s the white coat doomed? Karen Hebert asks whether doctors need a new medical uniform.

Medical students, like any other group, are a diverse mix of people--from the Prada clothed Jimmy Choo wearing clothes horse to the person who wears the same clothes four days in a row and always looks like they have just got out of bed. From a personal point of view our choice of clothing is an indication of our individuality and personal taste. As members of the medical profession, however, choice of clothing becomes more a statement of our professionalism than our personality. What we wear gives out a message to our patients about what type of doctor we are before the consultation even begins. So should there be a case for all medics wearing a uniform? And if so should this be the white coat or scrubs?

White coat washout

Although the white coat used to be the classic symbol of a doctor, this no longer holds true. White coats are generally worn for easy recognition by patients and staff, and some medics wear them simply for the storage pocket.¹ Medical students are required by their universities to wear a white coat for identification purposes. Few doctors wear a white coat any more, however, and hospital staff from porters to laboratory assistants, pharmacists to radiographers, now wear the white coat. If anything, the white coat now creates confusion rather than easy identification.

One study found that only 52% of patients preferred doctors to wear a white coat.² Paediatric doctors and psychiatrists tend not to wear a white coat in an effort to build up a good relationship with their specific patients. Unfortunately, children associate a white coat with competence in a doctor.¹ Children also thought that casually dressed doctors were kinder and more friendly but less competent than those wearing a white coat.

So although some patients prefer the image of the white coat, on balance the white coat is too common, unhygienic, and old fashioned to be essential to a doctor's image.

Scrubs up well

Scrubs are another clothing option. These fulfil the purpose of easy identification, are unisex, comfortable, and hygienic. In fact, in some countries, all hospital doctors wear scrubs. In a study comparing formally dressed doctors with doctors dressed in scrubs, no differences were found in terms of a patient's evaluation of appearance, satisfaction, or professionalism.² This suggests that a "medical uniform" is not needed.

Respectable to retro trial

It seems that doctors' professional appearance is not dependent on a uniform. If this is true, do patients care about how we dress at all? A crossover trial--not to be confused with a cross dressing trial--explored patient opinion on doctors' clothing by looking at the correlation between a doctor's clothing and the trust and confidence it evoked in a patient.³ A total of 12 male doctors participated in the trial; 6 doctors smartened up gradually over a number of months. The other 6 underwent a "respectable to retro" transformation resulting in the doctor wearing a Hawaiian shirt, flared jeans, moussed highlighted hair, and a nose ring. The results from this study are very interesting. Formal attire was correlated with higher patient confidence and trust. However confidence levels did not deteriorate significantly if the doctor did not wear a white coat or a tie. Some patients described the retro look as an "affront to their sensitivities." Apparently, the worst thing a doctor could possibly wear was a nose ring. Although patients clearly did not want or expect their doctor to be dressed in a three piece suit, they displayed a need for a definite degree of formality in a doctor's attire. This formality demonstrates professionalism.

Double standards

Formality or smartness are, however, open to personal definition. Men tend to be expected to wear a shirt, tie, and smart trousers at the least. But the same guidelines or expectations do not exist for women, and, if anything, what constitutes smart for a female medic is a bit of a Pandora's box. A reader once wrote to studentBMJ and said, "Why do male students have to go through the routine of shirt, tie and trousers every day, when the women can wear what they like: in my opinion, some of them look really scruffy."⁴

A study comparing patients' perception of female doctors' and male doctors' clothing found that long hair and earrings were considered unsuitable in a male doctor and that mini skirts, shorts, or tight clothes were inappropriate attire for women.⁵ Clearly the sex difference results in differing patient expectations.

Consultation and clothing

Patients do not want all their doctors to dress and look alike. However it is also clear that a doctor's clothing definitely gives out a message about the type of doctor they are. For a consultation to be effective, the patient-doctor relationship must be good and this can be harmed before the first word if the patient is not happy with the doctor's image. Although no one is advocating a clone of lookalike doctors with no individuality, we should all bear in mind while getting dressed in the morning that in the doctor-patient relationship, first impressions most definitely count.