone in a hospital except for administrators likes to wear them at least occasionally. (Heck, they come in such fun prints and colors that I considered buying some myself to wear at home.) There were days when nurses on a certain ward all wore camouflage-print scrubs on the same day, just for fun. I found the military reference in a civilian hospital a bit odd. Is there some way to accommodate staff desire to dress with flair and individuality without constantly confusing patients? I suppose staff would hate it, but it is so much easier on patients if, say, all housekeeping staff wore blue outfits, all phlebotomists wore green ones, etc.

  • Guest.

    As long as they do their job RIGHT, I couldn’t care if they were wearing pajamas to work!

  • EmilyAnon

    I like the white coat because it’s a visual reminder that I’m dealing with a doctor. To me it unconsciously commands respect. If a doctor came into the exam room just in street clothes, I would feel it’s an invitation to call them by their first name, and even drop the Dr. title.

  • sparklingsoul

    My ENT wears scrubs, and it makes me feel more like we are equal, not one person higher ranking than the other. I vote for white coats with business casual, or scrubs.

  • Guest

    “Banning sleeves is just as ridiculous. Will physicians magically improve their hand-to-elbow washing habits when wearing short-sleeved shirts?”

    Made me LOL. Would love to walk in to see my physician wearing a wife-beater. “JCAHO said this was the optimal attire to wear to prevent spread of infection.”

    It’s just a matter of time people!

  • Guest

    I didn’t give 2 sh*ts what the plastic surgeon wore to my consultation appointment. All I knew is he came highly recommended from other physicians and my daughter’s future was in his hands. He could have come in dressed like Harry Potter for all I cared.

    I’ve never noticed what a practitioner was wearing honestly.

  • Kaya5255

    May I remind people of several old adages? “You have 30 seconds to make a good first impression”, and “in healthcare, people judge the care given by the appearance of the caregiver”. If you look like an unmade bed, people will determine the level of the care you give is substandard.

    Health professionals should dress appropriately.
    But it isn’t the attire as much as it is good infection control methods. I hate going to the grocery store and seeing people pawing over stuff in scrubs! I know where those have been!!
    Do me a favor, go home and change and then do your shopping!!

  • Carolina Dias

    I just find it ridiculous when I see health care professionals wearing lab coats on the streets… they were supposed to be worn inside medical care facilities, not on the streets!!!

  • Name

    There are diff. kinds of drs. n so the need is for diff. attires. Drs. in consulting room can wear the business attire, but I don’t see how residents n ERs can work well in that attire on the wards.
    I suggest color coded scrubs for each day, so that it is washed everyday.
    I don’t know about US, but in my developing country, drs./surgeons change their scrubs before heading out, and the laundry basket is rt. there in the changing rooms. So the hospital takes care of that. This way no one is wearing the same scrb/white coat everyday!!

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