Rheuminations: Can Clothing Influence How Physicians Practice?

It would be wrong to conclude that as physicians, we are what we wear. The white coat or the necktie won’t really make you a smarter doctor or a more astute clinician, despite what the behavioral economists suggest. Haven’t we all met buffoons wearing bowties? (Though I still love mine!) In fact, in the United Kingdom, the National Health Services advises doctors to shed their white coats, jackets, and ties because of the propensity for clothing to become vectors for transmission of infection. Though this admonition has not yet reached our shores, it may be time for doctors to reflect on their clothing choices.

A thoughtful opinion piece written by a neurology resident at my hospital describes his own views on the subject:

“I have had the good fortune to encounter a wide and rich spectrum of opinions from patients, friends, and colleagues on the matter of proper physician attire, perhaps encouraged by my absent white coat, absent necktie, shaved head, bilateral black hoop earrings, and tattoos covering approximately 17% of my skin (according to the Lund–Browder burn chart). With only one exception (a mildly demented elderly man in heart failure), every one of the uncommon suggestions to upgrade my appearance for the sake of patient care has come from a physician colleague. In contrast, there have been countless moments of connection with patients who confided that some aspect of my appearance made them feel more comfortable.”⁹

I wonder what Dr. Y would think about this resident’s appearance. Fortunately for all concerned, Dr. Y has retired.

Regardless of the chosen apparel, there is little doubt that what really matters is not the clothing, but the person. Care, compassion, and concern are the attributes that all patients seek from their caregivers. A smile and some genuine warmth go a long way toward reassuring the patient. Although you can probably get away wearing just about any clean outfit, I wouldn’t recommend those worn by the plague doctors. Unless you are playing doctor at a Halloween party.

Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.

References

1. Gherardi G, Cameron J, West A, Crossley M. Are we dressed to impress? A descriptive survey assessing patients’ preference of doctors’ attire in the hospital setting. Clin Med. 2009;9:519-524.
2. Townsend, GL. The plague doctor. J Hist Med Allied Sci. 1965;20:276-277.
3. Hochberg MS. The doctor’s white coat—An historical perspective. Virtual Mentor. 2007;9:310-314.
4. Chung H, Lee H, Chang DS, et al. Doctor’s attire influences perceived empathy in the patient–doctor relationship. Patient Educ Couns. 2012;89:387-391.
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6. Au S, Khandwala F, Stelfox HT. Physician attire in the intensive care unit and patient family perceptions of physician professional characteristics. JAMA Internal Med. 2013;173:467-468.
7. Adam H, Galinsky AD. Enclothed cognition. J Exp Soc Psychol. 2012;48:918-925.
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9. Bianchi MT. Desiderata or dogma: What the evidence reveals about physician attire. J Gen Intern Med. 2008;23:641-643.