Dress to impress

Does it matter if doctors wear white coats?

From germs to patient perception: Here’s what to consider when you’re considering the traditional physician garb.

Ashley Altus
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Patients care about what their doctors are wearing. A BMJ Open study published in May found that attire impacts how patients perceive care.

In the largest study of its kind, over half of over 4,000 patients surveyed said what physicians wear is important to them. One-third said attire influenced their satisfaction with the care they receive.

Participants were asked to rate providers pictured in a variety of clinical settings and outfits on various attributes, including trustworthiness and intelligence.

The traditional white coat paired with formal dress was the most highly rated outfit. Patients preferred to see doctors in scrubs or a combination of scrubs and a white coat in the emergency room and in surgery.

White coat vs. BBE

While the white coat is the traditional physician garb, some physicians are beginning to lean towards the bare below the elbows (BBE) movement. A 2017 study found health care providers wearing long sleeves were more likely to have transferable contaminations on their sleeves and wrists. They were also less likely to wash their wrists when they washed their hands if they were wearing long-sleeved coats.

Physicians should opt for a sleeveless vest over scrubs or a short-sleeved shirt instead of the traditional white coat, suggests Virginia Commonwealth University School of Medicine’s magazine. Vests have several pockets for easy storage and abide by BBE requirements while still looking uniform. Focusing on patient safety, the publication outlined the do’s and don’t’s of physician apparel.

In favor of the white coat

“I’m not opposed to physicians taking off their white coats in the office as they see appropriate, but it still sends a loud message about who we are and what we stand for in medicine,” says Anita Showalter, DO, associate dean at Pacific Northwest University of Health Sciences.

Dr. Showalter still wears a white coat. She says she usually tears up a bit when she sees medical students receive their coats at the school’s annual White Coat Ceremony because it’s a significant rite of passage.

This year marks the 25th anniversary of the beginning of the White Coat Ceremony, which started at Columbia University Vagelos College of Physicians and Surgeons.

In the emergency department at her hospital, a man once pulled a knife on Chris Giesa, DO, president of the American College of Osteopathic Emergency Physicians. It was her white coat that saved her from injury.

“I always wear a white coat,” Dr. Giesa says. “When I jumped back, it was my sleeve that got caught on my blade, not my arm, so I was very fortunate.”

Opting out of the white coat

In his first couple of years in practice as an internal medicine and hospice and palliative care specialist, Richard Thacker, DO, assistant dean at Alabama College of Osteopathic Medicine, wore a white coat. He then took off the coat and started wearing just a tie. Eventually he took off the tie and some days would even wear just a polo shirt.

“Professionalism can be projected by what you wear, but at some point, when you’ve established your professionalism and an atmosphere of trust, what you wear is less prominent,” Dr. Thacker says.

During his years of operating a private family medicine practice, David Garza, DO, rarely wore his white coat.

“I don’t feel like I need it to telegraph to the world who I am,” Dr. Garza says.

However, Dr. Garza began a new position this year as the family medicine residency program director of Laredo Medical Center in Texas. In the new role, he’ll be wearing his white coat more.

Further reading:

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

6 quick ways to build your DO brand

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9 comments

  1. Art Browne, DO

    The white coat is like a police officers badge, it announces I am a medical person of authority.
    It may be just fine in a private office setting where everyone is personally familiar with you not to wear aa white coat.

    In a hospital setting a name tag with DO, or MD is also important. I personally complained once when a person came to my bedside with scrubs on and started to irrigate my indwelling catheter. It turned out he was a legitimate urology resident, but introduced himself as Tom , rather than doctor. I told him how poor that was, that it was nice of him to be humble about his position but I wanted a doctor or equivalently qualified person to do what he was doing. He thanked me or my explanation.
    At a very prominent university hospital there was a standard practice of not wearing identification at all, just surgical scrub clothing.
    A patient complained that she had not been seen by a doctor for a couple of days. She had the female chief resident. But the university allowed maintenance personnel to wear the exact same garb.
    I was once asked, by another doctor, in 1984, what was with the white coat I was wearing.
    I am a doctor, I was chief of staff at the time I took the whole thing seriously.

    A lot of a physicians benefit to patients is the placebo effect, the authority of the white coat.
    That effect can be very, very helpful to many patients.

    Reply

  2. Dale Bratzler

    Bare Below the Elbow (BBE) and the role of physician attire in prevention of healthcare-associated infections (HAIs) has been the focus of much debate in the hospital epidemiology and infectious diseases community. Any clothing that a person wears can be contaminated with pathogens. But is there evidence that what a physician wears actually correlates with patient HAI rates? I have seen no good studies. For me, it is more important that whatever the physician decides to wear is clean and laundered as recommended by SHEA in the VCU document linked in this article. I routinely see physicians and students that wear white coats that clearly have not been laundered any time recently. Just like disinfecting a stethoscope, whatever the clinician wears needs to be clean.

    There has been recent debate in the infectious disease/prevention/epidemiology world about what surgeons should wear in the OR (should all hair be covered??). Proxy measures show that bacteria can be shed from clothes and hair in the OR, but evidence that it directly correlates with surgical infection risk is lacking. I would encourage readers to take a look at an invited article in Clinical Infectious Diseases – “Naked Surgeons? The debate about what to wear in the operating room.” The authors note – “Naked surgeons shed fewer bacteria into the operating room environment that ones wearing scrub suits.” (Clin Infect Dis. 2017;65: 1589–92). But, that is probably not a viable policy in most healthcare settings!

    Reply

  3. Hal Pineless

    I’ve been in solo Neurology practice for 33 years. I hated wearing white coats as a resident. My Neurology attendings wore blue long coats, and I made up my mind that blue coats would be worn by me in my practice. That’s what I have been wearing in hospitals and at the office as a neurologist. I only wear white coats for photo-ops with politicians. No white coat syndrome in my practice! Blue relaxes patients. In fact, during Project Mercury astronauts slept the night before a launch in a blue room as it was felt to be a relaxing color. My bedroom has blue walls for this reason. To quote Eiffel 65, “I’m blue!”

    Reply

  4. C. D. Owens, D. I.

    I contend that professional attire is important especially in the hospital setting.
    Even I sometimes have difficulty in discerning who is who, unless I am in contact with a colleague I know. Since not everyone wears an ID badge the white coat establishes, without a question,the one wearing it as a physician.

    Reply

  5. Geoffrey Ouma

    Sad that we debate this. Meanwhile, NPs and PAs are proud to wear their white coats. Most of the time they are referred to as “doctor” because they don’t part away with their white coats.

    Reply

  6. Jonathan Garber, DO

    I’m a 4th year resident and have ditched my white coat pretty much for the past 2 years or so. Everyone wears long white coats in my hospital including midlevels, clinical nurse specialists, chaplains, surgery techs, etc. I find it cumbersome, stifling, too warm, and furthermore it doesn’t distinguish physicians anymore.

    Reply

  8. Pingback: Why do doctors wear white coats? – A Better Man

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