Surgeons Will Probably Want to Avoid This Scrub Color

Clinicians wearing green scrubs were most strongly recognized as surgeons, a small survey study found, while black scrubs consistently evoked negative associations.

Of 113 adult patients and visitors who looked at pictures of models in four scrub colors, green was chosen most frequently as strongly identifying male (45.1%) or female (41.6%) examples of surgeons, followed by light blue scrubs, reported Casey Hribar, BS, a medical student at the University of North Carolina at Chapel Hill, and colleagues.

Respondents chose blue scrubs, however, as their top pick for most caring in both male (56.6%) and female (48.7%) clinicians, the group detailed in a JAMA Surgery research letter.

For each trait tested, male and female clinicians wearing black scrubs ranked most negatively among the four scrub colors (the fourth being navy):

• Least caring: male (55.8%), female (58.4%)
• Least trustworthy: male (44.3%), female (54.9%)
• Least knowledgeable: male (44.3%), female (40.7%)
• Least skilled: male (40.7%), female (45.1%)

The scrub color a physician wears can leave a small-yet-important first impression, Hribar told MedPage Today, as verbal, nonverbal, and physical cues all play a role in the doctor-patient relationship.

“We’re spending a lot of money in scrubs for hospital systems, but has anyone stopped to ask the patients?” she said, explaining the impetus for the research.

Participants also characterized their choices, with some finding green to seem janitorial, and “black scrubs to seem like morticians or death,” said Hribar.

Scrub colors were selected based on television shows set in hospitals, Hribar said, because not everyone surveyed might have spent time in a hospital setting seeing doctors in scrubs. By looking at shows from “M*A*S*H” to “Grey’s Anatomy” to “Chicago Med,” the researchers hoped to capture scrub colors that participants of different ages might have been exposed to. The four traits were chosen based on what Hribar’s group thought might be “most impactful,” but also what others had examined in prior research.

“There was more and more research coming out about scrubs versus formal attire, or formal attire versus white coats, and it seemed like especially as we got closer to the pandemic … there was a big transition to scrubs, and patients seemed to be OK with that, especially in procedural settings,” said Hribar. “But that’s kind of where the literature stops.”

Participants were adult patients and visitors at the University of North Carolina Medical Center at Chapel Hill who responded to an electronic survey. Researchers used Likert-style scales to rank two sets of four images (male and female sets).

Respondents were also stratified by age — 18-30 years (n=24), 31-60 years (n=60), and over 60 years (n=29) — and researchers noted an association between the youngest age group of respondents and selection of least trustworthy for the male models wearing green (41.7%) and blue (29.2%) scrubs, with a similar trend for least caring.

The narrow variety of physician models and age being the only demographic information collected were among the study limitations cited by the authors.

Hribar said that colors worn in hospitals have changed over time to serve various purposes or convey meaning. Early physicians did wear black to signify the formality and seriousness of medical matters. Later, white outfits became a signifier of cleanliness, and a white coat communicated scientific credibility. Increasing efforts have been made to build “humanized” healthcare spaces, with color among the considerations.

But with limited resources, small changes like the color of scrubs could be better than none. “We can’t always change the color of every single wall. We can’t always change that every room has a window,” Hribar said. “But we can take something that’s super simple and make these tiny adjustments.”

The next step, Hribar said, is to expand the research to include more types of providers and patients. Ultimately, though, she said it could affect system-wide choices. “I think it could scale all the way up to saying we change the way hospitals purchase their scrubs, or the way they assign or don’t assign dress codes.”

Perhaps just as important is clinicians actually knowing how their choices might affect a patient’s perception.

“What if we ask the physicians what they think?” said Hribar. “We might overwhelmingly get a bias in the opposite direction — that they love the black [scrubs] because they hide stains, they’re flattering.”

For now, it’s changed at least one person’s awareness. “It did make me double-take the last time I was ordering scrubs,” said Hribar.