Pediatric resident Ibukun Akinboyo noticed some recent journal articles on physician attire and the illustrious white jacket, which prompted her to look into why some physicians, particularly pediatricians, tend not to wear it. She was also curious about patients’ and parents’ perceptions of the white jacket and what it represents to them. What did she find?
“Rather than intimidation and fear, which some pediatricians see in the child’s face, it’s been shown that children perceive the doctor in a white coat as safe and confident,” Akinboyo reported at a recent Johns Hopkins Children’s Center Grand Rounds.
Indeed, when 100 4-to-8-year-olds and their parents were asked to choose their preferred physician from photographs of doctors with and without white jackets, children selected physicians in the white coats 69 percent of the time, and parents did so 66 percent of the time (Pediatric Emergency Care 1998;14(3):198-201).
Similarly, studies have found that the presence of a white coat, especially on a female physician, increased patients’ trust and willingness to share sensitive information. Patients’ general preference is for formal attire and the use of white coats.
So, why then do pediatricians—along with psychiatrists—tend not to forego the white jacket? Many of them, Akinboyo said, still subscribe to the “white coat syndrome,” a condition in which the mere sight of a white coat causes a patient to experience a surge in anxiety, accompanied by a spike in blood pressure. Then, there’s also the matter of hygiene.
“Pediatricians interact with children who sometimes spit up and vomit,” Akinboyo said. “You can easily clean off your hands but it’s hard to clean off a white coat.”
That raises an antiseptic, as well as an aesthetic, issue for pediatricians. Can the physician’s attire be a vehicle for transmitting microorganisms and pose a contamination risk for patients? And does the white jacket, which tends to be laundered less often than regular clothing, pose an even greater risk (Journal of Hospital Infection 2000;45:65–68)?
“The answer is unclear,” Akinboyo said. “You can have contamination of the white coat but we haven’t shown that there can be transmission to the patient.”
For both antiseptic and aesthetic reasons, hospitals do establish guidelines for physician attire. Some follow a BBE (bare below elbows) approach and recommend that staff wear short sleeves and avoid the wrist watch, jewelry or ties. Johns Hopkins outpatient standards, distilled from patient preferences, specify—
• Clothing be clean and well kept
• Pant lengths reach ankles
• No jeans, spandex, glitter, sequins, logo shirts
• Closed toe shoes and dress boots, and
• Lab coats are worn over business attire when interacting with patients.
So, white coat on or off?
“I’m not pushing that we wear or not wear the white jacket,” said Akinboyo, “but the take-home message for pediatricians is that we should pay attention to why we’re making that choice.”