Jane McCredie: Dressed to impress

THE physician, wrote Hippocrates, “must be clean in person, well dressed, and anointed with sweet-smelling unguents”.

But what, assuming you have your unguents sorted out, does “well dressed” mean in the context of modern medicine?

A much-cited 2005 study suggested patients had a strong preference for doctors in white coats over those wearing business suits, surgical scrubs or casual attire.

More than 80% of respondents rated a doctor photographed in a white coat as most trustworthy, knowledgeable and competent and said they would be most likely to follow this doctor’s advice and to return to them for follow-up care.

Humans have long used various kinds of attire as markers of authority or special knowledge — bishops and judges mostly still do. So have doctors got it wrong in turning away from their traditional uniform?

Well, the evidence may be less conclusive than is often claimed.

Dr Matt Bianchi is an American neurologist who eschews both white coat and tie, and describes himself as having a shaved head and “bilateral black hoop earrings” along with “tattoos covering approximately 17% of my skin”.

The only negative comments on his appearance (apart from those of “a mildly demented elderly man in heart failure”) had come from medical colleagues, Dr Bianchi wrote in a 2008 review of the evidence.

“There have been countless moments of connection with patients who confided that some aspects of my appearance made them feel more comfortable”, he wrote.

Although the literature was generally interpreted as supporting traditional attire, the data actually revealed a more balanced distribution of opinions by patients and doctors, he concluded.

A survey of American general practice patients last year also found no dominant preference for how doctors should dress.

The authors noted that other studies had produced conflicting results and there was also evidence that patients given information about potential bacterial contamination of clothing actually preferred that doctors not wear a white coat or necktie.

Overall patient preferences, they said, were likely to reflect both cultural setting and the specialty of a particular doctor.

One study, for example, had found 97% of psychiatry patients did not want to see their doctor in a white coat, while another in a primary care clinic for veterans found 76% of patients did prefer this item of clothing.

It’s not just doctors: a study of podiatry patients found 96% believed a white coat inspired the most confidence in the practitioner.

In fact, it may be that the white coat is now a more important marker for those who are not actually members of the medical profession.

Another study showed patients have more confidence in doctors’ competence and trustworthiness when they wear a white coat than when they are otherwise attired.

You wouldn’t know it from the paper’s title — “Doctor’s attire influences perceived empathy in the patient–doctor relationship” — but the “doctors” in this study were in fact practitioners of traditional Korean medicine and the research was conducted by that country’s Acupuncture and Meridian Science Research Center.

Perhaps the real message from all this conflicting evidence is that there is no one way to be a doctor in our diverse contemporary world. The most appropriate dress will vary in different cultures, different clinical settings and between individual practitioners.

And the symbolic power of the uniform assumed by 19th century doctors as a mark of scientific standing may in any case be fading as it is increasingly coopted by those peddling miracle cures, rejuvenating face creams and wonder diets.

The white coat may, in the future, become the symbol of the homeopath while doctors turn up for work in shorts and a T-shirt.

Mind you, there are always those unguents to fall back on …

Jane McCredie is a Sydney-based science and medicine writer.

Posted 7 May 2012