Is the Demise of the Doctor's White Coat Near?
Your doctor walks into the exam room wearing a white coat. Or perhaps your physician has on a fleece or softshell jacket.
Does it make a difference?
Yes, according to a survey that sought public perceptions on doctor attire and professionalism in the United States.
The lay public still appears to associate the traditional white coat with experience and professionalism, said study author Dr. Jordan Steinberg.
The study was conducted as the white coat has come under scrutiny lately, with the association of germ transmission between patients, the increase in casual wear, and the relaxation of appearances of elitism or hierarchy as health care moves to a more team-based approach, according to the authors.
"While casual wear appears to be more popular, and quite universal now, especially in U.S. hospitals, the lay public still associates elements of traditional doctoring with the symbolic white coat," said Steinberg, an assistant professor of plastic and reconstructive surgery at Johns Hopkins University School of Medicine in Baltimore.
"Younger individuals and those from the West Coast of the U.S. appear to perhaps be more tolerant of casual wear, with less penalties considered for the element of professionalism," Steinberg added.
The researchers surveyed nearly 500 U.S. adults from May to June, finding that a majority perceived doctors in white coats as more experienced, professional and friendly than those wearing a fleece or a softshell jacket.
Average age of respondents was 36. Photos used showed male and female models wearing various types of clothing, including white coats, business attire and scrubs.
For surgeons, survey respondents preferred a white coat worn with scrubs. For family physicians and dermatologists, they preferred a white coat worn with business attire.
Photographed female doctors were rated as less professional-looking than male physicians in the same attire. They were also more likely to be mistaken for a medical technician, physician assistant or nurse.
"The findings suggest that individuals prefer that physicians wear white coats and that gender biases in the perception of professional physician attire exist," the study found.
The findings were published July 30 in JAMA Network Open.
In a commentary with the study, Dr. Amalia Cochran, a general surgeon based in Bozeman, Mont., writes that resistance to the white coat has been mounting for 20 years.
Critics point to "white coat hypertension" -- falsely elevated blood pressure readings in the face of traditionally attired doctors -- but Cochran says evidence of that is poor at best. The coat may be a source of infection passed between doctor and patient, but no study has definitively shown this. Some have questioned whether the show of power is appropriate in humanistic delivery of care, she said.
"Perhaps the message embedded in the article … is simply that the white coat's importance is primarily symbolic and that it is no longer a prerequisite for physicians to provide high-quality and compassionate clinical care," Cochran wrote.
The results suggested that both younger respondents and people from the Western part of the United States were more receptive to physicians not in white coats, Cochran said.
"Perceptions of doctors in white coats as being more professional and experienced is likely a holdover from the days when the coats were valued as a marker of status and power," Cochran said. "For older respondents or people in more tradition-driven environments, those ideas may provide a signal that gives them comfort."
While pediatricians and psychiatrists might be less likely to wear a white coat, surgery still has more adherents to that tradition, Cochran said, though she doesn't routinely wear one.
"For me, the questions around white coats really boil down to wanting patients to be comfortable with their physicians, and with physicians wanting to be comfortable doing their work," Cochran said.
"If a doctor wants to wear a white coat because they feel better doing so or because they believe their patients value it, then they should," she said. "If a doctor doesn't care for a white coat and doesn't feel that it is right for their clinical practice, that should be OK, too. I simply want for us to be able to provide high-value, compassionate care and am less concerned about the optics or what people expect a doctor to look like being tied to an article of clothing."
So are white coats here to stay?
It's not clear, Steinberg said. The white coat still has powerful symbolism and white coat ceremonies continue to be a rite of passage for medical students, he said. However, in this time of COVID-19, there is a heightened emphasis on disinfection, and infrequently washed coats have fallen out of favor, Steinberg added.
"We suspect that while traditional academic institutions may hold on to white coats for staff in a more ceremonious fashion, everyday use of white coats may very well be on the decline," Steinberg said.
The Association of American Medical Colleges has more insights on doctors wearing white coats.
SOURCES: Jordan P. Steinberg, MD, PhD, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore; Amalia Cochran, MD, general surgeon, Bozeman, Mont.; JAMA Network Open, July 30, 2021