Specifically in healthcare, providers' clothing signifies everything from authority to cleanliness to patients and other staff members. The white laboratory coat, in particular, is most commonly associated with physicians and surgeons. But does a physician's attire — both the coat and the clothing underneath — even matter to patients?
Here are five thoughts on physicians' attire and the history of the traditional white coat, according to U.S. News and World Report:
1. During the 17th century, physicians wore full-length overcoats, wide-brimmed hats, gloves and a beak-shaped mask with pungent herbs, believing the attire would prevent the contraction of deadly diseases affecting patients, including the plague. As society's notions of how disease spread changed, physicians proceeded to wear formal garments in black, which was believed to more effectively convey physicians' solemnity for caring for the ill.
2. Physicians eventually shifted to adopt white coats to help the profession seem more scientific, according to Michael B. Edmond, MD, chief quality officer and an infectious disease specialist at the Iowa City-based University of Iowa Hospitals and Clinics.
"Initially the white coats were worn only in the operating room. Then in the early 1900s, physicians started wearing them outside the operating room because at that point in time, medicine wasn't considered to be scientific. The profession was viewed negatively by the public, so the concept was doctors would wear white coats because it reinforced the notion that they were scientists," Dr. Edmond told U.S. News.
3. In 2008, the National Health Services in the U.K. adopted a policy under which healthcare workers went "bare below the elbow," opting not to wear lab coats and long sleeves in favor of scrubs. Doing so would supposedly reduce the chance of providers' clothing coming into contact with patients' skin and other surfaces containing bacteria and other infectious agents, Dr. Edmond said.
4. However, there is debate among members of the scientific community as to how big of a role sleeves have in transmitting infectious agents. Dr. Vineet Chopra, associate professor of medicine and chief of the division of hospital medicine at Ann Arbor-based Michigan Medicine, told the publication that while "there is a theoretical risk that infections could be transmitted by white coats," that risk is relatively small, as long as proper hand-washing and hygiene systems are in place.
"Studies have isolated bacterial pathogens from white coats, ties, and it's for these reasons that nations like the U.K. have a 'bare below the elbows' policy. However, it is also true that if you simply swab hands of physicians, you can isolate bacteria," Dr. Chopra said. "What is most important to prevent infection is the basics of safe practice: washing hands before and after patient contact, making sure we adhere to best infection control practices, such as wearing gowns and gloves when appropriate. A little bit of hygiene is all that it takes."
5. Dr. Chopra and a team of researchers composed a study to determine if physicians' attire is important to patients and if it may influence how satisfied patients feel with the care they receive. In the study, participants examined photos of physicians in seven forms of attire and rated their appearance on how comfortable that attire made them feel as patients and how knowledgeable and approachable the physician seemed. Participants over the age of 65 tended to favor the traditional white coat. Scrubs with a white coat and formal attire without a white coat were also ranked highly.
"Our study shows that the majority of patients feel that how their doctor dresses affects their satisfaction with care. We didn't ask for outcomes, specifically and — as this was largely a survey-based study using pictures — that would be hard to assess. But the key point is this: First impressions matter. True in fields outside of medicine — and from what we have found — true in medicine as well," Dr. Chopra said.
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