Patients want their doctors to dress up

2/29/2004

Dress for success. The clothes make the man. You are what you wear. Dress like a slob, work like a slob. Be clean in person, well dressed.

That last advice was for doctors, courtesy of Hippocrates, the "Father of Medicine" who lived from 460-377 B. C.

Modern patients pay a lot of attention to the way doctors and nurses dress. Study after study shows that patients want doctors to wear the uniform, and dress like the popular image of a doctor.

Doctors began wearing the uniform in late 1800s, as medicine became more scientific. They adopted the white laboratory coat as their uniform. Those lab jackets were practical, just like coveralls. They kept street clothing clean and helped stop germs from passing from one patient to another.

The different ranks in medicine once had different uniforms, much like the military, and it helped patients distinguish the generals from the privates.

Interns wore white trousers, a high-collared white shirt that buttoned down the sides, a short white jacket, and white shoes. Residents and other more senior doctors dressed in a long white coat, white shirt and tie, and white shoes.

Nurses did the same. The typical registered nurse wore a heavily starched white uniform, white stockings and shoes, and their nursing school's own distinctive cap. No problem in telling a University of Michigan nurse from an Ohio State University graduate.

A few decades ago, sociologists decided that those uniforms were a communications barrier between patients and health-care personnel. Less-formal attire also caught on in other workplaces, including offices with their "casual Fridays." Doctors, especially, shed the old uniform, and in some hospitals today they are almost invisible.

That individual standing at grandma's bed. That man in blue jeans, a sports shirt, and sneakers. That lady in slacks, sweater, and sandals. Is that a doctor, or another patient's visitor who stopped by to chat?

One review of 31 studies, published last summer in the Archives of Internal Medicine, concluded that patients want their doctors to wear more traditional attire. They definitely want their doctors to dress professionally, and be identifiable as doctors.

Patients prefer a white coat with a nametag, or standard business attire. That means male physicians in a shirt and tie and dress shoes and female physicians in a skirt, dress, or dress pants.

Many feel uncomfortable when the doctor wears blue jeans, shorts, a T-shirt, sandals, clogs and other casual outfits. Male physicians with long hair and earrings get a frown. So do female doctors who wear perfume, long fingernails, and dangling earrings.

Casual dress also may cost doctors may some of their power to heal. Doctors have a placebo effect on patients. Just a visit to the doctor, with no treatment, makes many people feel better.

Much of that power is in the doctor's image. Patients' ideas about how a doctor should look have not changed, despite the trend toward "dressing down" elsewhere.