How do we choose what we wear when seeing patients? Is it by what tradition dictates? Do we need to meet our institution’s dress code? Or do we just like what makes us comfortable?  (Those scrubs sure are comfy — almost like going to work in pajamas!) Well, how about choosing what our patients prefer that we wear?

A recent study published in the British Medical Journal found that 53 percent of patients reported that physician attire was important to them, and 36 percent responded that what the doctor wore influenced how satisfied they were with the care they received.

Across all ages and genders of patients, the plurality preferred “formal” clothes (button-down blouse and suit pants for women, shirt and tie with suit pants for men) with a white coat for outpatient and hospital visits. For emergency department visits and surgery, patients preferred the doctors to wear scrubs and a white coat.

The last preference makes complete sense. Scrubs are doctors’ “work clothes,” what they wear in the heat of battle — particularly as those battles are portrayed on TV or in movies.  But what of the white coat? Why does wearing a white coat seem to affect patients’ perceptions of us and our care of them?

The white coat pro/con discussion has gone on for decades. Are they anachronistic? Apparently not, judging by the rapid spread of white coat ceremonies in medical schools over the past 25 years. Are the coats unhygienic, acting as bacteria-laden fomites? No good evidence to support that. Do they make the physician seem less approachable? Not according to the patients in the BMJ study.  What the white coat does do is denote professionalism, which was important to the patients.

And I submit that the white coat is something more to patients: It’s a crucial part of the ritual of the doctor visit.

A step back, if I may. When I first went into private practice, after years of training in internal medicine and gastroenterology in academic medical centers, I was surprised and disappointed by the mundane complaints of the patients I was seeing. Where were the exciting cases of jaundice and bloody diarrhea and projectile vomiting — stuff gastroenterologists like? I found myself thinking, “You’re coming to see me for a head cold? Don’t you know it just has to get better on its own?”

One of my senior partners informed me that patients were complaining about their visits with me, that I wasn’t taking their complaints seriously enough.  He suggested that even for “easy” cases I take a more complete history, do a more thorough physical, show more empathy. I said, “You want me to treat a head cold like a serious medical problem?”

“Well,” he said, “If they’re taking time out of their busy days to see you, for them it is serious. Maybe they want your help to feel better, or perhaps they’re worried that they have something more threatening.”

Then he made a crucial point, that the doctor visit is a kind of ritual involving an authority figure in a certain costume, the telling of a tale, and the laying on of hands.  Patients even leave with a talisman, in the form of a prescription. He said, “The ritual is an important part of the healing process, and patients expect that we will perform it in its entirety.”

Looked at from that point of view, the white coat is part of our costume and it  gives us an aura of professionalism and authority. And if you don’t think that’s important, consider how you’d feel about getting on an airplane if the pilot in the cockpit were wearing shorts and a tank top.

So by wearing a white coat we are fulfilling patients’ unconscious expectations. We are looking the part. We are dressing with authority. We are performing the ritual.  With the current primacy of patient satisfaction, let’s use every tool available to us to give patients the best possible experience.

Robert Baker is a retired physician and author The Performance of Medicine: Techniques from the Stage to Maximize Patient Satisfaction and Restore the Joy of Practicing Medicine.

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