Scrubs, suit, or jeans—what should doctors wear to work?BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3611 (Published 21 July 2015) Cite this as: BMJ 2015;351:h3611
- Kathy Oxtoby, freelance journalist, London, UK
Kathy Oxtoby considers varying expectations of what doctors should wear
The demise of the white coat has created a problem for many doctors. It has made it much harder for doctors to know what to wear at work, as well as how to stand out from other colleagues in the healthcare team.
“We have a deep seated need for doctors to look different from us,” says Mark Salter, a consultant psychiatrist in London. “There is a whole mythology around being a carer or healer, which is expressed through how they dress— their ‘uniform.’”
For many doctors, the white coat was a badge of office of which they could be proud. Instantly recognisable, for doctors starting out in their career it was a sign that they had “arrived.” “When you’d just graduated, you’d get your white coat from the hospital laundry and it was a symbol that you had started your new life,” says Brian Kelly, a consultant paediatrician for NHS Greater Glasgow and Clyde.
The white coat was also functional, allowing doctors to coil their stethoscope in one large pocket and cram books and notes in the other. But, like battle dress, it also took a battering. Salter remembers life as a junior house officer in 1983, working 120 hours a week, “covered in grime, dirt, and blood.”
“We went from life, to death, to horror. The white coat was more than just a coat—it was our armour then,” he says. With the realisation that this battle dress was also a potential infection hazard, the white coat was permanently consigned to the laundry bin in the 1990s.
After the white coats were put away, ties became a way for some male doctors to express their individuality and their professional status. Some doctors saw ties as a harmless accessory or a sign of smart dressing, and Steve Turner, a consultant paediatrician and senior clinical lecturer at the Royal Aberdeen Children’s Hospital, acquired a selection of Disney and Simpsons ties to make his young patients feel more at ease. But by the early 2000s, they were also believed to be an infection risk, and they are now rarely worn on the wards.
Some doctors still mourn the loss of the white coat. “When we wore white coats we looked quite smart, and like doctors,” says Derek Machin, a consultant urological surgeon at Aintree University Hospital, Liverpool. “Now the average doctor looks like a building labourer.”
Machin says that “doctors can be the scruffiest people in hospitals,” often wearing jeans and sweat shirts. “The state of clothing within the profession is a complete mess, and having people walking around wearing all sorts is seriously deprofessionalising,” he says.
Others have no regrets that the white coat has gone. “I think it’s fantastic as it was a symbol of a ‘Sir Lancelot Spratt’ atmosphere on the wards, and singled out doctors as being superior,” says Turner, name checking the pompous surgeon from the Doctor in the House films. The white coat made patients feel ill at ease, he says, and it even gave its name to the phenomenon of white coat hypertension.
Some doctors say there is still a dress code among doctors. Andrew Goddard, registrar for the Royal College of Physicians, says doctors use different types of clothing to differentiate and distinguish themselves from colleagues.
“It’s quite tribal how doctors dress,” he says. “For example, if a consultant is wearing a three piece suit, matching tie and silk handkerchief, it’s likely that everyone else in the team will dress the same way.” He also believes that doctors can identify different specialties by their choice of dress.
As a urological surgeon, Machin still opts to wear a suit, white shirt, and tie for patient consultations. Plastic surgeon Beryl De Souza says her specialty tends to wear smart clothes in clinic and theatre gear when operating—mainly greens or blues—“which is impersonal and does not distinguish theatre staff from surgeons.”
Those working in emergency medicine often wear scrubs. Chris Moulton, vice president of the Royal College of Emergency Medicine, drove the move towards scrubs in his emergency department in the 1990s. “Doctors in the specialty were wearing jeans and T shirts, so we at the Royal Bolton Hospital were one of the first to change to scrubs,” he recalls.
As a male paediatrician, not wearing a tie, sporting sombre colours, and opting for short sleeved shirts—bare below the elbows for hygiene reasons—suits Turner. He believes this attire shows professionalism, while not being too formal for children.
Psychiatrists are noted for taking a more laid back approach to what they wear at work, but that does not mean they shouldn’t still look professional, says Claire O’Donnell, a trainee psychiatrist based in south west London. “There is less pressure in psychiatry to wear a suit than perhaps in surgery, particularly for women surgeons who may feel they need to be more ‘alpha female,’ wear big heels and power dress,” she says.
But O’Donnell doesn’t believe there is a place for jeans or trainers when working as a psychiatrist. “You want your patients to feel like you are a professional and that sense of professionalism would be lost if things become too casual,” she says.
Keith Hopcroft, a general practitioner in Essex, believes there is still some truth to the stereotype that the male GP wears a tweed or cord jacket with elbow pads. “It’s probably because we’re a bit boring and predictable dress wise, and favour function over flair,” he says.
Brian Kelly believes doctors should be rated on what they do, not on what they wear. But he does feel “uncomfortable when colleagues turn up looking scruffy or are inappropriately dressed in T shirts and jeans.”
Machin believes that first impressions count for patients. For him that means wearing a suit and tie. “If I saw a patient [when I was] wearing a T shirt and shorts I might be a good doctor but I’d have a hell of a worse time treating patients,” he says. “This is because people have traditional ideas and you need to fulfil their expectations and build their trust.”
By contrast, Nigel Mathers, honorary secretary of the Royal College of General Practitioners and a GP in Sheffield, favours informal dress and has never worn a tie to work. “In our practice we’ve always dressed informally, as we believe that by looking open and relaxed it makes it easier for patients to talk to us about intimate and difficult things,” says Mathers.
This lack of uniformity means that doctors and patients may find it difficult to know who is who in healthcare. Individual trusts have their own dress codes, such as different colour coded uniforms. But for patients it can be hard to identify people.
“It can be confusing when patients are faced with orange, yellow, and green uniforms, and aren’t sure who is a porter and who is a doctor,” says Turner.
For doctors, particularly when new to a trust, working in a busy department, or when there is a high turnover of staff, it can be hard to tell who does what within the healthcare team. “When you’re working, say, in a busy intensive care or A&E [accident and emergency] department, where there are so many different doctor and nursing roles, it’s important to know who is who, but that’s not always apparent,” says Sally Davies, president of the Medical Women’s Federation, and a clinical genetics consultant.
To tackle these problems, Moulton would like to see a national uniform where the colours that healthcare professionals wear are the same nationwide. “People need to know who you are, and we need uniforms to show this,” he says.
Goddard believes it would be better to have standardised, colour coded name badges. “That way patients and doctors can see who a person is and what role they have,” he says. A simple introduction, both to patients and to colleagues, would also help to identify who you are and what you do, he suggests. “We need to have a culture of everybody knowing who everyone is,” says Goddard.
For Turner, smart but professional means a return to something not dissimilar to a school uniform—“a ‘greyness’ that fully accepts the rules.” “That’s not a bad model for a uniform requirement for healthcare professionals,” says Turner.
Comfort is also a key consideration whether you’re on the wards or in general practice. “Comfort is important, particularly for junior doctors who are on their feet for long periods, so it’s important to have comfortable but smart shoes,” says Davies.
Doctors’ choice of dress is a way of expressing what they do and their desire to make patients feel better, says Salter. “It’s also about sharing the fear of illness, as we all do—and that we as doctors know what to do. What we wear must also reflect being different, showing the subtle nuances of each specialism, while at the same time, being like everyone else.”
Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.