With great interest, we read the paper from Clement Rhys about his idea for a uniform for doctors and were fully convinced by his demonstration.1 However, we were surprised about one element of his ideal uniform that did not seem to fit any of the criteria developed in his arguments – accounting for prominent abdominal muscles. Indeed, physicians’ prominent abdominal muscles, to our knowledge, are not especially required for optimal patient safety – except perhaps for prevention of falls in older people -- and may even represent a disadvantage for staff comfort if they are too prominent, as in the example presented by the author. Therefore, we wondered whether the author believed that such a physical attribute could enhance patient confidence in the physician.

We have conducted a cross-sectional study of the French adult and paediatric population to determine whether dress style (professional -- white coat and stethoscope, formal -- shirt and tie, semiformal or casual attire -- T-shirt, jeans) affects patient confidence in the physician. Patients of all ages, in hospitals as well as private practice, had the most confidence in a physician wearing a professional white coat.2 Unfortunately, we forgot to include the presence of abdominal muscles in our images presented to subjects and cannot confidently conclude whether this attribute would contribute to increasing patient confidence. Perhaps the author subconsciously added this attribute in realizing the ideal uniform.

Accounting for the presence of abdominal muscles in the uniform suggests an underlying “muscle dysmorphia,” an exclusively male phenomenon characterised by a preoccupation with muscle size and build.3 This kind of “body dysmorphic disorder” is accompanied by a pressure to be muscular and is related to the feeling of young boys and men that physical size would be associated with success and heroism. This cognitive bias develops in early ages among boys through the influence of superhero figures such as Superman.3 Whatever the explanation for the presence of this attribute in realizing the ideal uniform, the fundamental question is What would be the female equivalent? In other words, which part of the female body should be oversized to maximize patient safety or confidence?

Finally, this ideal uniform would suggest that the suitable doctor should look like a superhero. But what is a good doctor? According to the Superman protrayed in film, Christopher Reeve, a quadriplegic later in life:4 “I think that today we are in a new era of medicine, one that is very different from the old. The old way, it used to be that the doctors were the experts, and the patients knew nothing and were expected to rely on the doctors' expertise.” To the question, What makes a good doctor?, “Superman” answers: “It's giving the patient control and developing a partnership with the patient. That is clearly the way to go.” The “patronizing” attitude of physicians is outdated and obsolete. The physician must be not a superhero but rather an accompanying partner (see George Clooney in “Emergency Room”).5 Therefore the ideal uniform presented by Clement Rhys does not seem appropriate at this time and should have been proposed in the mid-20th century, when Jerry Siegel and Joe Shuster created Superman.

References
1. Rhys C. Is it time for an evidence based uniform for doctors? BMJ 2012;345:e8286 doi: 10.1136/bmj.e8286
2. Maruani A, Léger J, Giraudeau B, Naouri M, Le Bidre E, Samimi M, Delage M. Effect of physician dress style on patient confidence. J Eur Acad Dermatol Venereol 2012;9. doi: 10.1111/j.1468-3083.2012.04665.x.
3. Knoesen N, Thai Vo S, Castle D. To be Superman--the male looks obsession. Aust Fam Physician 2009;38:131-3.
4. Reeve C. Man and superman. Interview by Lynn Eaton. BMJ 2003;326:1287-90.
5. Trilla A, Aymerich M, Lacy AM, Bertran MJ. Phenotypic differences between male physicians, surgeons, and film stars : comparative study. BMJ 2006;333:1291-3.

Competing interests: None declared