Last year, an article in JAMA about public perceptions of physician attire and professionalism in the U.S. received a considerable amount of attention on the Doximity network. The study aimed to understand if the public perceived casual attire and white coats differently. Are those who wear the latter deemed more professional? Furthermore, are there differences across physician gender?
Participants rated physicians wearing white coats as more experienced and professional than those wearing fleece or softshell jackets — ratings that reflect results found in a 2018 BMJ Open study, in which 53% of U.S. patients indicated that physician attire was important to them during care, with the white coat being most highly rated.
As for the gender component, after the JAMA study participants viewed photographs of models of women and men, they rated women as less professional regardless of attire, and were more likely to mistake the models as medical technicians, PAs, or nurses.
To understand how patient perceptions compare with physician perceptions, Doximity reviewed the comments on the JAMA article and spoke with several physicians about their thoughts on physician attire and what clothing means for professionalism. Responses varied, but a few consistent themes emerged.
Many clinicians commented on the potential downsides/challenges of wearing white coats and ties. Orthopaedic surgeon, Eli Ziv, MD, shared that he’s always worn business attire consisting of wool slacks, a button down shirt, and a tie. He doesn’t wear a white coat because he finds that “the white coat sometimes hinders the orthopaedic physical exam.” He also expressed concerns about fomites. Dr. Ziv does not think the white coat is mandatory, but does believe that business attire “instills an atmosphere of professionalism and produces respect.” His work isn’t always surgical in nature, and he expressed that he’s had patients who’ve shared that “a surgeon wearing scrubs in the office seemed more eager to recommend surgery.”
Others shared that attire can enhance patient biases that may be related to a physician’s race, gender, or age. Theresa Marie Redling, DO, has been practicing geriatrics for 30 years and believes that the white coat influences how women in particular are viewed, especially in the hospital environment. She shared that outside of the hospital, though, like in an outpatient clinic, a white coat feels uncomfortable since the environment is generally more relaxed. Similar to the JAMA study’s findings, some women said patients thought they were nurses instead of physicians because all staff wear scrubs, and others shared stories about being mistaken for custodial or other staff. Related to this, clinicians also shared the importance of having one’s name and title shown clearly, whether that be via a nametag or embroidery on a jacket or fleece. Katina Yolanda Brown-Burgess, DO, an ob/gyn, said, “The white coat does matter. As a Black physician, wearing my scrubs with a stethoscope, and my badge … I still get mistaken for the housekeeping, or a nursing student or tech. I’m not a white coat-wearing doc, but I have to make a conscious effort to wear my coat in certain clinical situations because of people’s perception.”
Physicians discussed the importance of not only what one wears, but how one presents and carries oneself. Neil Stalker, MD, a pediatrician, said that he’s worn Hawaiian shirts, jeans, and western boots for 42 years. He shared, “Kids under 2 don’t care what you wear, most scream when you walk in the room” — although he recounted that a 4-year-old recently asked him if he was wearing his “vacation shirt.” He expressed that in primary care, clothes are a minor issue, and what matters more is good care, which “hooks ‘em every time — well almost every time.”
Dr. Redling, the geriatrician, also values her individual style and prefers to wear professional attire consisting of a dress, skirt, or pants, and shoes with a moderate heel if she’s not doing rounds. She explained, “My older, frailer patients look forward to seeing their physician in a professional outfit that is not scrubs. Someone that looks nice, smells nice, and is bright and caring truly makes a difference in their day.” She thinks that “physicians should be able to express themselves in their work by appearance, if it suits them, or if not, then certainly in other ways that reflect who they are.” Dr. Redling explains that she inspires trust in her patients not by wearing a classic physician uniform but by being neat, trim, and generally fit. She remarked, “If we ask our patients to take care of their health and exercise, and focus on healthy lifestyles, then they should expect the same from their physician. Of course it's not all about appearances. It is the whole package. And if taking a few minutes a day to look my best for my patients makes their day better, then I am up to the task.”
Regardless of how patients and physicians feel about it, the white coat is cemented into the culture and training of medicine. It follows a physician throughout their training, starting with a short jacket, and then migrating to a longer one, marking an important achievement in a physicians’ long journey. While the studies mentioned above found that patients do tend to prefer a white coat, the jury is still out on the attire most widely embraced by physicians. And while each doctor has their own personal preference, style, and opinion around dress, the one thing that a white coat, scrubs, or a tie can’t show is the most important. As Dr. Stalker, the pediatrician, summed up: “All the white coats and Armani suits in the world are not going to cover for a physician who does not convey warmth and caring.”
Let us know what you prefer to wear in the comments.
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