If you ask a child to draw a doctor, a white coat will probably appear on the page. But many physicians are forgoing this time-honored garment and donning professional business attire or scrubs instead. In the United Kingdom, white coats are already passé; the U.K. Department of Health banned them, along with ties, in 2007, citing concerns about hospital-acquired infections. The updated U.K. dress code calls for physicians’ arms to be “bare below the elbows” during clinical encounters, according to the Infectious Disease Special Edition website.
Dress codes that discourage white coats exist at U.S. institutions too. The Mayo Clinic is one example, says Robert Orenstein, DO, an associate professor of medicine and chair of the infectious diseases division at the Mayo Clinic in Arizona. “Mayo has always recommended business apparel for its consulting staff rather than white coats,” says Dr. Orenstein, who also serves as the AOA’s editor in chief.
One DO pushed her white coat to the back of her closet because she feels it induces nervousness in patients, while another says her white coat is uncomfortable and restricts movement. Here’s what they and other DOs have to say about white coats and physician dress.
Patients who display elevated blood pressure levels during medical appointments are said to have white coat hypertension, and a recent study by the Exeter Medical School found that patients’ blood pressure was higher when measured by a physician than when measured by a nurse.
For physicians who work with kids, the stakes can be even higher.
“Starting in residency, I was asked to never wear a white coat, since the kids in the hospital were already scared and vulnerable,” says pediatrician Michelle Curtin, DO. Physicians and students in Dr. Curtin’s current practice in Louisville, Kentucky, sport business casual attire rather than white coats.
“The immediate and visceral fear reaction from young children, who associate the white coat with getting a shot, makes it impossible to get anything else accomplished,” she explains.
Angela Lim, DO, says the white coat restricts her movement, especially when she’s performing osteopathic manipulative treatment. Skipping the coat can also help build trust, says Dr. Lim, an osteopathic manipulative medicine and neuromusculoskeletal medicine specialist in Vacaville, California.
“Wearing a white coat can distance you from the patient,” she explains. “Many patients are nervous, and you’re already in a position of power because you’re the physician—a white coat only reinforces that difference.”
But Justin Hamlin, DO, a senior family medicine resident in Tahlequah, Oklahoma, maintains that white coats bolster patients’ confidence in their physicians. “The white coat conveys expertise,” he says. “When we step into the hospital, physicians are stepping into a role—we’re not just some person coming up with random things, we’re experts in medicine. The white coat conveys that message.”
Who’s the doctor here?
Although white coats instantly connote “doctor” for some physicians and patients, others say they no longer hold the same import.
“In my institution, there are more nonphysician providers who wear white coats than physicians,” explains emergency medicine resident Andy Little, DO, of Columbus, Ohio. “Wearing a white coat does not automatically mean you are the doctor.”
Dr. Curtin agrees. When health care professionals in so many different roles wear white coats, they stop having a special significance, she says.
What patients want
The majority of patients prefer physicians to wear formal clothing or white coats, according to a 2015 review of studies in the British Medical Journal Open.
Individuals over age 40 and patients in Canada, Europe and Asia were more likely to prefer formal clothing. Younger patients and Americans were more accepting of casual attire; of the 10 U.S.-based studies included in the review, only four found that physicians’ attire impacted patients’ perceptions.
The context of care also played a role, with patients who received surgery, emergency care and intensive care more likely to say attire didn’t matter, or to prefer scrubs. Health care systems should consider their patient populations and the care setting when deciding on a dress code, the study’s authors say.
Are white coats on their way out? Our limited sample had divergent views. Dr. Hamlin says he’ll definitely go on wearing one. Dr. Lim predicts that growing numbers of physicians will go coatless in outpatient settings. In emergency medicine, Dr. Little foresees scrubs prevailing. But he believes physicians in inpatient settings, such as surgeons and cardiologists, will continue wearing white coats. Michael Mank, OMS III, of the Midwestern University-Chicago College of Osteopathic Medicine in Downers Grove, Illinois, speculates that a color shakeup may be in store:
@TheDOmagazine Blue and slate grey have become popular
— Michael Mank (@WindyCityMed) March 17, 2015
The white coat may be declining in popularity, but it hasn’t completely lost its meaning, says Dr. Lim. Although she doesn’t wear a white coat these days, Dr. Lim says she values the symbolic moment when she received hers as a student entering medical school. “I think it instills a sense of duty as well as pride in the career you’ve chosen,” she says. “Medicine really was a calling for me, so I still connect with the white coat ceremony, and I think a lot of young physicians and physicians-to-be do as well.”