Medical Attire and the Doctor
by Sabrina Brar

In modern day medicine, the doctor-patient relationship is central to clinical practice. It is a therapeutic alliance, essential for optimal patient care that is dependent upon an environment of mutual trust and respect, thereby maintaining a professional rapport between a doctor and their patient (Hall, 2001). A patient’s initial consultation is vitally important in the development of the doctor-patient relationship (Val Dulmen et al., 1997). Studies have demonstrated that effective doctor-patient communication is correlated with positive health outcomes and also patient satisfaction, (Lee & Wong, 2006). A patient’s first impression of his/her doctor may not however, be limited to verbal communication; attributes such as cleanliness, clothing and grooming may play a vital role in the development of the doctor-patient relationship (Cope et al., 2005).

Throughout Whole Person Care, I have become increasingly aware of the importance of valuing medicine as an art and science. Similarly the speaker Tom Isaacs explained the importance of viewing a patient as a person, considering the ‘bigger picture’ rather than solely focussing on their illness or disease (Isaacs, 2012). Taking the aforementioned into account, the purpose of this essay is to investigate whether doctors’ clothing, often associated with an expression of one’s creativity, personality and emotionality, has an influence on patient reactions and the doctor-patient relationship (Brase & Richmond, 2004). Doctors’ fashion inspires colourful commentary in clinical and literary contexts - it is an interesting topic for discussion, being a concept of professionalism, as well as ethics, values and humanism (Bianchi, 2008). I have decided to focus on the impact of attire in a paediatric setting, in which a doctor has the difficulty of dressing appropriately not only to treat their patient, but also to convey a feeling of professionalism and trustworthiness to the patient’s parents. Clothes play an important role in one’s perception of responsibility. Doctors’ attire is therefore an important factor to consider when studying the relationship and behaviour between a child and their doctor (Teiford, 2008).

After completing a literature search to obtain primary papers and conducting interviews of 8 medical students, 5 doctors, 5 parents and 5 healthy children aged between 6 – 13 in order to determine the impact that a doctor’s attire has on the doctor, patient, and parent relationship, I was inspired to create a piece of artwork, entitled ‘Dress your Doctor’; it is a child-friendly illustration of different doctor’s outfits (casual – formal - white coat), similar to those described in the literature and interviews. A combination of different outfits can be assembled which may be perceived as ‘good’ and/or ‘bad’ doctor attire by different people.

Throughout this study, I am going to explore a brief history of clothing in a medical context. I will outline the importance of appropriate doctor’s attire in a paediatric setting and discuss the key findings of my literature review and interview. I will conclude with a reflective summary of the study as well as providing the reasoning behind my subsequent creative piece.

The White Coat Effect

The subject of doctor attire can be traced back to the time of the Greek physician Hippocrates, who stated that a doctor should be ‘clean in person, well-dressed, and anointed with sweet smelling unguents that are beyond suspicion’. (Jones, 1923) Following on from this, in the 11th to 12th centuries, a well-dressed physician could expect to receive higher fees compared to a poorly dressed physician. (Bishop, 1934) The doctor’s white coat was introduced into western medicine in the 19th century (Blumhagan, 1979). Its white distinction was said to inspire a perception of competence and confidence, whilst also being casual in order to promote approachability. In recent years however, the white coat has come under debate, with evidence suggesting that patients may feel unnerved by the presence of a doctor in a white coat. Practitioners have also questioned whether a more mutualistic as opposed to a paternalistic doctor-patient relationship might be achieved through different attire (Brase & Richmond, 2004.) In modern day society, formal attire, commonly associated with societal expectations, tradition, competence and authority, is generally deemed important for the establishment of a doctor-patient relationship beneficial for patient care (Bianchi, 2008).

Why Paediatrics?

Paediatrics is a unique branch of medicine, providing medical care for infants, children and adolescents. A paediatrician is a medical specialist accustomed to treating an extraordinary range of patients, who differ in age, behaviour and verbal skills. Studies have shown that children develop social perception and awareness from a young age; investigating the impact of doctor attire in a paediatric setting is therefore of clinical importance as it may elucidate information which will aid a doctor’s ability to form a relationship with hospitalised children (Furst et al., 1996) - for infants and children with limited verbal capacity, non-verbal characteristics, such as facial expression and posture are important to elucidate their perception of the doctor’s appearance.

How to dress as a paediatrician

My literary findings and the results of my interviews clearly illustrate that there are varying opinions on how a paediatrician should dress. Existing evidence suggests that children are more flexible and open-minded in their consideration of what they deem to be appropriate doctor attire, compared to their parents. The results clearly demonstrate that children prefer coloured clothing; one study which investigated the impact of multi-coloured attire (as worn by medical professionals) on children admitted to a paediatric hospital, found that children were more perceptive to the medical professionals wearing coloured clothing, with reports of lower levels of anxiety and fear with regards to the hospital setting. It is also apparent that non-conventional, coloured clothing is significant in creating a friendly environment and reduced distrust towards healthcare providers (Biermann et al., 2009).

More than anything, parents expect clothing to express approachability; parents therefore also favour coloured clothing, as it conveys a feeling of friendliness as well as promoting a relaxed atmosphere (Campbell et al., 2000). All of the parents that were interviewed expressed the importance of a paediatrician to look clean, competent and trustworthy; these attributes are commonly associated with a white coat, however in a paediatric setting, more informal attire (than a white coat) was favoured in the hope of improving communication and creating a more equal doctor, patient, parent relationship. Similarly, the medical students and doctors interviewed did not find a need to wear a white coat. Contrary to beliefs, a recent, albeit small study in Great Yarmouth, found that only 25% of 25 children interviewed, expressed feelings of anxiety towards doctors wearing white coats (Collins & Doddamani, 2011). This finding is consistent with the results from my interviews, in which children did not express any concern with doctors wearing a white coat. Both the medical students and children I interviewed stated the importance of treating children as young adults and this is more easily achieved through more formal attire.

A clear theme running through my interviews was the importance of consistency of doctor’s attire. From a parent’s perspective, it allows easy identification and recognition of a reliable doctor and from both a parent and child’s point of view it provides stability and support in the establishment of an effective doctor-patient relationship.

In Paediatrics, the importance of providing atraumatic care (providing therapeutic care through interventions which minimise physical and psychological distress to the child and their parents) is widely recognised (Hochenberry, 2003). It is clear from the literature that doctor’s attire is a long-standing topic of discussion, in particular, the effect it has on the relationship between the doctor and their patient, which in turn has an affect on a patient’s healthcare. Significantly more research has been undertaken to investigate the impact of doctor’s attire in adults, however the following conclusions can be made from this study. Children are more accepting of a wider range of doctor’s attire compared to adults, for example, a minority of children express feelings of anxiety towards doctors wearing white coats, compared to a majority of their parents. Coloured clothing is perceived as being more approachable (by parents) and denotes a friendlier doctor (as reported by children). Both parents and children acknowledge the importance of a doctor to be recognisable and in general, prefer more formal attire.

Creative Piece

The aim of this study was to investigate whether clothing has an impact on the doctor-patient relationship in a paediatric setting, not only because I am interested in paediatrics as a career but also because previous experience working with children has made me aware of how children of all ages are extremely perceptive to all things creative and interactive. The reason for the creation of ‘Dress your Doctor’ is that I have always had a keen interest in fashion and thought it would be interesting to see if the way we dress is important to our patients. I feel that this artwork conceptualises the findings from my research and interviews and it illustrates the variety of clothes that are associated with doctors; the concept that different outfits can be assembled together reflects upon the varying opinions of the people that I interviewed. Making it into an interactive game is significant as it indicates the interactive nature of healthcare and the doctor-patient relationship. Aside from my personal interests in fashion and paediatrics, ‘Dress your Doctor’ was based around a number of themes namely the importance of a therapeutic relationship for effective healthcare, considering what might influence this relationship and also, an appreciation that medicine is as an art as well as a science. I have now come to realise that another aspect, mind-body medicine, focussing on the links between emotions and bodily health may also be important when considering doctors attire and its impact on their patient. Since clothes are often an expression of someone’s personality and/or emotionality, the perception of a doctor’s clothes by a patient may influence their mood and thinking, which can have a powerful effect on their thoughts towards medical professionals and in turn, their recovery.

I have found it interesting to consider the impact of doctor’s attire on the doctor-patient relationship. The ‘white coat syndrome’ is something that I had heard about and I would personally prefer to see a doctor is less formal clothing, without the need of a white coat. I thought it was interesting that children are generally un-phased by a doctor in a white coat; perhaps this is because of the way that practitioners are portrayed in the media and therefore the elusive figure of a doctor in a white coat is what young children envision prior to being admitted to hospital. Having explored this area, I have been able to reflect on the findings – I have begun to appreciate the complexity of each hospital patient and the importance of considering them as an individual rather than isolating their illness or disease. The relationship between a doctor and their patient, which is central to clinical practice, can be determined by much more than verbal communication, since each patient has their own perceptions and expectations. Taking this into account, I believe that as a future doctor, it is my duty to ensure that I cater for a patient’s individual requirements, remembering that they may be very different from someone else’s. I think that I will make an effort to think about the way in which I dress and how this might affect the patient. It does however beg the question of whether doctors have an obligation and responsibility to their patients, to dress, as the patient would like, or whether there is room for one’s individuality to be expressed through their attire.

The limitation with my interviewees is that everything was hypothetical since the children and parents were not in a hospital environment. Additional research in a paediatric hospital will further elucidate how children and parents feel about doctors’ attire and its influence on the doctor-patient, parent relationship. The process of reflecting about this topic has led me to think about another topic for future research: the impact of the sexes on doctor-patient relationship and whether different attire is deemed appropriate for male or female doctors. This may also incorporate the idea of desexualisation in a hospital setting.

Full consent was gained from the participants of my interviews to use their opinions/results in this study.

Sabrina Brar, Whole Person Care, Year One, 2012

References

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Biermann, K., Caprilli, S., Cocco, M., Festini, F., Galici, V., Giannini, C., de Martino, M. & Occhipinti, V. (2009) Use of non-conventional nurses' attire in a paediatric hospital: a quasi-experimental study, Journal of Clinical Nursing, 18 (7): 1018 – 1026

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