Thursday, January 20, 2011

White Coats

After the (greatly appreciated!) multiple responses to my last entry on the "Doctor" title, I thought I'd expand the conversation to include another of those doctor identifiers: the white coat.

In my time in the medical world, I have seen a wide variety of attitudes from my medical colleagues regarding the white coat.  Some appreciate the pockets.  Some worry that it may be off-putting to patients, especially disadvantaged ones.  Some feel that it's an important symbol of the doctor-patient boundary.  Some don't like having their style cramped by white polyester. 

We physicians might make assumptions about what patients want us to look like, but what does the evidence say?

A cross-sectional survey in Tennessee a few years ago found that patients prefer family physicians who wear white coats (1).  Another study in a South Carolina internal medicine office found that patients "overwhelmingly" preferred physicians in white coats (2).  A Northeast Ohio OB residency found similarly; patients preferred a white coat and professional dress to scrubs (3).  A quick PubMed search pulls up the same theme over and over: the patients studied have more trust in, and comfort with, physicians who wear white coats. 

We can misuse boundaries and labels, and they can chafe at times.  But the chaos of a totally boundary-less world is equally unappealing.  Patients already struggle at times to identify what role each of the people they interact with play.  In our hospital, the nursing students wear long white coats while physicians often favor fuzzy half-zip sweatshirts over their scrubs. 

Some may argue that the above studies are not generalizable to the populations they care for.  Others may describe their excellent patient relationships despite abolishing the white coat long ago.  I'm certainly not discounting any of those thoughts; actually, I was quite surprised that my literature findings were so one-sided.  I have to wonder if these studies are demonstrating our patients' desire to clearly identify who we are and, by extension, what we have pledged regarding our duty to them.

Fuzzy half-zip, I'll see you after work.

(1) Keenum AJ, Wallace LS, Stevens AR. Patients' attitudes regarding physical characteristics of family practice physicians. Southern Med J 2003; 96:1190-94.
(2) Rehman SU et al.  What to wear today? Effect of doctor's attire on the trust and confidence of patients.  Am J Med.  2005 Nov;118(11):1279-86.
(3) Cha A et al.  Resident physician attire: does it make a difference to our patients? Am J Obstet Gynecol.  2004 May;190(5):1484-8.



  2. Interesting topic, thanks for raising this issue.

    From my perspective, the most important factor to consider in the decision of what one wears to a patient encounter should be based on infection prevention.

    [I really don't care for the idea of scrubs being worn outside of their intended setting; nor do I care for a tie that I suspect has hung over many sick faces.]

    I'm not sure that white coats signal much these days. (most of the medical attire I see in my travels looks like everyone comes to work in pyjamas and running shoes).

    That said, it is nice to know what roles people are taking. I appreciate when anyone involved in my care makes a point to tell me who they are and why they are interacting with me.

  3. I believe White coats go a great way in convincing patients about the doctors professionalism.
    Scrubs for residency and all, but a practicing physician is better off with a white coat.

    Personally, when I graduated from scrubs and I was tottering around like a toddler learning to walk (i.e when i started seeing patients individually in the OPD),the White coat offered great support and confidence of sorts.

  4. Jen,
    You raise a topic my students have asked me about, and which I've considered a lot as a practicing physician and, more recently, as a patient.

    I think the white coat helps patients have confidence in a doctor. It's a sign of doctors' professionalism. But of course it needs be clean, and it shouldn't be worn for purposes of intimidation.