Early in the COVID-19 pandemic, Trisha Pasricha, MD, a gastroenterologist and research fellow at Massachusetts General Hospital in Boston, was talking to a patient who had been hospitalized for a peptic ulcer.
Like other physicians in her institution, Pasricha was wearing scrubs instead of a white coat, out of concern that the white coat might be more prone to accumulating or transmitting COVID-19 pathogens. Her badge identified her as a physician, and she introduced herself clearly as "Dr Pasricha
Like Shaffer, Workman has seen changes in physicians' attire during video meetings, where they often dress more casually, perhaps wearing sweatshirts. And in the hospital, more are continuing to wear scrubs. "But I don't see it as people trying to consciously experiment or push boundaries," she says. "I see it as a more organic, subtle shift."
Petrilli thinks that, at this juncture, it's "pretty heterogeneous as to who is going to return to formal attire and a white coat and who won't." Further research needs to be done into currently evolving trends. "We need a more thorough survey looking at changes. We need to ask [physician respondents], 'What is your current attire, and how has it changed?' "
Navigating the Gender Divide
In their study, Steinberg and colleagues found that respondents perceived a male model wearing business attire underneath any type of outerwear (white coat or fleece) to be significantly more professional than a female model wearing the same attire. Respondents also perceived males wearing scrubs to be more professional than females wearing scrubs.
Male models in white coats over business attire were also more likely to be identified as physicians, compared with female models in the same attire. Females were also more likely to be misidentified as nonphysician healthcare professionals.
Shikha Jain, MD, assistant professor of medicine at the University of Illinois Cancer Center in Chicago, told Medscape that Steinberg's study confirmed experiences that she and other female physicians have had. Wearing a white coat makes it more likely that a patient will identify you as a physician, but women are less likely to be identified as physicians, regardless of what they wear.
"I think that individuals of color and especially people with intersectional identities — such as women of color — are even more frequently targeted and stereotyped. Numerous studies have shown that a person of color is less likely to be seen as an authority figure, and studies have shown that physicians of color are less likely to be identified as 'physicians,' compared to a Caucasian individual," she said.
Does that mean that female physicians should revert back to prepandemic white coats rather than scrubs or more casual attire? Not necessarily, according to Jain.
"The typical dress code guidance is that physicians should dress 'professionally,' but what that means is a question that needs to be addressed," Jain said. "Medicine has evolved from the days of house calls, in which one's patient population is a very small, intimate group of people in the physician's community. Yet now, we've given rebirth to the 'house call' when we do telemedicine with a patient in his or her home. And in the old days, doctors often had offices their homes and now, with telemedicine, patients often see the interior of their physician's home." As the delivery of medicine evolves, concepts of "professionalism" — what is defined as "casual" and what is defined as "formal" — is also evolving.
The more important issue, according to Jain, is to "continue the conversation" about the discrepancies between how men and women are treated in medicine. Attire is one arena in which this issue plays out, and it's a "bigger picture" that goes beyond the white coat.
Jain has been "told by patients that a particular outfit doesn't make me look like a doctor or that scrubs make me look younger. I don't think my male colleagues have been subjected to these types of remarks, but my female colleagues have heard them as well."
Even fellow healthcare providers have commented on Jain's clothing. She was presenting at a major medical conference via video and was wearing a similar outfit to the one she wore for her headshot. "Thirty seconds before beginning my talk, one of the male physicians said, 'Are you wearing the same outfit you wore for your headshot?' I can't imagine a man commenting that another man was wearing the same jacket or tie that he wore in the photograph. I found it odd that this was something that someone felt the need to comment on right before I was about to address a large group of people in a professional capacity."
Addressing these systemic issues "needs to be done and amplified not only by women but also by men in medicine," said Jain, founder and director of Women in Medicine, an organization consisting of women physicians whose goal is to "find and implement solutions to gender inequity."
Jain said the organization offers an Inclusive Leadership Development Lab — a course specifically for men in healthcare leadership positions to learn how to be more equitable, inclusive leaders.
A Personal Decision
Pasricha hopes she "handled the patient's misidentification graciously." She explained to him that she would be the physician conducting the procedure. The patient was initially "a little embarrassed" that he had misidentified her, but she put him at ease and "we moved forward quickly."
At this point, although some of her colleagues have continued to wear scrubs or have returned to wearing fleeces with hospital logos, Pasricha prefers to wear a white coat in both inpatient and outpatient settings because it reduces the likelihood of misidentification.
And white coats can be more convenient — for example, Jain likes the fact that the white coat has pockets where she can put her stethoscope and other items, while some of her professional clothes don't always have pockets.
Jain notes that there are some institutions where everyone seems to wear white coats, not only the physician — "from the chaplain to the phlebotomist to the social worker." In those settings, the white coat no longer distinguishes physicians from nonphysicians, and so wearing a white coat may not confer additional credibility as a physician.
Nevertheless, "if you want to wear a white coat, if you feel it gives you that added level of authority, if you feel it tells people more clearly that you're a physician, by all means go ahead and do so," she said. "There's no 'one-size-fits-all' strategy or solution. What's more important than your clothing is your professionalism."
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