Issue 17 / 7 May 2012

THE physician, wrote Hippocrates, “must be clean in person, well dressed, and anointed with sweet-smelling unguents”.

But what, assuming you have your unguents sorted out, does “well dressed” mean in the context of modern medicine?

A much-cited 2005 study suggested patients had a strong preference for doctors in white coats over those wearing business suits, surgical scrubs or casual attire.

More than 80% of respondents rated a doctor photographed in a white coat as most trustworthy, knowledgeable and competent and said they would be most likely to follow this doctor’s advice and to return to them for follow-up care.

Humans have long used various kinds of attire as markers of authority or special knowledge — bishops and judges mostly still do. So have doctors got it wrong in turning away from their traditional uniform?

Well, the evidence may be less conclusive than is often claimed.

Dr Matt Bianchi is an American neurologist who eschews both white coat and tie, and describes himself as having a shaved head and “bilateral black hoop earrings” along with “tattoos covering approximately 17% of my skin”.

The only negative comments on his appearance (apart from those of “a mildly demented elderly man in heart failure”) had come from medical colleagues, Dr Bianchi wrote in a 2008 review of the evidence.

“There have been countless moments of connection with patients who confided that some aspects of my appearance made them feel more comfortable”, he wrote.

Although the literature was generally interpreted as supporting traditional attire, the data actually revealed a more balanced distribution of opinions by patients and doctors, he concluded.

A survey of American general practice patients last year also found no dominant preference for how doctors should dress.

The authors noted that other studies had produced conflicting results and there was also evidence that patients given information about potential bacterial contamination of clothing actually preferred that doctors not wear a white coat or necktie.

Overall patient preferences, they said, were likely to reflect both cultural setting and the specialty of a particular doctor.

One study, for example, had found 97% of psychiatry patients did not want to see their doctor in a white coat, while another in a primary care clinic for veterans found 76% of patients did prefer this item of clothing.

It’s not just doctors: a study of podiatry patients found 96% believed a white coat inspired the most confidence in the practitioner.

In fact, it may be that the white coat is now a more important marker for those who are not actually members of the medical profession.

Another study showed patients have more confidence in doctors’ competence and trustworthiness when they wear a white coat than when they are otherwise attired.

You wouldn’t know it from the paper’s title — “Doctor’s attire influences perceived empathy in the patient–doctor relationship” — but the “doctors” in this study were in fact practitioners of traditional Korean medicine and the research was conducted by that country’s Acupuncture and Meridian Science Research Center.

Perhaps the real message from all this conflicting evidence is that there is no one way to be a doctor in our diverse contemporary world. The most appropriate dress will vary in different cultures, different clinical settings and between individual practitioners.

And the symbolic power of the uniform assumed by 19th century doctors as a mark of scientific standing may in any case be fading as it is increasingly coopted by those peddling miracle cures, rejuvenating face creams and wonder diets.

The white coat may, in the future, become the symbol of the homeopath while doctors turn up for work in shorts and a T-shirt.

Mind you, there are always those unguents to fall back on …

Jane McCredie is a Sydney-based science and medicine writer.

Posted 7 May 2012

6 thoughts on “Jane McCredie: Dressed to impress

  1. Tom Ruut says:

    I am interested in when white coats went out of favour in Aussie hospitals. Did it happen suddenly? By decree?
    When I was a JMO in the 70s everyone wore white.
    Any thoughts?

  2. Sue Ieraci says:

    I also started internship in a white coat – in the early 80’s. By the time I was a registrar, it had gone. When I later worked in Canada in 1990, I picked up the habit again and, continued back in Australia into the 1990’s. Patients and ancillary staff regularly commented that they liked the coat, but I eventually gave up after a number of years. For people who wear women’s clothing, the lack of pockets made the coat very useful for various odds and ends.

  3. Sally Tsang says:

    I think the lack of white coats in hospital causes a lot of confusion for doctors and staff members alike. There are frequent anecdotes of doctors listening to the medical student or nurse rather than the registrar because they are male, taller or older whereas the registrar isn’t. I don’t believe this is a positive thing for patient care.

    I think the point to note is that people will always make assumptions based on appearance – without the white coat, people will simply judge in other ways – stethoscope, age, gender, clothing. We all do this – it is normal and human. Without an outward symbol of being a doctor, many patients who are ill (who may also be elderly, NESB, hard-of-hearing) will simply find it too hard to work it out or take in the introductions, and therefore will judge erroneously. Is it okay to allow this to happen, to allow our patients to be misinformed in this way?

  4. Max Kamien says:

    What about cycling gear. Informs your patients you are serious about exercise.
    Gets you a reputation as a bit eccentric that many patients equate with cleverness.
    And patients put more store on punctuality than on how you dress.

  5. D M Cunningham says:

    I remember being summoned by my GP, who delivered me at home, Hector M Calder DSO MC MD., the day after I qualified in March 1951. I was ushered into his consulting room at the end of his evening surgery. I was congratulated on my qualification, asked to be seated and two large single malts were poured, no ice and no water. I was then lectured on how to behave as a member of this exalted profession.
    I was informed that my car had always to be black, I had the choice of two colours for my suits, dark blue or dark grey. My shirts were always to be white, I should wear my old school tie, my university tie or if I was fortunate enough to be called to the colours, my regimental tie. My shoes and socks had always to be black.
    What followed was a discourse on how to treat my patients. They were to be met at door of the consulting room greeted in a courteous manner and their hand shaken. At the end of the consultation, they were to be escorted to the door and their hand again shaken. I was then lectured on how to treat my fellow doctors and members of the nursing profession. In these days the public treated us with respect. I am rather proud to say that I did my best to maintain that standard to the end
    In general practice I did not wear a white coat as it appeared to frighten the children.

  6. Prof Alex Crandon says:

    As a JRMO in the early 1970s white shirt and a tie, white shorts, long white socks and white shoes were compulsory dress. You could wear long white trousers as a SRMO and then a white coat. When I came back to Sydney in 1980 after 5 years in UK white coats were just about a thing of the past. Apart from identifying the doctors easily they also provided some degree of protection to your clothes.

    An interesting study by a registrar in New Zealand several years ago produced the following results: most patients wanted their doctors to be neat clean and tidy, a white coat wasn’t that important. However, they very much did not see themselves as either clients or consumers, they considered themselves patients and very much disliked the other titles. They also very much preferred the nurses to look like nurses with many complaining that they now frequently couldn’t tell the nurses from the domestics or cleaners and felt their lack of a formal “nurse’s uniform” indicated a lack of respect for their profession.

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