The COVID-19 pandemic added fuel to the fire of a question that’s been debated among HCPs for some time: White coats vs scrubs?

Research has shed light on the subject, finding that physician attire can be perceived as a form of nonverbal communication that could significantly impact the patient-physician relationship. Consequently, while attire changed for many HCPs during the COVID-19 pandemic, the question of implementing these changes permanently should be carefully considered.

 

Did doctors switch to scrubs during COVID?

A study published by the Irish Journal of Medical Science found that 76% of 151 hospital-based physicians changed their attire during COVID from white coats to scrubs (54% to hospital-provided; 22% to private).

Nordrum OL, Aylward P, Callaghan M. Hospital doctors’ attire during COVID-19 and beyond: Time for a permanent change. Ir J Med Sci. 2022;191(6):2445–2447.

 

Thirty-eight percent of respondents reported feeling uncomfortable bringing clothing home, citing concerns over infection control risk. Ultimately, 74% wanted to permanently change to scrubs as standard attire (65% to hospital-provided; 9% to private).

 

Experts weigh in on attire

MDLinx asked a US-based physician to weigh in on these findings.

Vincent Carr, DO, FACC, FACP, CHCQM-PHYADV, said, “While there is no literature that I am aware of that documents that clothing transmits COVID, all the hospital-based physicians I know changed into scrubs during [the pandemic], as there was a great need for respiratory precautions.”

In addition to the scrubs, most physicians have added shoe covers and masks.

The same approach was used by an HCP who works and lives in India.

“I made several changes to my attire during COVID,” dermatologist Alpana Mohta, MD, told MDLinx. “I wore an N-95 mask at all times while at the hospital, and gloves whenever I had to examine a patient. I also switched to wearing scrubs as my primary attire. I wore my white coat daily, even in my regular outpatient clinics. Additionally, I wore a hairnet during the first wave to protect my hair.”

During my COVID-19 ward duties, which were pretty much throughout the second wave of the pandemic, I had to wear a complete PPE kit, including an N-95 mask, two pairs of gloves, an eye shield, a gown, and plastic bags to cover my feet.

 

Patients prefer white coats on physicians

Patient preferences for types of physician attire were the focus of an international, multicenter, cross-sectional study published in BMJ Open.

Houchens N, Saint S, Petrilli C, et al. International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents. BMJ Open. 2022;12(10):e061092.

 

The authors surveyed the preferences of 9,171 patients in the USA, Italy, Japan, and Switzerland on their opinions regarding physician attire. They found that patients in all of these countries strongly preferred a white coat for physicians, confirming many previous surveys on this topic.

However, there was a clear exception for ED physicians and surgeons, for whom 44.2% and 42.4% of patients accepted the wearing of scrubs, respectively. While there were nuances in local and regional areas and among various clinical settings, this study clearly demonstrated that patients have definitive expectations of how their physicians should dress.

Here are some of the study’s notable findings:

• Preferred forms of attire in each country were scrubs and a white coat in Italy (41.7%) and Switzerland (31.5%), and formal attire with a white coat in the US (45.7%) and Japan (35.3%).

• The highest-rated clothing among all survey participants was formal attire with a white coat (38.6%).

• Among all participants, 78.6% preferred some type of attire with a white coat, while 21.4% preferred that HCPs ditch the coat.

 

Clothes show you care

“Physicians are professionals and are often looked at as role models or leaders in society,” Kristen Fuller, MD, commented on these findings to MDLinx. “I believe that physicians should always dress professionally—think ‘dressy casual’ such as black jeans instead of blue jeans, for example. Unless you are on call, working in an ER, in surgery, or in OB/GYN, scrubs are not appropriate.”

My opinion is that physicians need to show they care about their own attire, which means they need a clean white coat, rather than the soiled white coats that I have often seen worn.

Dr. Fuller added that she didn’t think that there are gender expectations regarding physician attire in general.

I think all males and females should be encouraged to dress professionally in a ‘dress casual’ fashion.

“Although there are a lot of gender biases in medicine, I don’t think it relates to attire,” she added. “However, I will say, females tend to ‘get away’ with wearing stretchy clothes more often than men … and in general, I don’t think these stretchy clothing types are appropriate for a professional medical setting.”

 

A personal choice

Ultimately, it’s a matter of choice for each HCP as to what they wear when treating patients. The COVID-19 pandemic may have moved the bar for what is considered acceptable medical attire, but research shows that how HCPs dress still matters to many patients.

While this may be a contentious topic, the AMA does not have any specific recommendations regarding attire. Employers may have guidelines established that should be adhered to. Beyond that, it is up to the HCP to determine what is best for them in terms of their comfort and that of the patients they treat.