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By Meredith Harris

 

Medical research never fails to amaze me.  We sequenced the entire human genome nearly half a century after discovering the 3D structure of DNA, we have the capability to give face transplants and as I now know after this month’s exhilarating tour of the female reproductive tract, we can use mare urine to help with post-menopausal symptoms.  While these are some notable discoveries, the intelligence of those I am surrounded by on a daily basis is quite humbling to me.  However, while physicians and medical professionals are some of the best and brightest there is one concept that seems very elusive to us despite the daily decisions we have to make about it and the numerous studies that have been conducted…the ever vague dress code.

In early America physician dress code was much more black and white. Throw on your favorite Puritan uniform of the time (many doctors were also preachers and deacons) and you are good to go.  Following this, the uniform became the typical gentleman’s suit.  While this uniform may not have been simple, at least they knew what was expected.  And women did not have an issue at all because…well…a female doctor?  That’s just crazy talk.  Towards the end of the 19th century white coats were adopted by physicians for the first time.  Physicians were looking for a way to distinguish themselves from the many quack doctors;  the lab coat, worn by respected scientists,  seemed like a good way to go.  Scientists traditionally wore beige lab coats but with the recent adoption of aseptic technique and the evolution of hospitals from places of dying to institutions for restoring the living, physicians saw white as a more appropriate color to represent purity and life.  

 

 Fast forward about 100 years, and we see an  increasingly lax notion of a dress code in modern society.    The white coat can now seem a little stuffy.  It can induce fear in small children who associate the white coat with pain and unpleasantness.  The white coat has even been thought to elevate hypertension in the clinical setting, a phenomenon creatively named “white coat hypertension.”  Furthermore, there are several concerns about the hygiene of white coats as the long dragging sleeves travel from one ill patient to the next.  All of this has left us in confusion about not only the white coat, but appropriate medical dress in general.

Before our first Physician and Society session this semester, we received the following email from Dr. Kiesler.  “I received a couple of questions about dress for the patient tomorrow. White coat is optional. The attire should be professional/business causal. According to the New York Times this means, ‘“In general, business casual means dressing professionally, looking relaxed, yet neat and pulled together.’”  While I appreciate his effort to inform us on what we are expected to wear, this concept of business casual still confuses me.  Perhaps this is because I have seen such a wide gamut of outfits being passed off as business casual.  I have seen male physicians in darker wash jeans that they may or may have not been wearing when they changed the oil in their car to physicians who think they dress down when they do not wear a tie with their designer suit.  And at the risk of polarizing the men, women naturally have it much harder (yes, I did just go there).  We have to think of how low our shirts are, how high our skirts are, how tight our pants are, how pulled back our hair is- I could go on and on.  And then there is the pantyhose debate.  In 201 2, are we still expected to wear “stockings” under our dresses and skirts?  I have no idea.  

Clearly no one else has any idea either.  In perhaps the most recent study on physician dress code, over 400 patients surveyed in Ohio and South Carolina in the summer of 2010 did not show much of a preference at all to physician dress code.  When asked to choose between a dress shirt and slacks with a tie and a white coat, a dress shirt and slacks with a tie and no white coat, a dress shirt and slacks with no tie or white coat, or slacks and a neat polo, the patients choose all four options at a fairly similar rate. Unfortunately for those who want to live in their pajamas, scrubs scored much lower than these other four options. The other studies before this were about as equally inconclusive.  

 

Medical dress has not escaped the societal trend of increasingly lax dress codes.  While these studies do not help us understand the concept of business casual, perhaps what they are trying to say is that as long as we appear moderately put together our patients will be more concerned with the quality of care that we give them rather than focusing on whether a three inch heel is appropriate for the clinic while the three and a half inch heel is distasteful.  While I may be surrounded by geniuses every day it looks like our kindergarten teachers knew the answer to the dress code mystery: the way we act that is more important than the way we look.  Mystery solved.

 

References:

1. Hueston, WJ and Carek, SM. Patients' preference for physician attire: a survey of patients in family medicine training practices. Fam Med. 2011 Oct;43(9):643-7.

2. Jones, Valerie A. The White Coat: Why Not Follow Suit. JAMA. 1999;281(5):478.doi: 10.1001/jama.281.5.478

The Dress Code Mystery

How important is the medical uniform?

 

3/26/12

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