What Shall I wear?
I was invited to present at a surgical workshop that was held on a Saturday. The faculty arrived a little early for a brief and I was surprised how the dress code differed among equally qualified surgeons. The esteemed president of the society wore torn jeans, t-shirt and a pair of sneakers, which triggered mixed responses among other members of the faculty. Would patients respond in a similar way?
Would it make a difference for you if I were to wear a suit, scrubs or cotton trousers? Would it influence how patients view me? Would it be OK, if I just wear jeans and a t-shirt like our president above?
In your opinion – What should I wear when I see patients?
Asking myself all these questions, I searched the scientific literature on this important topic. There is an international review of the outcomes of 30 studies published only last year (1). The authors found that the doctor’s attire did influence patients’ perceptions in 21 of the 30 studies. Together the studies examined included the views of 11,533 adult patients in 14 countries. In brief, professional attire was much preferred in the majority of studies.
In former days it was often custom for doctors to wear white trousers, white buttoned shirt and a white coat. That was when I trained in one of the largest European hospitals, and this is still the case for large parts of Europe.
When I moved to Australian in 1999, one of my medical students was sent home from clinic because he failed to wear a tie at work.
Current research suggests that doctors, both male and female, in a professional outfit during a consultation are more likely to instill trust and confidence. However, in an emergency or surgical situation clothes do not matter as much and patients may prefer to see doctors in scrubs.
In the above review the perception was also influenced by the patients’ age and culture. Preference for formal attire and white coats was more prevalent among older patients and in studies conducted in Europe and Asia. Americans in Generation X and Y tended to accept casually dressed doctors much more willingly.
The only Australian study that enrolled inpatient Medical and Surgical patients in two teaching hospitals in Sydney found that patients preferred white coats. In this study older patients (53 or older) preferred white coats more than younger patients.
A more recent US study published last month found professional attire is again the predominantly preferred option (2). Before patients (mean age 56 years, 49% male) saw their dermatologist they were asked to view pictures of four physicians dressed in four ways a) wearing a suit (including a tie for men), b) white coat, c) scrubs or d) casual attire.
Of the 255 respondents, 73% of patients preferred the white coat, followed by 19% for scrubs, 6% for a suit and 2% for casual attire. In an emergency situation, 49% of patients responded they would prefer the doctor in scrubs and 47% picked the doctor dressed in a white coat.
Why are researchers studying doctors’ attire?
Patients’ first impression may be instrumental to form an opinion about their doctor during their initial encounter very quickly. Patients may feel more comfortable when they perceive their doctor as being competent, supportive and trustworthy. Hence, they are more likely to discuss important information and studies have demonstrated that such patient-doctor relationships positively impact patient outcomes, such as reductions in disease symptoms, fewer side effects of treatment or better quality of life.
A doctor’s attire should mainly be functional with scrubs that are changed at least once a day preventing patients from acquiring infections. It is well known that ties (that are worn with suits) are carriers of germs and many colleagues and hospitals warn against wearing ties.
Are white coats necessary?
On the other hand, it is also about creating a professional first impression. As a surgeon, I am concerned that the white coat can distance a doctor from his patient. Some patients can be nervous, and white coats can symbolise authority or power which only reinforces the difference between doctor and patient. I prefer professional attire rather than the white coat because I want my patients to feel like equal partners in our conversations.
Scrubs worn in doctors’ offices, outpatient clinics and in public places may also trigger viewed responses and some may relate to the fact that we re-enter the operating theater again with those scrubs, thus potentially introducing germs from the outside into a clean environment (3).
In my experience the main concern with scrubs is that they cause fright in some patients who associate surgical scrubs with “cutting” and “blood” especially if they are stained (e.g., with soap). As part of surgical training courses we offered role plays where some participants play doctors and others patients. Since then I have made a conscious effort to change into civil clothes before I see my patients after an operating day. In civil clothes, my patients are more likely to comprehend when I tell them about their surgery.
I would be very interested in your opinion on what you prefer me to wear
Dr Colin Holloway 