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Dressing like a doctor: Does the white lab coat matter?

June 16, 2003|Jane E. Allen | Times Staff Writer

Although casual dress has become the fashion rule in many workplaces, we prefer our doctors to be dressed neatly and formally in the old-fashioned white lab coat. So says Dr. Lawrence J. Brandt, a medical school lecturer who has become a 21st century one-man band for the return of dress codes.

He's just written a heavily researched commentary in a major medical journal to make his case.

A few years ago, the chief of gastroenterology at Montefiore Medical Center in the Bronx, N.Y., began noticing that many of the medical students attending his lectures were slouched and unkempt, wearing scruffy jeans and sneakers, toting filthy, beat-up backpacks. There was barely a pressed shirt or a tie to be seen. What a contrast to his medical school days in the late 1960s, when everyone was expected to be neat, well-groomed and professionally dressed.

He noticed the trend among interns and residents not only at Montefiore, but at other hospitals and medical centers as well. "I have stopped people in the halls who didn't know me and said, 'Have you looked in a mirror recently? What would your mother think if she were approached by someone looking like you?' "

Brandt, 59, wondered whether he was being stodgy, or whether a doctor's appearance truly matters. After searching medical literature for studies about attitudes toward doctors' dress, he found that patients do feel more comfortable with a doctor in the traditional white lab coat and name tag. (The exception is so-called "white-coat syndrome" in which patients' blood pressure goes up when a medical professional approaches, but that's linked to anxiety, not attire.) It holds true across all ages, gender and geographic regions.

Brandt's findings are published in an article in the June 9 issue of the Archives of Internal Medicine. He noted that a doctor's appearance was important to the father of medicine, Hippocrates, who said a physician should "be clean in person, well-dressed, and anointed with sweet smelling unguents that are beyond suspicion. For all these things are pleasing to people who are ill, and he must pay attention to this."

The white coat became a medical fixture in the late 19th century, when doctors began to focus on hygiene, because it kept blood and body fluids off a doctor's street clothes. Today, it's practical, with deep pockets that hold tools of the trade, including a stethoscope, reflex hammer and personal digital assistants.

The coat has always been rich in symbolism. It confers scientific rigor and seriousness (just note how many drug ads feature a doctor in a white lab coat), along with purity. Since 1993, most U.S. medical schools have conducted the "white coat ceremony," during which medical students don the white coat they're expected to wear during the clinical part of their training. For example, UC Davis medical students learning how to perform a physical exam are told to always wear the white coat with a name tag.

Sloppy and overly informal attire "just brings the whole level of professionalism down," Brandt said. "As goes the dress, so goes the speech and so goes the personal intercourse."

Brandt believes he's the lone Montefiore doctor to impose a rigid dress code on doctors in training. "If you make the rounds with me in internal medicine, you have to dress as I believe a professional person should dress," he said

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