Letter to the Editor: Editor’s Spotlight/Take 5: Physicians’ Attire Influences Patients’ Perceptions in the Urban Outpatient Orthopaedic Surgery Setting

To the Editor,

Thank you for publishing the recent article by Jennings and colleagues [1] regarding physician attire and patient perceptions of care. I also appreciated the Take Five commentary [2] on white coats and professionalism.

It was reassuring for me to learn that white coats on male surgeons are associated with higher patient ratings in confidence, intelligence, surgical skill, trust, ability to discuss confidential information, caring, and safety compared to business attire. This favorable rating of white coats also applied to female surgeons regarding confidence, ability to discuss confidential information, trust, and safety. Furthermore, white coats were preferred by patients compared to business attire for male and female surgeons.

For 35 years, I have encouraged my students, residents, fellows, and staff to “dress for patients” and wear a white coat. I believe that more formal, conventional dress inspires confidence among patients and reduces patient anxiety.

The following sentences are copied from our Adult Reconstruction Fellowship Manual at the Kaplan Joint Center.

“Adult Reconstruction Fellows at Newton Wellesley Hospital are expected to comply with a code of conduct that maintains the highest standard of professionalism. This includes words, actions, behavior, and personal presentation during clinical and academic activities … Personal presentation is an important component of professionalism, and personal presentation of healthcare professionals is important to patients … Adult Reconstruction Fellows at NWH are expected to make rounds on patients in professional attire wearing white lab coats. Scrub suits are not appropriate attire for clinical and academic activity outside of the operating room … When fellows must leave the OR in scrubs, white lab coats should be worn.”

I acknowledge that white coats may create an authoritarian atmosphere, and white coats may serve as vectors for transmission of disease. However, in my opinion, the potential benefits of inspiring patient confidence and trust and reducing patient anxiety with a white coat outweigh potential adverse responses to a white coat.

When caring for patients, there is no substitute for knowledge and skills, but our appearance can reduce patient anxiety, and patient outcomes can improve when anxiety is reduced. Substance should always trump form in our professional activity, but the best among us will always find a way to present both form and substance to our patients.

Thank you for publishing the study by Jennings and colleagues, as well as for presenting your thoughts. I hope our colleagues are reading and listening.