Casual attire is becoming more popular among physicians, but patients prefer white coats

August 06, 2021

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In a recent study, clients reported they seen medical professionals in everyday apparel this sort of as a fleece jacket in position of a white coat as much less qualified and much less experienced.

The results, released in JAMA Network Open, also disclosed that casual clothes led to misidentification of roles, notably among the woman physicians, and that feminine physicians ended up typically rated as less experienced than their male counterparts, even when donning a white coat.


“The results of the review propose that woman medical professionals are much less possible than male doctors to be identified as medical professionals and more likely to be misidentified as nurses, healthcare specialists or medical doctor assistants,” Jordan P. Steinberg, MD, PhD, of the office of plastic and reconstructive medical procedures at Johns Hopkins University College of Medicine, and colleagues wrote. “This misunderstanding may well be connected with prevailing stereotypes.”

Irrespective of a shift in the U.S. wellbeing care workforce, most physicians are continue to adult men (604,560 gentlemen vs. 293,120 ladies), whilst most nurses are girls (3.2 million gals vs. 330,000 men), in accordance to the scientists.

“The public’s greater publicity to male medical professionals and woman nurses contributes to the formation of gender-based mostly specialist stereotypes and affiliated biases,” they wrote.

Steinberg and colleagues executed a population-primarily based survey through the Amazon Mechanical Turk system from May possibly 2020 to June 2020. The study cohort was comprised of 487 adults in the U.S. The signify age of respondents was 36.2 a long time 53.4% were ladies 76.4% identified as white and 6.8% as Black.

The respondents delivered responses on a five-position Likert scale about the place and how often they see wellbeing treatment industry experts donning white coats, scrubs, fleece-blended sweaters or vests and softshell jackets, and the most critical characteristics in a well being care qualified: encounter, professionalism or friendliness.

Respondents also ranked on a six-place Likert scale the practical experience level, professionalism and friendliness of industry experts in a collection of photos that confirmed versions putting on several health and fitness care apparel. Their choices for well being care apparel had been primarily based on a professional’s function, which incorporated nurse, technician, phlebotomist, relatives medical doctor, skin doctor and surgeon.

Perceptions and gender bias

The the greater part of respondents claimed seeing well being care practitioners in white coats “most of the time” (42.5%), in scrubs “sometimes” (36.6%) and in fleece and softshell jackets “rarely” (37%), in accordance to the scientists. When a practitioner in a white coat was perceived as extra seasoned (indicate professionalism rating: 4.9 for white coat vs. 3.1 for fleece jacket vs. 3.3 for softshell jacket P < .001), a practitioner in a softshell jacket appeared more friendly to respondents (mean friendliness score: 3.6 for white coat vs. 3.1 for softshell P < .003).

Older respondents were significantly more likely than younger respondents to perceive a model in a white coat with business attire underneath as having more experience (P < .009). Also, Steinberg and colleagues reported that fleece jackets with scrubs underneath reduced professionalism scores for all regions in the U.S. except the West. Most respondents reported a preference for surgeons wearing a white coat with scrubs underneath and, for family physicians and dermatologists, a white coat with business attire underneath (P < .001).

When comparing men and women, respondents perceived a male model wearing business attire with any outerwear item as significantly more professional than a female model wearing the same attire (mean professionalism score: 65.8 for men vs. 56.2 for women). When shown photos of models wearing only hospital or fashion scrubs, respondents still perceived the male model as more professional than the female model (P < .001). Moreover, male models in white coats with business innerwear were more likely to be identified as a physician than female models in the same attire (88.3% for men vs. 71.7% for women P < .001), according to Steinberg and colleagues.

“The white coat still has powerful symbolism, and ‘white coat ceremonies’ continue to be a rite of passage for medical students. Our study seems to indicate that, despite this, the white coat does little to address the problems of role misidentification and gender bias, particularly as (a) more and more clinical personnel these days may be offered white coats to wear, and (b) many hospital or office personnel have come to prefer casual wear,” Steinberg told Healio Primary Care. “In the COVID-19 era, where there again is heightened emphasis on disinfection, infrequently laundered white coats may also be disfavored.”

He added that the research team suspected that gender bias and physician role misidentifications would persist “irrespective of formal vs. casual wear.”

The ‘symbolic’ white coat

In a related editorial, Amalia Cochran, MD, FACS, an associate professor of surgery at University of Utah Health Care, and Gilbert R. Upchurch Jr., MD, a professor of surgery and chairman of the department of surgery at the University of Florida College of Medicine, weighed in on the longevity of the white coat culture in medicine. The history of the white coat dates back to the latter part of the 19th century, though resistance to it has mounted over the last 20 years, according to Cochran and Upchurch.

“Although public perceptions related to expertise may still favor white coats, perceptions of expertise also still widely favor older male physicians. It is therefore intriguing that for women physicians, no clear benefit to the patient-physician relationship can be attributed to wearing a white coat,” they wrote. “This work still does not help us to unravel the relationship, if any, between patient biases and clinical outcomes. Perhaps the message embedded in the article by Xun et al is simply that the white coat’s importance is primarily symbolic and that it is no longer a prerequisite for physicians to provide high-quality and compassionate clinical care.”


Cochran A, Upchurch GR. JAMA Netw Open. 2021doi:10.1001/jamanetworkopen.2021.19881.

Xun H, et al. JAMA Netw Open. 2021doi:10.1001/jamanetworkopen.2021.17779.

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