Medical professionals wear uniforms of sorts - white coats and scrubs, for example, -and one might think the question of clothing would go no further than these clothing styles, well-accepted as they are in the public mind. However, it’s not so simple. In fact, what medical providers wear is fraught with details and complications that require a little extra thought. It’s not simply what style is in vogue this year, as if clothing for doctors is a matter of haute couture.

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What we wear is impregnated with questions of authority, credibility, approachability, and even cleanliness.

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What we wear is impregnated with questions of authority, credibility, approachability, and even cleanliness. Is the white coat the best covering to portray expertise and strength to a patient desperately seeking resolution of their cancer? Or are scrubs the clothing that best portray the precision of the surgeon who is going to excise that malignant lesion? Perhaps it’s the tie and dress clothes that best represent the sage internal medicine expert.

What Should Doctors Wear?

A new study, published in the British Medical Journal, has entered the discussion, and is the most recent foray into answering the question - What type of attire do patients want their doctors to wear? Petrilli and colleagues performed the largest study to date examining patient preferences of dress for their physicians.¹ They asked a convenience sample of adult patients at ten American academic health centers to complete a questionnaire regarding dress preferences for physicians. As part of the survey, participants were shown images illustrating types of outfits.

The questionnaire had four major parts: 1. Rate the physician on five domains (knowledge, trust, care, approachability, and comfort); 2. Dress preferences for their doctors; 3 and 4. General opinions regarding doctor attire and various demographic information.

The researchers sent out 6,280 surveys and received 4,062 responses. Their results were as follows.

Ratings of physician attire

Patients scored formal attire with white coat highest on a composite score of the five domains mentioned above. Formal dress was the overall most preferred appearance for both male and female physicians. In essence, patients felt the doctor appeared more knowledgeable, trustworthy and caring than the other appearances. Scrubs with white coat was rated second overall.

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Formal dress was the overall most preferred appearance for both male and female physicians. Scrubs with white coat was rated second overall.

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Preferences for physician attire by care settings

There were some important differences for dress based on where physicians practice. Formal attire was preferred for primary care and hospitals, while scrubs were highest for emergency and surgical locations. To make clear this point: scrubs alone were preferred for emergency room settings rather than scrubs and white coat. This makes sense considering that white coats display authority and knowledge, but approachability and comfort might be what patients most seek in the ER and surgical realms.

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Practice setting mattered. Formal attire was preferred for primary care and hospitals while scrubs were highest for emergency and surgical locations

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Perceived influence on satisfaction, importance, and appropriateness of attire

Fifty-three percent of patients felt how their doctor dresses is important to them, and 36% of respondents admitted dress influenced how satisfied they were with the care they received.

Fifty-five percent of patients felt doctors should wear a white coat in the office, while only 44% felt the white coat should be worn in the ER. Sixty-two percent also agreed that doctors should wear white coats in the hospital.

Demographic and miscellaneous preferences

Women generally preferred white coats in the ER and hospital over men. Patients over 65 years preferred white coats over younger patients. Additionally, patients with a college degree preferred the more formal white coat compared with those without a degree. Perhaps not surprisingly, there were geographical differences in preference for physician attire with the West and South (50% and 51%, respectively) preferring the white coat, versus the Northeast (38%) and Midwest (40%) with a less formal preference.

These geographic differences are fascinating if one considers the stereotypes of the West being a little less formal than the east side of the country. Think of the shorts-and-T-shirt stereotype of California, for example. Clearly, these are only stereotypes and nothing more.

A few aspects need to be noted about the generalizability of this study. This study only included the United States, so can’t be extrapolated to the rest of the world, and it can’t tell us if there is a common human preference for a particular type of appearance for our medical professionals. Sixty-four percent of the patients were surveyed while admitted to the hospital, and they were most often white (71%) and male (65%). Seventy percent had either attended or graduated from college. Despite the large numbers and strong response rate this study surveyed a somewhat specific demographic which limits the external validity of the study. Interestingly, many more Northeast patients preferred surgeons to wear scrubs than those in the South (54% versus 25%, respectively). Additionally, the people in the survey images were young and white, which could have a significant effect on results from certain demographic populations.

Take-to-the-Office Points

Health providers should weigh these preferences when deciding how to dress but must also consider other factors such as infection transmission, general cleanliness, comfort, and individual preferences. We should also be cognizant of the fact that preferences don’t always lead to behaviors. On that note I’m going to try on that white coat. Maybe it still fits.