If Clothes Make the Man, Do They Make the Doctor?
October 1, 2008
By Julia Hess
Image: Lawrence J. Brandt, Professor of Medicine and Surgery and Chief of the Einstein-Montefiore Division of Gastroenterology
In Britain and the U.S., the media spotlight--and microscope--have recently focused on how physicians’ clothing could be a more powerful contaminant than we realize. Little research is available on the role of ties, white coats, and long sleeves in transmitting bacteria, but according to Lawrence J. Brandt, Professor of Medicine and Surgery and Chief of the Einstein-Montefiore Division of Gastroenterology, elements of today’s more casual work attire must also be examined.
“Everywhere I go, I see physicians wearing jeans, t-shirts with slogans, sneakers—clothes that make sense in the schoolyard, but not in the hospital,” said Brandt. “I cringe to see a colleague carrying a backpack because I know that it’s come in contact with hair, hands, even the subway floor. It’s no longer a book bag, it’s a Petri dish.”
Brandt believes that a more formal dress code would benefit both doctors’ reputations and patients’ health. He has refused to allow residents to make rounds with him if they arrive in casual clothing. When challenged by one intern (“dressed like a slob,” according to Brandt), a compromise was struck: Brandt would find fact to back his stringency, and the intern would dress according to Brandt’s code. “We discharged our obligations to each other, and at the end of the month he agreed that there was a difference in the way patients treated him,” said Brandt.
Brandt’s research, a review of 31 articles exploring the degree of comfort patients have in the presence of a formally or casually dressed physician, concluded that health care providers’ attire is important to patients regardless of age, gender, or geographic location. Patients indicated more confidence in physicians with name tags, white coats, and a neat, clean appearance; less in those wearing jeans and sneakers. Female physicians were given greater latitude by patients of all ages, though many thought that green scrubs best distinguished these doctors from secretaries, dieticians, nurses, and social workers. Children perceived formally dressed doctors as more competent and casually dressed physicians as friendlier, but children with extensive medical histories preferred doctors in more informal attire. Overall, formal dress was said to indicate professionalism, experience, and cleanliness; informal attire was seen as “sloppy” and “coming off the street.”
“Call me old fashioned, but I think the pervading informality in how doctors choose to dress evidences a lack of respect for the patient and for the job,” said Brandt, who now plans to initiate a study examining the roles of culture and socioeconomic class in patients’ perceptions of physicians’ dress. Past studies that showed little or no influence of these variables were conducted, in his opinion, in an entirely different age.
“A lot of the traditional concepts are not only not respected, they’re not even present in today’s culture,” said Brandt. “I don't know what's right and wrong anymore, but I do know that we doctors need to be critically aware of how the choices we make each morning influence our relationships with our patients.”