The doctor’s dress code: professional, yes; piercings, no

The physician’s attire isn’t necessarily a reliable indicator of his or her skill and competence, but patients do notice what docs are wearing and often judge them accordingly, a recent Canadian survey has found.

The consensus: People want doctors to look professional. Piercings and body art? Not so much.

The survey, which appeared last month in JAMA Internal Medicine, zeroed in on patient and family perceptions of doctors in hospital intensive care units.

A majority of the 300-some respondents agreed it’s important for doctors “to be neatly groomed, to be professionally dressed, and wear visible name tags, but not necessarily a white coat.”

They associated professional attire with honesty, knowledge and high-quality care. In fact this counted for more than the doctor’s age, gender or ethnicity. About three out of five preferred the intensive care unit doctor to dress professionally, and one-third frowned upon visible tattoos and piercings.

In another setting, such as a children’s clinic or an emergency room, dress code might not matter so much. But intensive care units are a different matter – more pressure-ridden and more demanding of the need for patients and families to quickly form a bond of trust with a doctor they may have never met before, the study’s authors said.

Dr. Selena Au, of the University of Calgary critical care department and lead author of the study, told the Canadian Press: “I think more than anyone in the hospital, that we are having very intense discussions where we’re talking about end-of-life care, where we may be talking about treatment options where decisions have to be made quickly. And so family members have to make some quick judgments as to whether or not they trust us… So things that are part of non-verbal communications come into play quickly.”

Some of this seems to happen at the subconscious level. The patients and families who participated in the survey didn’t look favorably on doctors wearing formal suits and ties in the intensive care unit, probably because they perceived them as less willing to roll up their sleeves and pitch in during a crisis.

In a commentary accompanying the JAMA Internal Medicine article, Dr. Rebecca Lesto Shunk of San Francisco Medical Center, puts it another way: “Maybe I am old fashioned, but I think the dress and appearance of health care providers should demonstrate professionalism and support a serious and sacred pact with our patients. By dressing and appearing professionally, we validate the significance of the relationship, acknowledging that we are not their barista, but a person to whom the patient entrusts their most private thoughts and concerns.”

Other studies have found definite opinions among patients about physician dress code. White coats seem to be falling out of favor, especially for physicians who work with children (although, interestingly, some studies have found that children are less intimidated by the doctor’s white coat than adults think they are). Neckties worn by male physicians are no longer de rigueur, and in fact there’s valid debate about the necktie’s propensity to spread undesirable germs. There also seems to be a generational divide in how people perceive the doctor’s appearance, with older patients more likely to appreciate some formality.

Is it frivolous to devote time and thought to how doctors should dress? Perhaps not, suggest the authors of a 2004 study on “The White Coat Effect.”

First impressions count, they write: “The clean, carefully dressed doctor might give the impression that patient contact is an important event and that it takes time to prepare for it, whereas the unkempt doctor can be perceived as unskilled and uncaring.”

They found that doctors in casual attire tend to be perceived as having less authority and are less likely to inspire trust. Their conclusion: “What would appear to be the most reasonable sartorial advice for doctors is to dress formally and to wear a white coat, but perhaps to remove the white coat in more socially delicate contexts.”

Dr. Erin Marcus of the University of Miami Miller School of Medicine found herself in a dilemma several years ago with a young resident physician who was smart, thoughtful and skilled but couldn’t refrain from wearing a low-cut dress. It was hard not to be distracted, Dr. Marcus wrote in a New York Times essay.

And she wondered: “Do patients and colleagues underestimate her abilities?”

Fairly or not, the doctor’s appearance ultimately is one of the ways patients judge clinical skill, she concluded. “Patients and colleagues may dismiss a young doctor’s skills and knowledge or feel their concerns aren’t being taken seriously when the doctor is dressed in a manner more suitable for the gym or a night on the town.”

One thought on “The doctor’s dress code: professional, yes; piercings, no

  1. I am a 39 year old female physician and completely agree with Dr. Marcus’ essay. The physicians in my practice teach medical students, and I am appalled by the short skirts and sky high heels I have seen on some students. I feel that it is my responsibility as an older physician to address this issue with the student. I try to do this in a very nice and non-judgmental way and have had good results.

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