Over the last few years, controversy about what physicians wear has simmered. The debate has centered on the theoretical risk of infection transmission by clothing, focusing on the traditional white coat and scrub suits worn outside the operating room.

Some researchers decided to ask the patients what they think.

They surveyed more than 4000 out- and inpatients at 10 different academic medical centers in the United States and found more than half the patients said what doctors wore was important to them. And 36% of those surveyed said doctors’ clothing had an impact on the degree of satisfaction with their care.

The subjects were shown photographs of the same male and female physicians in seven different types of attire as shown in the figure below.

Based on the photographs, they were asked to rate the physicians on knowledge, trust, care, approachability, and comfort on a scale of 1 to 10. After combining the scores, the number one choice overall was formal attire—button down dress shirt, tie, suit pants, black leather shoes, and white coat for men and dress shirt, suit pants, black leather shoes, and white coat for women.

Patients would rather see emergency physicians and surgeons wearing scrubs with or without a white coat. They were also asked to choose what they would like their physician to wear in certain clinical situations. See figure below. Orange indicates no white coat and yellow is white coat preferred.

White coats prevail in most areas, and scrubs are the choice for surgeons and ED physicians.

When asked if doctors should wear a white coat when seeing patients in a hospital, 62% responded “agree or strongly agree.

The study investigators were internists from the University of Michigan and physicians from Georgetown and Baylor.

In the discussion section of the paper, the authors said “despite the abundance of literature on infection prevention, we are unaware of any study that links physician dress to source or transmission of infection.” I have said the same thing in several blog posts over the years.

Here’s what I thought of some 2014 guidelines on wearing white coats. In short, they were based on no real evidence.

My reasons for wearing a white coat are listed in this post and include having a lot of pockets, protecting my clothes from bodily fluids, and laundering by the hospital.

And this is what I thought and still think about the “bare below the elbows” policy of the UK National Health Service.

It’s the era of patient-centered care. The patients who have a preference have spoken.

 

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 18,000 followers on Twitter.