Opinion | When Was the Last Time You Wore a White Coat?

When the COVID-19 pandemic began to dominate all aspects of healthcare, many of our colleagues opted to wear scrubs instead of their routine work attire and white coats. They cited concerns about personal infectious risk and not wanting to bring the virus home to their loved ones on their clothes.

This reluctance aligned with research on the white coat as a nidus for infection, but it conflicted with the powerful symbolism and professional imagery it evokes for patients. Given the conflicting perspectives, we were curious whether other doctors and clinicians across the country continued to dress the way they did in the past or if they were ditching their white coats and business casual attire for scrubs.

To answer this question, we conducted a confidential survey through a private Facebook group comprised of physicians (MD/DOs), nurse practitioners and advanced practice registered nurses (NPs/APRNs), and physician assistants (PAs).

Among the 1,493 respondents, 43.4% routinely wore white coats in the outpatient setting before the pandemic, but only 21.4% wore white coats during the pandemic. Before the pandemic, 24.0% wore scrubs in the outpatient setting; but during the pandemic, the proportion of clinicians wearing scrubs increased to 85.4%.

The overwhelming majority of respondents who switched to wearing scrubs had worn business casual attire prior to the pandemic. Specifically, 86.9% wore business casual clothes before the pandemic and only 16.1% did so during the pandemic.

Most clinicians can probably empathize with these trends. It is convenient and psychologically reassuring to be able to toss our dirty scrubs in a bin and pick up a fresh pair of scrubs without having to worry about viruses, stains, or dry-cleaning costs. And from a comfort perspective, why restrict mobility with a button-up and slacks when you can wear glorified pajamas to work? This trend in medicine seems to mirror the work-from-home athleisure attire that has been adopted by people employed in most other industries.

The evolution in clothing and dress is more significant than just comfort and cost. Symbols, rituals, and traditions have long been important facets of society. People’s rank and importance have traditionally been communicated through their clothes and uniforms.

Healthcare is no exception. In fact, uniforms have been used to outfit healthcare providers since medieval times, helping to distinguish those in medicine from those in various trades. Across millennia, there has been an evolution in what doctors wear based on historical events and the transformation of medical practice.

In medieval times, during the bubonic plague, doctors wore beaked masks filled with flowers or herbs, thick wax-coated leather trousers, ankle-length hooded overcoats, gloves, wide-brimmed hats, and covered boots. These clothes and accessories were thought to protect physicians from contracting whatever was killing patients and served to repel emanations from the bodies of the afflicted. In the 18th and 19th centuries, doctors wore dark and heavy leather coats to symbolize the highly respected status of physicians at the time.

Not until the late 19th century did clinicians switch to white coats. This shift in fashion had multiple reasons, but an important motivation was to distinguish doctors from the barber-surgeons and “quacks” of the time. Over time, the white coat became the most widely recognized symbol identifying physicians in both the inpatient and outpatient settings.

In the 1960s, green surgical uniforms, “scrubs,” were introduced in surgery as the bright lights and all-white environment of operating rooms began to cause eyestrain for surgeons. Over time, their cleanliness and comfort have made them omnipresent in surgical suites around the globe. The demand for scrubs grew massively during the pandemic, with various companies churning out new colors and styles to meet it.

Although there is still controversy about patient preferences for how physicians should dress, research has demonstrated that patients seem to consider both white coats and scrubs as professional attire for doctors. Consistent with that perspective and our survey results, providers across the country engaging in face-to-face patient visits have shifted their attire away from business casual and white coats to scrubs.

Our survey is a reminder of how quickly customs on dress and attire can evolve in the context of major events. Whether the preference for scrubs will persist or if white coats will re-emerge in popularity can’t yet be determined. But it is likely that coming out of the pandemic, the next generation of symbolic attire will arise to reflect a new culture of medicine.

If you shifted attire during the height of the COVID-19 pandemic, do you plan to return to wearing more formal clothing in the future?

Janet Chao, MD, is otolaryngology chief resident and Yan Lee, MD, an otolaryngologist at Yale School of Medicine in New Haven, Connecticut.

This post appeared on KevinMD.