Great Debate

Physician dress: Is the white coat becoming a fashion don’t?

Are white coats going the way of powdered wigs and monocles? Some DOs say yes.

Laura Selby
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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.

Alleviating anxiety

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.

Building trust

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.

Future trends

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:

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.”

10 comments

  1. Justin Hamlin, DO

    I’m disappointed that they didn’t mention at all that I talked about the very well studied and documented fact that white coats do not cause fear, but do invoke an instant sense of expertise. I will refer you to the groundbreaking Milgram Obedience study. The phrase hypertension” is merely a cute cliché. It has nothing to do with the actual white coat, and occurs even in absence of white coats.

    Also, I see a lot of peds patients. The white coat is NEVER a problem.

    And all due respect to Dr Curtin; “concerns” about infection control may be “well documented,” however evidence of an infection control problem are not. I studied this when I was in grad school working on a master’s degree in basic science epidemiology. I did extensive literature searches and reviews. While it’s been looked at a lot, the “concerns” are merely speculative and are not evidence based.

    Reply

    1. Justin Hamlin, DO

      The web comment form partially deleted my statement about about the phrase “white coat hypertension” being a cute cliché.

      Reply

  2. John Cottle, DO

    I guess I’ve been rural for too long, I don’t own a white coat and the last time I wore a necktie was a funeral a couple of years back. I thought ties for docs died with that study showing they were the most dangerous fomites in the office, ahead of hands, stethoscopes, and phones? Probably surpassed by computer keyboards now…

    Reply

    1. Sandra Robinson

      I wore my white coat in all my Residencies and Internships and also in the Hospitals after the Residencies but do not where it in the office. I wear my stethoscope and well groomed and styled clothes for the rural frontier practices, which I have owned and worked. I distinguish myself with my attitude and demeanor and always introduce myself or am introduced to each of my patients at each encounter. I am well known in the small communities that I have served by patients, collegues and administrators without any other outward attire. When in my surgery days the Coat covered my blue surgical scrubs. In the office I found it a hinderance as i was always having to remove it to do small proceedures and put on a protective gown or it was not convienient for doing OMT treatments. It was too hot once I reached menopause. I wear it only if required for special presentations but prefer a womens business jacket for those occasions as well.

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  3. Ruth Robinson, DO

    I have always worn a white coat. At first, it was to establish that I was not a Candy Striper (I looked at lot younger than I was for many years, not an issue now that I am 62!)
    I am surprised that no one has mentioned an issue for women–our “business attire” rarely has pockets. I need to carry a pen, a highlighter, a tape measure, a quick visual acuity chart, distractors for squirmy kids and some brief clinical references. And sometimes I want my stethoscope off my neck and in a pocket.

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  4. Carol Lang DO

    I HAVE NEVER WORN A WHITE COAT SINCE I STARTED PRACTICING FAMILY PRACTICE. IT JUST SCARES THE KIDS I SEE AND PUT OFF SOME OF THE ELDERLY TOO. I HAVE MADE MY SHIRTS W POCKETS OR MY JACKETS WITH POCKETS THAT ARE SUIT TYPE SO I HAVE THE POCKETS I NEED, THAT WAY I GET DOWN TIME W MY SEWING MACHINE AND SIMPLY MAKE THE CLOTHES I NEED TO MY WORK SPECIFICATIONS. MY PT OVER THE YEARS GET CLOSER TO ME I THINK AND TELL ME MORE, INSPITE OF NOT BECAUSE OF THE COMPUTER IN THE ROOM WHICH I DO NOT AGREE WITH EITHER. I AM 63 AND STILL LOOK YOUNGER THAN MY AGE, BUT NEVER HAVE HAD ANY TROUBLE BEING MISTAKEN FOR ANOTHER PROVIDER, IN THE HOSPITAL OR CLINIC. BUT UNDERSTAND HOW THAT COULD HAPPEN TO SOME FEMALE PROVIDERS.

    Reply

    1. William C. Wilson, DO

      I wear blue and gray lab coats to play down my white coat syndrome to my patients about their fear of such. I’m pretty laid back on the outside to let my pts know, I’m not there to judge them but to help them live their lives to the fullest potential. I’m there to be a approachable, not to be the school marm and give them a guilt trip. Society does enough of that, I try to give them guidance and a lil levity, not a guilt trip and encourage them the the idea the good health can actually be a lil fun and beneficial. They can come to me for anything no matter how small or trivial. As an FP, I’m the last bastion of logic, not just another pain in the ass of overwhelming bureacracry they have to overcome….a friend where hope is only a whisper away, not another overwhelming blockage to progress or hope to better life……Hope it works…..

      Reply

      1. John Cottle DO

        How refreshing! You summed up the answer to fears that docs could someday be replaced by AI. A skilled compassionate human can never be fully replaced.

  5. Ben Papoi, DO

    I have worn Hawaiian shirts since I was a resident, I am sure they remember. I stopped briefly one year and ALL patients asked about it incredulously; two brought in Aloha shirts the next day, and I have received many from patients over the years.

    Stop this silly debate; wear what is appropriate for your practice/setting and most of all be really good at practing medicine, staying current and caring about your patients. Very respectfully submitted, BP

    Reply

  6. John Kazilionis

    ‘We need to be concerned about fomites.’ That is one of the most common statements I hear from medical students about wearing ties and white coats. But, they seem to forget that stethoscopes and percussion hammers are not equally capable of being a fomite.

    The reality is that there are times when a white coat is helpful. For example, when a surgeon leaves the OR suites and dons a white coat, he/she has less of a chance of bringing back contaminates from the floor to the OR, or vice versa. In reality, they should totally change scrubs before every case.

    So, we should not bicker about white coat or no white coat. I believe it is often a matter of the circumstances that should dictate whether one wears or does not wear one.

    Reply

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