Physician Attire And Gender Bias

A Question of Attire: The White Coat, Gender Bias, and Patient Trust

A doctor’s traditional lab coat remains a potent emblem of reliability and expertise for patients, yet this conventional garment is also at the centre of a persistent issue of gender bias. A worldwide analysis of studies has shown that while patients feel reassured by the sight of this professional attire, they frequently misidentify female doctors as part of the nursing team or other healthcare support staff. This disparity highlights deeply ingrained societal expectations and their impact on the perception of medical professionals. The way physicians dress, it appears, carries a weight of meaning that extends far beyond simple aesthetics, influencing patient confidence and even the respect afforded to practitioners based on their gender.

The Enduring Symbolism of a Doctor's Coat

For well over a century, the medical coat has served as the pre-eminent emblem of the medical profession. Its adoption in the late 19th and early 20th centuries marked a significant shift in medicine. Before this, physicians commonly wore black, a colour that reflected the formal and often grim nature of medical encounters. The transition to white was a deliberate move to align medicine with the rigour and cleanliness of science. It came at a time when figures like Joseph Lister were revolutionising surgery with antiseptic practices, fundamentally changing the understanding of hygiene.

The garment became a visual representation of this new, scientific approach. It symbolised purity, sterility, and a commitment to cleanliness, which helped to build public trust in a profession that was actively distinguishing itself from the quackery of the past. This association was so potent that the garment was established as the conventional uniform for doctors everywhere. The coat itself is more than just clothing; it represents authority, candour, and the immense responsibility of the medical profession. For many patients, it is a source of reassurance and a visual cue for competence and care.

First Impressions and Patient Confidence

The attire of a healthcare professional is a powerful, non-verbal communication tool that shapes the crucial first impression. In the often stressful and unfamiliar environment of a clinic or hospital, patients rely on visual cues to make rapid judgements about the competence and reliability of their caregivers. A growing body of evidence shows a clear link between a physician's clothing and a patient's confidence and trust. Studies consistently find that patients report feeling more at ease and willing to discuss sensitive issues, such as social or psychological problems, with a doctor who is dressed in professional clothing.

This perception is not merely superficial. The trust established in these initial moments can have a tangible impact on health outcomes. When patients feel a strong sense of confidence in their physician, they have a greater tendency to adhere to medical advice and treatment plans. Consequently, the decision of what to wear is not just a matter of personal preference for a doctor; it is a factor that can genuinely influence the effectiveness of the patient-physician relationship and the overall quality of care provided.

A Pervasive Gender Bias in Perception

Recent research highlights a troubling and persistent gender bias in how patients perceive doctors based on their clothing. A comprehensive review, analysing 32 studies from around the globe, found that women practitioners are consistently and unfairly judged on their appearance more so than their male colleagues. This scrutiny directly affects patients' assessments of a female doctor's professional conduct and ability. The most striking finding is the frequent misidentification of female doctors as part of the nursing staff or as clinical aides, even when they wear the exact same professional attire as men, including the symbolic medical coat.

This issue of mistaken identity was consistently observed across various cultural settings, from the US and Germany to India and Japan, indicating it is a widespread phenomenon rooted in deep-seated gender stereotypes. Such biases mean that female physicians must often navigate an extra layer of scrutiny where their clothing choices significantly influence perceptions of their capability. This reality underscores the urgent need for medical institutions to address these ingrained biases and promote a more equitable environment for all their medical staff.

Unconscious Bias and its Impact

The misidentification of female doctors is often driven by unconscious bias, which are subtle, ingrained stereotypes that affect our understanding and actions without our awareness. These biases are shaped by lifelong exposure to societal narratives and media portrayals, which have historically presented physicians as predominantly male. As a result, many people, including patients, unconsciously associate maleness with medical authority. This can lead to instances where a female doctor's expertise is questioned or overlooked, while a male colleague, even a junior one, is automatically assumed to be in charge.

Research shows that both men and women hold these gender biases. This can manifest in patients interrupting female doctors more often or perceiving their communication style differently than that of male doctors. Such biases not only undermine the authority of female physicians but can also create a challenging work environment and contribute to burnout. Addressing unconscious bias requires a conscious effort from both individuals and institutions to challenge these automatic assumptions and recognise professionals based on their credentials and expertise, not their gender.

Differing Standards for Male and Female Surgeons

Assumptions about physician attire based on gender are particularly evident in surgery. Studies have revealed intriguing, albeit different, patient preferences for the clothing of surgeons of both genders. Male surgeons wearing a suit with a medical coat, or just scrubs alone, are often seen more favourably by patients than those who wear a medical coat over their scrubs. This suggests that for male surgeons, a clear distinction between formal business wear and practical surgical gear is preferred. It appears patients associate suits with authority and scrubs with preparedness in the operating theatre.

Conversely, female surgeons are rated more highly when they wear a medical coat over their scrubs compared to when they are in suits or casual clothes. This finding aligns with the broader evidence that female doctors face greater scrutiny regarding their appearance. The preference for a medical coat on a female surgeon may reflect a subconscious need for an additional, explicit symbol of authority to overcome inherent gender biases. These differing standards highlight the complex interplay of gender, professionalism, and perception within specialised medical fields.

The Influence of Accessories on Perceived Authority

Beyond the main garments, smaller details can also significantly shape a patient’s perception of a male physician's authority. Research has shown that accessories like timepieces and eyewear can have a notable impact on how professionalism and trustworthiness are judged. When worn by male doctors with formal attire, these items appear to enhance their perceived credibility and authority in the eyes of many patients. This suggests that even subtle visual cues contribute to the overall impression of capability and reliability.

This perception adds another layer to the complex issue of physician attire, where every element of a doctor's appearance can be subject to interpretation. However, it is important to note that the very accessories that might boost a male doctor's perceived authority are restricted in some healthcare settings. For instance, the UK's "bare below the elbows" policy prohibits watches and other wrist jewellery to minimise infection risks. This creates a direct conflict between patient perceptions of authority and essential infection control protocols, highlighting the challenges institutions face in setting dress code policies.

The Rise of Scrubs and the COVID-19 Effect

The recent coronavirus outbreak significantly shifted patient attitudes towards medical attire. Before the global health crisis, formal clothing, often paired with a medical coat, was the widely preferred standard for physicians. However, the pandemic brought a heightened awareness of hygiene and infection control to the forefront of the public consciousness. This led to a greater acceptance and even preference for scrubs, which are seen as practical, hygienic, and appropriate for high-risk settings.

During the pandemic, many doctors reported favouring scrubs for their ease of movement and hygiene benefits. Patient preferences mirrored this shift, with studies showing people felt increasingly at ease with doctors dressed in scrubs. While the medical coat still holds its symbolic value, scrubs have become firmly established as an acceptable and often preferred alternative, particularly within urgent or high-acuity environments. This change reflects a broader evolution in healthcare, where practicality and safety are increasingly valued alongside traditional symbols of authority.

The Psychology of Colour in Medical Uniforms

The colour of a medical professional's uniform can also have a psychological impact on both the wearer and the patient. Different colours evoke distinct emotional and psychological responses. White is traditionally associated with cleanliness, purity, and trust, which is a primary reason it was established as the norm for medical coats. In contrast, colours like blue and green are known to have a calming effect, which can help to reduce patient anxiety. This is why scrubs are often produced in these soothing shades.

Other colours have different associations. Yellow, for instance, can act as an antidepressant and create a more activating environment, while darker shades of blue might evoke feelings of sadness. The concept of "enclothed cognition" suggests that the clothing a person wears can influence their own psychological processes and behaviour. For healthcare workers, wearing a clean, well-fitting uniform can boost self-confidence and reinforce a sense of purpose and professionalism, which in turn can positively affect their performance and patient interactions.

Context is Key: Attire Preferences Across Specialties

Patient preference for a doctor's attire is not uniform; it varies significantly depending on the clinical setting and medical specialty. For example, in high-acuity areas like emergency rooms or operating theatres, there is a strong and consistent preference for scrubs. Patients associate this attire with preparedness and hygiene, which is reassuring in an urgent care context. Similarly, specialties like anaesthesiology and gastroenterology, which often involve procedures, also see a preference for scrubs.

In other contexts, the medical coat remains dominant. Patients in fields such as dermatology, ophthalmology, and neurosurgery tend to prefer that their doctors wear these coats. Interestingly, in primary care settings, the evidence is more mixed. Some studies suggest that a combination of casual attire with a medical coat can make a doctor seem more approachable and improve communication. In palliative care, however, a doctor's clothing appears to have very little impact on patient trust or their perception of competence, suggesting that in this highly sensitive field, relational skills far outweigh visual cues.

The 'Bare Below the Elbows' Policy in the UK

The National Health Service (NHS) in the United Kingdom introduced a significant change to its dress code back in 2008 by banning the long-sleeved white coat. This decision was part of the "bare below the elbows" (BBE) policy, which also prohibits wristwatches, ties, and long sleeves. The primary driver for this policy was infection control. The Department of Health aimed to reduce the risk of healthcare professionals spreading infections by ensuring their hands and wrists could be thoroughly decontaminated, and by preventing clothing from coming into contact with patients.

However, the policy has become a subject of debate since its implementation. Uncertainty about whether sufficient evidence justified the ban was voiced at the time by the British Medical Association. While some studies suggest that being bare below the elbows facilitates more effective handwashing, others have found no significant difference in bacterial contamination between long-sleeved and short-sleeved uniforms. This leaves a tension between infection control protocols and the strong patient preference for the conventional medical coat as an emblem of reliability and professionalism.

Institutional Responsibility to Foster Equity

The widespread evidence of gender bias tied to physician attire places a significant responsibility on hospitals and healthcare organisations. These institutions are urged to take proactive steps to address and reduce patient bias. This involves more than simply setting a dress code; it requires a conscious effort to foster a culture of equitable perception for all medical professionals, regardless of gender. Initiatives could include public awareness campaigns or clear visual identification systems in clinical settings to help patients correctly identify the roles of their caregivers.

Furthermore, medical institutions should consider adopting more flexible and context-dependent dress codes. Recognising that patient expectations change based on the clinical environment—from the emergency room to a primary care office—can help tailor attire guidelines appropriately. The ultimate goal is to create a healthcare environment where every physician is judged on their skills, knowledge, and compassion, rather than on their appearance or adherence to outdated gender stereotypes. By actively working to mitigate bias, institutions can improve the working lives of their female physicians and strengthen the trust at the heart of the doctor-patient relationship.

The Impact on the Wearer

The psychological impact of uniforms extends to the healthcare professionals who wear them. The concept of wearing a uniform can reinforce a sense of identity and belonging to a professional group. For many, putting on a medical coat or a set of scrubs is a mental cue that prepares them for the responsibilities and challenges of their role. This is part of a psychological phenomenon known as "enclothed cognition," where the symbolic meaning of clothing influences the wearer's thoughts and behaviour. A professional uniform can boost confidence and enhance a sense of competence.

However, the daily experience of wearing medical attire is not always positive. For patients, being required to wear a standard hospital gown can lead to feelings of vulnerability and a loss of personal identity. For doctors, especially women, the constant misidentification and scrutiny based on their clothing can be emotionally taxing and undermining. These experiences highlight that clothing in a healthcare context is never neutral; it carries a significant psychological weight for everyone involved, shaping interactions and influencing feelings of confidence, control, and respect.

Navigating Patient Preferences and Practicality

Healthcare institutions face the complex task of balancing patient preferences, professional image, and the practical demands of medical work. Patients overwhelmingly prefer formal attire with a medical coat, associating it with trust and competence. Yet, in many clinical situations, scrubs are far more practical, offering comfort, ease of movement, and superior hygiene. The recent global health crisis highlighted this, accelerating the acceptance of scrubs among both patients and physicians.

A recent study found that patients actually rated physicians in scrubs higher in terms of professionalism, friendliness, and empathy compared to those in formal office attire. This suggests a potential shift in perceptions, where the practicality of scrubs is now regarded as a sign of a competent, hands-on professional. For female physicians, scrubs had the added benefit of reducing the negative bias in perceived professionalism that was observed when they wore formal attire. This evolving landscape suggests that the ideal dress code may be one that is adaptable and prioritises both safety and the psychological comfort of patients and staff.

The Broader Context of Gender Inequity in Medicine

The issue of how female doctors are perceived based on their clothing is part of a much larger pattern of gender inequity in medicine. Despite the fact that women now make up half of all medical students in the US, significant disparities persist. Women in the medical field are still underrepresented in leadership positions, often receive less favourable evaluations, and face a persistent gender pay gap. These inequities are frequently rooted in the same unconscious biases that lead to a female doctor being mistaken for a member of the nursing staff.

These biases can subtly and systematically disadvantage women throughout their careers. The stereotype that associates men with career and leadership roles, and women with nurturing or support roles, remains pervasive. This can affect everything from who gets invited to speak at conferences to how research is evaluated. Addressing the gender bias in perceptions of attire is therefore not just about clothing; it is a crucial step toward dismantling the broader structural inequities that continue to challenge women in medicine.

Moving Toward a More Equitable Future

Creating a more equitable future in medicine requires a multi-faceted approach. On an institutional level, it means implementing transparent processes for hiring and promotion and providing implicit bias training for all staff. It also means actively promoting and sponsoring women for leadership roles and other opportunities. On an individual level, it involves being more mindful of our own potential biases. This includes making a conscious effort to use formal titles when addressing physicians, regardless of their gender, which can help to reinforce their professional status.

For medical education, it means ensuring that students are aware of these gender dynamics from the beginning of their training. The traditional Coat Ceremony, a modern rite of passage marking the start of a medical career, symbolises the moment a student takes on the mantle of professionalism. This is an ideal opportunity to discuss the responsibilities that come with the coat, including the importance of upholding respect and equity for all colleagues. Ultimately, changing long-standing societal beliefs is a slow process, but by actively working to challenge biases, the medical community can move closer to a future where every doctor is recognised and respected for their expertise alone.