August 2007 | Back to Table of Contents

Pulse

Dapper Docs

Scrubs versus shirt and tie: Physicians think patients care about the way they dress.

Levi Downs, M.D., is known as a sharp dresser: not showy, but smart. On a day with no meetings, the assistant professor of obstetrics and gynecology at the University of Minnesota may wear dress pants and a crisp shirt with a button-down collar rather than a suit and tie. A Pittsburgh native, Downs became accustomed to a “very strict” dress code during his residency at the University of Pittsburgh—he recalls a male classmate being sent home for wearing a diamond stud in one ear. So after moving to Minnesota, Downs was “astonished” by how casually people dress here.
It’s not about snobbery or status, he emphasizes. Rather, it’s about professionalism and showing respect for one’spatients.

Does Dress Inspire Confidence?
Numerous studies have explored the relationship between physicians’ attire and patients’ confidence in them. The most recent, published in the February issue of the American Journal of Obstetrics and Gynecology, showed no significant link between the two. But several others—including research published in the American Journal of Medicine, Pediatric Emergency Care, and the Journal of American Podiatric Medical Association—have suggested that wearing businesslike or formal attire increases patients’ confidence in their doctors.

At Mayo Clinic, the dress code has always been “fairly strict,” says Michael Brennan, M.D., associate chair for the department of medicine and medical director for Mayo’s professionalism program. Although the standards are less rigid for physicians in inpatient settings, many wear business formal—a suit and tie for men and a suit or dress for women—even in the hospital.

“There’s a certain discipline, an almost military precision, that [business formal] conveys,” Brennan says. “It sets the right tone, an overall sense of tidiness and decorum. The patient thinks, ‘My goodness, this institution pays attention to details.’”

Eugene DiMagno, M.D., an emeritus professor of medicine at Mayo who still serves on the medical school admissions committee, says attire is a key factor in medical school applicant interviews, “a very important part of nonverbal communication.” DiMagno, who grew up in Pennsylvania in the 1940s, vividly recalls his own family doctor making house calls in a suit and tie: an image that defined, for him, what a doctor should look like.

At the University of Minnesota, the Medical Student Professionalism Code instructs students to dress “appropriately, including wearing a clean white coat and/or appropriate identification during all anticipated patient contact.” The difficulty lies in defining “appropriate,” which for some is a slippery and evolving concept.

What Not to Wear
What is considered appropriate may be more straightforward for men than for women. “It’s pretty much a jacket and a tie,” Downs says. “For a woman, if you say ‘dress pants and a top,’ it could be khakis and a white T-shirt.”

Third-year medical student Gloria Swanson admits she has seen questionable interpretations of appropriate dress. “When we first got our white coats, I noticed a few women wearing strappy dresses and tank tops.” Recently, during clinical rotations, she’s noticed sandals and open-toed shoes—a clear violation of JCAHO regulations.

Carrie Terrell, M.D., clinical assistant professor of obstetrics and gynecology at the University of Minnesota, emphasizes that regardless of how formally or informally a physician dresses, neatness matters most. Although she’s partial to a dressier look—suits, tailored pants, and blouses—and jokes that she and her colleagues have been told they work in “the best-dressed clinic” at the university, she says some physicians look very professional in more casual clothing. “The khaki look can work, as long as it’s clean and polished.”

What’s never acceptable, she explains, is a “torn, filthy white coat with the pockets overstuffed.” More than once, she or one of her colleagues has had to tell a resident wearing a dirty or rumpled white coat, “You need to wash that,” or “Don’t wear that to work again.”

Terrell’s colleague, Diana Saari, M.D., an adjunct assistant professor of obstetrics and gynecology, says the physicians in their practice are sympathetic to the challenges facing residents. For one, grueling schedules make it hard to appear fresh. “And you don’t have any money when you’re a resident. You’re in clinic with all these physicians who make eight times more than you.”

Still, neatness is imperative, and it needs to extend beyond garments to other aspects of appearance, Saari says. She remembers having a discussion with one resident whose dreadlocked hair had grown increasingly unkempt. “Finally I just said one day, ‘What is going on with your hair?’ It was getting away from her, and she knew it. It was a very complicated hairstyle, and her lifestyle precluded her from taking care of it.”

Downs admits he has difficulty with what he calls “more edgy personal choices: tattoos, piercings, blue-frosted hair.” Although he hasn’t observed a great deal of that among University of Minnesota medical students, he recently noticed a lip ring on a visiting student and wonders what effect it might have on patients—especially those from an older generation. When asked what he would do if appearance became an issue with one of his own students, he admits he would struggle with how to handle it. “I realize I’m probably more judgmental than most people,” Downs says with a chuckle. But then he adds, “I’d probably think, maybe it’s not my place to comment.”

The Sartorial Equalizer
Most physicians interviewed for this story agreed on one thing: that scrubs have become widely accepted, particularly in inpatient settings. In a June 2006 essay in Family Practice Management, Bobby J. Newbell, M.D., a Hazel Green, Alabama, family physician, called scrubs “the ultimate triumph of function over style.” For better or worse, they are “democratic in their indignity to the human form.”

Function is trumping style in more subtle ways as well. Edward Cheng, M.D., a University of Minnesota professor of orthopedic surgery, became a bow tie aficionado for practical reasons.

“I used to wear a straight tie, but I realized that a bow tie doesn’t get in the way when you’re leaning over, taking care of your patients,” he explains.

Cheng’s thinking was affirmed in 2004, when a study presented to the American Society for Microbiology showed that nearly half the long neckties worn by clinicians harbor disease-
causing bacteria.—Susan Maas