Patients are still more likely to trust doctors and consider them more professional when they wear white coats, although women doctors in this attire are often misidentified as nurses or medical assistants, finds a review of the available research on the topic, published in the open access journal BMJ Open.
But patient preferences for doctors' attire seem to be strongly influenced by clinical context and medical specialty, with a growing acceptance of scrubs, especially in emergency or high-risk settings, the findings indicate.
In the 19th century, doctors primarily wore black, because medical encounters were viewed as serious and formal occasions. But with the growing emphasis on hygiene and scientific advancements in medicine, white coats represented cleanliness and professionalism and became standard attire for doctors worldwide in the 20th century, note the researchers.
Since the publication of a previous comprehensive review of the published research on the impact of doctors' attire at work, which highlighted the significant role this has in patient satisfaction, trust, and adherence to medical advice, healthcare practices and societal expectations have evolved, they explain.
The researchers therefore wanted to update those findings, broadening the scope to include diverse clinical contexts, in a bid to gain a deeper understanding of how doctors' attire might influence interactions with patients and treatment outcomes.
They scoured research databases for relevant studies published between January 2015 and August 2024. From an initial haul of 724 studies, 32 were eligible for inclusion in the review.
Most of the studies were carried out in the USA (17); two each came from Japan, China, and Pakistan; and the rest were carried out in Indonesia, India, Ethiopia, Korea, Germany, Malaysia, Saudi Arabia, Singapore and Switzerland.
Clinical setting had some bearing on patient preferences. For example, palliative care doctors' attire didn't affect patients' trust, or assessments of the practitioner's capabilities, but patients preferred emergency care doctors to wear white coats or scrubs. And they were happy for primary care doctors to be dressed casually and to wear white coats.
Specialty also seemed to influence perceptions, with patient preferences for doctors to wear white coats observed in orthopaedics, surgery, dermatology, ophthalmology, and obstetrics and gynaecology, for example.
The included studies indicated a distinct preference among patients for male doctors to wear suits. One study indicated that accessories, such as watches and glasses worn by male doctors significantly enhanced perceived professionalism and trustworthiness, which aligns with the findings of previously published studies, note the researchers.
The UK, however, has implemented a 'bare below the elbows' policy, which bans doctors from wearing white coats, watches, ties and long sleeves to minimise infection risks.
And even when male and female doctors wore identical attire, female doctors were still more likely to be misidentified as nurses or medical assistants—a misidentification that was consistently observed across different cultural settings.
But patients preferred white coats over business or casual attire for both male and female doctors, and irrespective of gender, they favoured doctors wearing white coats, perceiving these practitioners to be trustworthy, respectful, skilled, communicative and empathetic.
Notably, male surgeons wearing a white coat over scrubs were looked on less favourably than those wearing a suit with a white coat, scrubs, or just a suit. On the other hand, female surgeons in white coats over scrubs were preferred over those in suits or casual attire.
"This preference aligns with recent evidence indicating that female physicians are often judged more on appearance than their male counterparts. The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold," write the researchers.
"These gender-specific preferences for surgical attire were each supported by a single study and warrant further validation… None the less, gender-related perceptions of physician attire were consistently reported across studies with a low risk of bias, supporting the robustness of this theme," they add.
A few studies explored doctors' attire during the COVID-19 pandemic, when numerous doctors reported a preference for wearing scrubs to prioritise hygiene and ease of movement.
These studies consistently reported a shift in patient preference towards practical and hygienic attire, such as scrubs and face masks, reflecting heightened sensitivity to infection control, say the researchers.
The researchers acknowledge various limitations to their findings, in particular the fact that most of the included studies were carried out in the USA, there were none from South America, and only a few from European, Asian, and African countries. Many of the studies also relied on self-reported data, and none included children or patients with mental health issues.
"While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings," they write.
"The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians, which highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients," they add.
Medical institutions should consider adopting flexible dress codes that align with patient preferences for different clinical environments and medical specialties, they suggest.
