This one is going to piss some people off. It is still good to have the conversation. There was a a survey study  in JAMA Network Open where 500 laypeople were asked to rate professionalism and guess the job classes of male and female models in different types of clothing often worn by healthcare workers. They conceived the study primarily to examine the growing trend favoring more casual clothing for healthcare workers, including vests and jackets worn either over scrubs or office attire.

Participants were shown photos of models wearing various combinations of white coats, scrubs, and softshell jackets and pullovers, some with office wear underneath and some with scrubs. In one series, participants were told that the models represented family physicians, dermatologists, or surgeons, and were asked to rate each according to their perceived experience in healthcare and overall professionalism. Another phase asked participants to guess whether the model was a physician, surgeon, nurse, physician assistant, or medical technician.

Here some of the things found and pointed out in this MedPage article:

• Want to look “professional” in healthcare? Wear a white coat, and over office-type clothing, not scrubs. Especially if you’re a woman.
• On the other hand, if you’re a surgeon, scrubs under the white coat actually add to your perceived professionalism. And nobody should wear fleece vests or softshell jackets (even when embroidered with names and institutional logos) if they want patients to think they know what they’re doing.
• Probably the least surprising finding in the study was that women were significantly less likely than men to be taken as physicians, no matter what they were wearing. Women also drew lower “professionalism” ratings than men when they wore white coats over business wear or were clad in scrubs — but curiously, not when the attire was scrubs underneath other garments.
• White coats were the clear winner for the family physician and dermatologist, whereas scrubs either on top or underneath drew higher ratings for surgeons. Overall, the white coat over business dress came in with a mean experience rating of about 5, versus 3 for all other attire combinations (P<0.05); scores were similar for ratings of professionalism.
• Xun and colleagues were struck by one particular finding: “the tendency of respondents to rate a model wearing either a gray fleece jacket or a black softshell jacket as less experienced and less professional compared with a model wearing a white coat.” The researchers hypothesized that, because such casual wear is a relatively recent phenomenon, participants may not have seen it often in real-life healthcare, and thus wouldn’t connect it to “valued physician characteristics.”
• The group also observed that replacing white coats with casual attire, to the extent that it’s driven by concerns about cleanliness, could be a mistake, since there’s no obvious reason to assume that fleece vests or jackets would be any less vulnerable to contamination

Many of you will claim this is BS and that’s fair. Do NOT kill the messenger. I think the article, however, is right in pointing out that “providers must take patients’ perceptions, whether rational or not, into account as they seek to build rapport.”

The point of this blog is not to harp on the injustices of some patient’s perceptions (though that is a worthy goal) but to find ways to use this information to your advantage.

Don’t lose patients over your ego.

I have seen hundreds and hundreds of pictures of DPC Docs on FB and on their websites. The types of clothing are all over the place. No judgment here because I don’t know what is right or wrong. But maybe we should think about it more? Or maybe not and this blog post is stupid?

Personally, I always wore a tie for the first 4 to 5 years and then relaxed that a little bit at the end. I did not wear a white jacket. I think I used a tie to show professionalism, at least until the patients knew me and were comfortable with my care. I did talk about professionalism in my first book but also in my churn book. Do NOT ignore patients’ perceptions!

What’s your thoughts? Is this all BS?