• White coats in the intensive care unit

    Great little study in this month’s JAMA Internal Medicine. “Physician Attire in the Intensive Care Unit and Patient Family Perceptions of Physician Professional Characteristics“:

    Our study provides the first description of ICU patient family perceptions and preferences of physician attire. Our results highlight 3 key observations. First, in contradiction to the theory that patients have less preference for traditional attire in the acute care setting, we observed a family preference for physicians wearing white coats or scrubs. Second, the 2 most preferred attires in our study, white coat and scrubs, share the commonality of being a uniform, which may help patients and families identify their health care providers. Third, we affirmed that regardless of dress, professionalism, neat grooming, and a clear name tag are perceived as a requisite by patient families. These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs. Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence.

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    Back at Penn, I always used to assert that when it came to the short white coat, there was a fine line between “medical student” and “busboy”. As a resident, my long white coat and scrubs were so ratty that they were more like pajamas than a uniform. I still have a coat today, but the only time I ever put it on is when a news station begs me to so people will “know” I’m a doctor. Evidently, all of you think this is how physicians are supposed to dress. Crazy.

    The study is short. Go read it. Accompanying editorial here.

    @aaronecarroll

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    • What this study ignores is that EVERYBODY wears a white coat, not just doctors. It was started by lab scientists 100 years ago, then the doctors took it over. Doctors held onto it for about 80 years, and around teh 1990s the nurses started wearing them. Now, EVERYBODY wears them, including the following people:

      1. RNs
      2. NPs
      3. CNAs
      4. Dietitians
      5. Social workers
      6. Pharmacists
      7. Speech therapists
      8. Respiratory therapists
      9. Phlebotomists
      10. PAs
      11. EKG technicians

      I did my own little experiment on this awhile back. I watched for people walking by in white coats thru a hospital corridor and counted how many of them came thru in a 10 minute period. I counted 17 people, and only 2 of them were physicians.

      White coats are not the best distinguishing mark of a doctor — a suit is. People in suits are either CEOs or doctors.

      I think its quite funny actually. If doctors started walking around in purple wizard hats I bet it wouldnt be too long before EVERYONE started doing the same.

      The white coat frenzy has gotten so bad at hospitals that some of them have changed their color scheme and come up with rules that physicians must wear gray coats, nurses wear white coats, RTs were blue coats, etc

    • I had a procedure recently and my doctor was Hispanic. Her first name was a Greek muse, so I assumed she was a Brit. While I was waiting to go to the procedure room, she passed by bed and said, Hi, without introducing herself. I wondered who she was.

      She was wearing scrubs and she had a backpack or satchel. I didn’t really think about scrubs being doctor-wear, they looked like sweats, were unflattering, and the backpack was student-like, but it wasn’t a teaching hospital, so I assigned her to janitor status.

      I might not have made the mistake if her name was something I recognized as Hispanic, and I was quite embarrassed about my unconscious racism, but she came off as looking less professional than the nurses, who were wearing blue coats.

      With hindsight, it is interesting to think about the visual cues that help us know who is a doctor.