By Deanna Leonard, MBA
Vice President and General Manager - Professional Healthcare Apparel
Encompass Group, LLC
What a time to be a medical professional! As we celebrate National Physicians Week in the U.S. (March 25-31), with Doctors Day on March 30, we should consider where we'd be without the dedication and expertise of our physicians during the pandemic. These clinicians and researchers have saved countless lives and sacrificed their own to treat COVID-19 patients and try to stop the spread of the virus. Faced with a dire situation few of them could ever have imagined, they have been creative and collaborative in finding the best ways to treat COVID patients of all ages while attending to other urgent medical needs from heart attacks and strokes to cancer treatment to chronic conditions like diabetes.
When people are very sick (and often afraid), the last thing they think about is what their doctor is wearing. Patients want to get an accurate diagnosis, the proper treatment(s), and feel better. However, consumers have expressed very strong views about how their physicians should look when interacting with patients when they're not being treated. So let's look at the history of doctors' apparel in our country and why it makes a difference to them, the people they're treating, and the institutions they work for.
Physicians didn’t always wear white
Doctors wore black apparel until the late 1800s because medical treatment was a serious and formal interaction. Also, when a patient sought out a physician up to that time, the illness or injury unfortunately often led to death. When medical education was restructured around laboratory science in the early 1900s, cleanliness and antisepsis became the core values of medicine. By the end of that century, the "pureness" of medical science was embodied by the white apparel worn by doctors and nurses.1
Since 19932 physicians have received their first official apparel, a symbolic lab coat, upon graduation from medical school. From this white coat ceremony, they move into their clinical internships. For sentimental reasons, they often continue to wear the same brand and fit of that white coat for years. When it comes to their professional apparel, some doctors are trendsetters, some like timeless traditions, some are fashionistas, and some are all about comfort.
Depending on their age, where they work overtime, whether in private practice or a large health system, physicians may continue to wear the same white coat, need to choose a different type, or give up the coat altogether. For instance, a large hospital or health system may have an apparel program color-coded by discipline or partner with a supplier to provide their professional healthcare apparel.
What about scrubs…and other clothing?
For many years, scrubs were the uniform of surgeons and others in the OR. That trend has expanded to include many other physicians, particularly in hospital settings, for several reasons:
- Scrubs tend to be supplied and laundered by the hospital or hospital vendors, ensuring better infection control and taking the apparel choice off the doctor's plate;
- Physicians and other healthcare providers find scrubs comfortable and flexible (and one less thing to consider when preparing for work), important features when they're looking at long shifts under pressure; and
- Scrubs can be changed quickly and easily if necessary.
Scrubs aren't the only option that physicians choose for their on-the-job apparel. You've probably seen doctors, nurses, and other caregivers in fleece jackets or vests (very beneficial in emergency departments serving cold climates). Like the rest of the professional world, some physicians are moving away from more formal - and recognizable – attire. How do you know whether that person at your E.R. bedside is a doctor, nurse, or lab technician? Unless your team members introduce themselves, or you can read their badges, it may be tough to tell. That's why many hospitals have created color-coded uniform programs...and patients have entered the debate about physician apparel.
“Casual attire is becoming more popular among physicians, but patients prefer white coats”
Last summer, this headline from a Healio.com article summed up many consumer research findings on physician attire. The study cited here was published on JAMA Network Open and was conducted by physicians at Johns Hopkins University School of Medicine. One of their goals was to understand patient perceptions of casually-dressed doctors.
Analyzing nearly 500 results, the study found that the public considered doctors wearing casual attire less professional and experienced than those in white coats. However, while white coats denoted professionalism, casual attire received higher "friendliness" scores. Understandably, older respondents tended to see doctors donned in white coats over business attire as more experienced and professional. Interestingly, the majority of respondents preferred that surgeons wear white coats with scrubs underneath but wanted their family doctor to wear a white coat over business attire.3,4
A study of more than 4,000 patients at 10 U.S. academic medical centers published in BMJ Open also points to the significance of physician attire. More than half of the respondents said their doctor's attire is "important" to them, and more than one-third of them said it affected how happy they were with their care. High percentages of patients preferred their physicians wear a white coat in a medical office (55%) and a hospital (62%). Again, older respondents were more likely to prefer a white coat worn over formal attire - overall, the most highly rated apparel. Once again, scrubs were the top preference for surgeons.5
“I will prevent disease whenever I can, for prevention is preferable to cure.”
Part of the modern version of the Hippocratic Oath, this statement guides physicians in their work and must be factored into their apparel. Infection prevention and control is a constant concern of doctors and all medical professionals as well as the hospitals or health systems that employ them. The COVID-19 pandemic has only heightened efforts to limit the spread of infection among both patients and caregivers. One hospital-acquired infection of any kind is one too many, often resulting in complications for the patient and higher costs for the facility.
Professionalism is also crucial for physicians, not only in their behavior but also in their appearance. When polling our nurse advisory board, we learned that health systems want their employees to show up as "professional" - including their apparel. Uniform programs were born from this desire to make dress and demeanor as professional as possible while also making patients comfortable knowing who's who on their care team.
Plus, wearing uniform apparel as part of an integrated delivery network helps employees feel part of a larger team. Uniform healthcare apparel can enhance professionalism with branding and identification elements, too, such as a healthcare facility logo and perhaps their name and title. We've also noticed increases in lab coat and scrub coat purchases during the past few months. We hypothesize that now that some PPE layers are not being used, the coats add an extra layer to the safety factor while enhancing professional appearance.
Doctors are people too
So take a moment this week to send your physician(s) a note of thanks - in the U.S. mail, via email or on the patient portal. These women and men continue their chosen practices with the underlying implications of COVID-19 always present. As one E.R. doctor told us, they also need to get enough rest, exercise, and stay as healthy as one can be, challenging goals to achieve these days. If you employ doctors, be sure you're supporting them with clean, functional, and comfortable professional apparel, so they can concentrate on what they do best!