Put your ties back on: scruffy doctors damage our reputation and indicate a decline in hygiene
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3211 (Published 13 June 2013) Cite this as: BMJ 2013;346:f3211
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I agree wholly with this article. I was appalled when I moved to Bermuda from the UK in the late 90's to observe the scruffy attire of many of my colleagues, some even wearing shorts without belts and boating shoes
There is also the trends here where physicians, nurses, and other healthcare workers wear 'scrubs' everywhere. This means seeing them in supermarkets, hairdressers', etc in the same garments worn when dealing with patients.
The idea of 'dressing down' in these cases probably will account for the rise in hospital infections now prevalent here. This idea also, in my opinion belittles the professions. A man who doesn't want his tie dangling in a patient's face or elsewhere can wear a bow tie, even a clip-on one will do!
It is interesting to note that my legal colleagues, my spouse sits on the Supreme Court bench here, are sticklers for what is permitted as attires, and they don't have to deal with ill people.
By being scruffy and ignoring our physical appearance also means that we have no respect for our patients, who undoubtedly will query our standard of hygiene.
Competing interests: No competing interests
I am a junior doctor, and had the importance of handwashing impressed on me from early on in my medical career. Since starting work I have also had teaching on this subject from the infectious diseases consultants in my hospital. I do not believe that current junior doctors are any less clean than previous generations. Since the profession was started, each generation of consultants has complained about how terribly scruffy and uncouth the younger generations are and this article appears to continue in this tradition.
While I do agree that doctors need to dress smartly, I do not think that a return to the era of suits and ties is a step in the right direction. For me, and other doctors my age, especially those in minority groups, that clothing represents an era where 99% of doctors were white men from privileged backgrounds.
In order to provide care for the whole population, doctors need to be representative of the whole population, and an unofficial uniform of shirts and ties erases people's cultural identities, replacing them with the generic "male, pale and stale" standard.
This leads patients to make assumptions about our cultural values which can lead those patients in marginalised groups feeling that they cannot talk to their doctors about aspects of their lives which may be highly relevant to their health but seen as controversial by some - for example minority sexualities and alternative lifestyles. Many people in these marginalised groups have had awful experiences being judged by doctors as the #transdocfail Twitterstorm a few months ago demonstrated.
I think that the way forward here is for doctors to have a uniform, like the majority of other hospital workers. Scrubs are already associated with doctors in the minds of the public thanks to their use in medical dramas. In the hospital I work in, all medical students wear turquoise scrubs labelled "MEDICAL STUDENT". At the end of each day they are laundered, ensuring that the students are always in clean clothes and look professional. Certain doctors in my hospital already have navy blue uniform scrubs - these often have their name embroidered on them and "DOCTOR" or "CONSULTANT" in clear lettering. The use of scrub uniforms would eliminate patients', relatives' and healthcare staff's uncertainties about who on the ward is a doctor. It will also mean that doctors at all levels of training will be similarly dressed, which might facilitate a move towards a less hierarchical culture within medicine - something that the Francis report has identified as being a step towards higher standards of care.
The scrubs uniform is neutral and does not carry so many class or cultural implications with it - and so it does not carry the negative associations of class, gender and privilege that the suit and tie cannot shake off. They are also comfortable and the ones with pockets restore one of the practical aspects that was lost when white coats were phased out.
In short, I agree that doctors need to be easily identifiable, cleanly and smartly dressed, but I do not think that our profession will be enriched by enforcing the dress code that developed historically due to the homogenous make up of the medical profession. We are now more diverse a population than we have ever been - if we are to have a uniform it should be something neutral and easy to keep clean, not a wardrobe hangover from the bad old days.
Sy Parker
sy.parker@nhs.net
Competing interests: No competing interests
I totally agree. I graduated overseas in the early eighties. We were taught in the medical school to wear nice clean clothes, shoes and with ties to match. This has been my norm since graduation. One of my teachers in the medical school from the UK used to come into the Hospital at mid-night, when on call to attend to children, dressed in well matched clothes and tie. He was well liked by all.
Scrub clothes should be the norm in ITUs, SCBU, Labour wards and other areas in the Hospital where strict infection control is paramount.
Street clothes should be clean smart and professional. Simples!
Competing interests: No competing interests
As a patient, do you know what goes through MY mind when I see a doctor in a suit? Filth! I wonder how CLEAN that suit really is? When was it last dry cleaned? Yes, I do! Suits are NOT dry cleaned after EVERY wear! I know this as fact as my father wore a suit to work every day. He alternated suits over a two week period, and had enough for others to go to the dry cleaner while he wore the other.
Sanitary to me means SCRUBS, with or without a white coat, because that white coat may or may not be cleaned as often either! My mother ran many doctor offices, and was responsible for making sure the Dr's white coats were in tip-top shape, right down to sewing them, if need be. (Say if a hem fell out, or the suit coat needed to be tailored to fit the doctor better. She would NOT TOUCH that white coat unless it was dry cleaned FIRST! After she was done customizing or whatever, it went back to the cleaners all over again.)
Scrubs, on the other hand, are EASILY washed! To me, scrubs mean CLEAN! They are the most easily cleaned, and you can be ASSURED they ARE CLEAN!
As a patient, my preference IS clean! That is what I expect from my doctor! I do NOT expect MRSA, which is what I worry about with suits and white coats!
Also, a suit and tie, as compared to my casual dress in the office, to me feels as if that doctor is showing an air of authority. I do NOT want my doctor to make me feel as if they are authoritative! I should be made to fee as l comfortable, down to earth, and on the SAME LEVEL AS THE DOCTOR! That way i KNOW they CARE! I do NOT want a doctor who thinks they are so much better than I am, and i am a simple procedure waiting to happen. $$$ coming their way.
Suits, to me, are NOT impressive. Give me a doctor in business casual, or scrubs, NO white coat, and I am MORE than happy! I am assured they are VERY clean! Cleanliness is what matters to me!
Competing interests: No competing interests
Why is the vacuum autoclave in my dentist's surgery able to sterilise instruments whilst the same autoclave is said to be dangerous in my surgery?
Competing interests: No competing interests
Scruffy doctors: time to scrub up?
Dr. Stephanie Dancer’s recent article (1) highlighted many important aspects regarding doctors’ appearances and how doctors are perceived by their patients. Not only does Dr. Dancer discuss the importance of hygiene but she also explores professionalism portrayed by doctors depending on their style of dress. In response to this compelling commentary we designed a survey to further investigate the general public’s perceptions of doctors’ professionalism, hygiene and approachability, all determined by different appearances.
50 randomly-selected members of the general public (45% male and 54% female) examined photographs of the same doctor in 4 styles of work clothes: scrubs; white coat; ‘smart casual’; and a pinstriped suit. Each photograph was scored (0-10, with 10 being the highest rating) according to how professional, hygienic and approachable the doctor appeared. Respondents were then asked whom they would ‘most like to be cared for on a ward’ and whom they would be most confident operating on them.
The highest scoring photograph for professionalism was the white coat (mean=8.38/10), with scrubs (mean=7.96/10) following in second place. Our participants most preferred the scrubs look for both hygienic appearance (mean=8.66/10) and approachability (mean=8.32). Scrubs were preferred over the ‘smart casual’ attire in all 3 categories: professionalism (p<0.005), hygiene (p<0.005) and approachability (p<0.005).
Our group most preferred a doctor dressed in scrubs to treat them on a ward and to carry out their operation; with the white coat appearance following closely in second place for ward care.
These results reinforce Dr. Dancer’s opinion that scruffy doctors may indeed be damaging reputations and that it is time for change. However the reintroduction of the white coat may prove controversial given current infection control policy and is by no means a panacea to placate current impressions of doctors in terms of hygiene and approachability. Instead we believe our research shows that scrubs could provide a balanced solution. They fulfil the public’s idea of what a doctor should look like, near matching white coats in terms of professionalism and surpassing them in terms of hygiene and approachability while addressing any concerns which may be raised regarding infection control.
1. Dancer S. Put your ties back on: scruffy doctors damage our reputation and indicate a decline in hygiene. BMJ 2013;346:f3211
Competing interests: No competing interests
Over the past few months, following a significant event audit meeting, I have been considering the issue of visual identification of doctors and their training grade in UK hospital wards. I have sought feedback from patients, public (including individuals working in the airline industry), medical students, doctors in training and consultant colleagues (including microbiology colleagues with responsibility for infection control) on the possible introduction of a system to address this.
Feedback suggests that there is a problem. There is currently no easy way for patients or colleagues to identify who is a doctor and at what level they are working. Medical students are not distinguishable from doctors in training, who in turn are not distinguishable from medical colleagues who have completed their training. This leads not only to potential confusion, but much more importantly, to potential threats to safe patient care, particularly during clinical emergencies. Individuals could be expected to take on tasks and demonstrate competencies beyond their training grade.
Doctors in the UK appear to be currently out of step with medical colleagues in other countries in this regard and also with colleagues working in other sectors with responsibility for public safety and whose work depends on effective team working. This includes the airline industry, where the wearing of uniforms, which indicate individual roles and responsibilities, is accepted as good practice.
I therefore believe that the time is right for the reintroduction of a uniform for all doctors and medical students in the UK. Feedback suggests that scrubs are not the answer, outside the emergency department, as they are regarded as cold, uncomfortable and insufficiently smart. I therefore propose the introduction of a short sleeved white coat/tunic for all hospital doctors, with the addition of different coloured shoulder epaulettes to denote the grades of doctors in training. Shoulder epaulettes have the advantage of being visible from both the front and back, perhaps vital in a clinical emergency situation. These could be worn over the individual’s own clothing and taken off prior to leaving the hospital environment, for which changing rooms would be required. I also suggest the coats/tunics be designed with a place for the application of Velcro name badges including the doctor’s GMC number. I propose that medical students wear a different coloured uniform, including the name of their medical school and their own name and year of studies.
The introduction of a visual identification uniform could positively impact on patients, non medical colleagues and doctors at all stages of their professional development. It would remove the confusion and uncertainty which currently exists and potentially enhance safe patient care.
Competing interests: No competing interests
I am pleased to see that this issue has garnered a lot of attention and debate. I am a firm believer that the image projected by a healthcare professional, whether doctor or student, is key to the patients' perception of competence.
Work in political psychology has shown appearance has a significant impact on unconscious perceptions of competence (1). Indeed, evaluations of attractive professors are 0.8 points higher on a five point scale (2). It would therefore be advisable for doctors to take note of their own appearance, particularly in a world of patient evaluations and physician rating websites.
Lastly, the placebo effect is an established part of the medical literature (3). It is therefore not inconceivable that perceptions of competence derived from appearance may correlate with outcomes and may be an interesting avenue for future research.
1. Olivola C, Todorov A. Elected in 100 milliseconds: Appearance-Based Trait Inferences and Voting. J Nonverbal Behav. 2010 2010/06/01;34(2):83-110. English.
2. Riniolo TC, Johnson KC, Sherman TR, Misso JA. Hot or not: do professors perceived as physically attractive receive higher student evaluations? The Journal of general psychology. 2006 Jan;133(1):19-35. PubMed PMID: 16475667. Epub 2006/02/16. eng.
3. Benson H, Epstein MD. The placebo effect: A neglected asset in the care of patients. JAMA. 1975;232(12):1225-7.
Competing interests: No competing interests
I am an international medical student from Russia currently studying at the university of Glasgow. On my first visit to a hospital in Glasgow, I was surprised to see that doctors do not wear white coats and are indistinguishable from visitors. The image of a doctor that is imbedded in my mind has always been the same: a female or male in a white coat with a stethoscope around the neck. I was even more surprised to see a female junior doctor wear knee high boots on the ward.
I agree that a doctor's knowledge and ability is more important than their attire, yet a patient should be able to distinguish a doctor from a visitor on the ward. There is a difference between not wearing a tie and looking scruffy. There should never be an excuse for a person of the medical profession to look scruffy, with or without a tie.
Competing interests: No competing interests
Re: Put your ties back on: scruffy doctors damage our reputation and indicate a decline in hygiene
There is no doubt that all health professionals should be smart and adhere to a sensible dress code, however, there is a need to keep in mind the health risks involved in "over-dressing" (this is of course open to debate as was the "bare-below-the elbows" campaign).
As the public becomes more and more aware of cleanliness and infection risk we are always going to be required to reduce the risks of microbe transfer as much as possible. There is only so much one can do with barrier methods and hand-washing.
I am disappointed that, in general, doctors are not required to wear scrubs or a similar form of uniform. Nurses, Occupational Therapists, Physiotherapists and Specialist Nurses (to mention a few groups of professionals) generally have a uniform of sorts, so why not us too? Uniformity and cleanliness does not come at too high a cost.
I am aware of the risks of transfer on leaving hospital too. In fact, on arriving home I change my clothes immediately - even before picking up my one year old daughter.
Competing interests: No competing interests