In the ever-evolving landscape of medical practice, the attire of physicians remains a subtle yet powerful communicator of professionalism, trust, and competence. A recent comprehensive systematic review published in BMJ Open sheds new light on how patients perceive physicians’ clothing in a broad range of clinical contexts and cultural settings, unraveling the nuanced dynamics of dress codes in modern healthcare. Spanning research published between January 2015 and August 2024, this meta-analysis synthesizes findings from 32 studies across multiple continents, revealing enduring preferences for traditional white coats alongside emerging acceptance of more practical attire such as scrubs.
Historically, the symbolic role of physicians’ attire underwent significant transformation during the 19th and 20th centuries. Initially, doctors wore black garments, emphasizing the solemnity and gravity of medical consultations. The advent of germ theory and an increased understanding of hygiene propelled white coats to prominence, underscoring cleanliness and scientific rigor. This shift entrenched the white coat as a globally recognized standard of medical professionalism, conveying trust and a sense of clinical authority. Despite its iconic stature, recent decades have seen challenges to this tradition, influenced by evolving clinical environments and infection control policies.
The review found that patient preferences for physician attire are heavily context-dependent. In low-acuity settings, such as primary care, casual dress complemented by white coats was generally acceptable and engendered patient confidence. Conversely, in high-stakes environments like emergency rooms, both white coats and scrubs were favored, the latter increasingly associated with practicality, hygiene, and readiness to respond to urgent situations. In stark contrast, in palliative care—a setting imbued with emotional sensitivity—the clothing of physicians appeared to bear little impact on patient trust or perceptions of competence, suggesting that relational and communicative factors outweigh visual cues related to dress.
Medical specialty further modulates patient expectations around physician attire. Disciplines traditionally linked to surgical intervention or invasive procedures, including orthopedic surgery, dermatology, ophthalmology, and obstetrics-gynecology, tended to evoke preferences for white coats. This may reflect entrenched cultural notions that equate white coats with authoritative expertise and meticulousness. Intriguingly, male physicians who donned suits, often complemented by accessories such as watches and glasses, were perceived as more professional and trustworthy. These sartorial choices, in turn, reflect a confluence of social norms and gender-based expectations influencing the doctor-patient dynamic.
However, a persistent gender bias emerged in the form of misidentification of female doctors as nurses or medical assistants, regardless of identical attire with their male counterparts. This phenomenon was consistently documented across disparate geographical and cultural contexts, highlighting deeply embedded stereotypes in healthcare perception. The consequences are far-reaching, potentially undermining female physicians’ authority and complicating patient interactions. This disparity underscores the pressing need for institutional policies and public education aimed at addressing and mitigating gender bias within healthcare environments.
The attirescape of surgeons likewise reveals striking gender-specific preferences. While male surgeons wearing white coats over scrubs were less favorably viewed than those in suits, female surgeons received higher preference ratings when dressed in white coats over scrubs compared to suits or casual clothing. This asymmetry suggests that society holds divergent benchmarks for professionalism and competence based on gender, reinforcing that female physicians’ appearances are scrutinized more intensely and impact patient perceptions differently than their male peers. Given the limited number of studies addressing these nuances, the authors call for more rigorous research to substantiate and explore these preliminary findings.
The recent COVID-19 pandemic precipitated a considerable shift in both physician attire and patient attitudes toward it. Emphasizing infection control and ease of movement, doctors increasingly favored scrubs, often coupled with face masks and other protective equipment. Patient preferences mirrored this adaptation, with a pronounced tilt toward hygienic, functional clothing over traditional sartorial markers of status. This pivot reflects not only practical necessities but also a heightened collective awareness of contagion risks, underscoring the dynamic interplay between public health imperatives and medical image.
Notably, institutional dress-code policies such as the United Kingdom’s ‘bare below the elbows’ initiative, which prohibits white coats, long sleeves, ties, and wristwatches, exemplify a systemic effort to minimize infection transmission vectors. These regulations challenge conventional attire norms, prioritizing hygiene over symbolism. Yet, patients still demonstrate a marked preference for white coats, associating them with qualities such as trustworthiness, skillfulness, respectful communication, and empathetic care. This tension between infection control measures and patient expectations presents a complex dilemma for healthcare organizations intent on balancing safety with patient satisfaction.
Geographical disparities permeated the reviewed studies—with the bulk conducted in the United States, fewer from Asian and European nations, and none from South America. Such skewness in data sources limits generalizability and highlights the urgent need for broader international research to capture cultural variations in how physician attire influences patient perceptions. Equally, many studies relied on self-reported data from adult patients, omitting vulnerable groups like children and individuals with mental health conditions—populations whose perceptions might differ substantially and warrant targeted investigation.
The cumulative insights from this review advocate for flexible, context-aware dress codes tailored to specific clinical specialties and patient demographics. Rather than rigid adherence to tradition, medical institutions are encouraged to embrace variability that harmonizes practitioner comfort, infection control, and evolving patient preferences. Such adaptability could enhance trust, improve compliance with medical advice, and ultimately augment clinical outcomes through strengthened doctor-patient rapport. Further research exploring how attire intersects with other non-verbal cues, such as body language and verbal communication, could enrich understanding of the psychosocial components underpinning healthcare interactions.
In conclusion, the white coat remains a potent emblem of medical professionalism, yet its primacy is increasingly negotiated amid changing societal attitudes, gender dynamics, and public health contexts. Patient perceptions are not monolithic but vary widely based on clinical setting, specialty, and physician gender. As healthcare systems strive toward inclusivity and excellence, recognizing and addressing these nuanced views on physician attire emerge as an essential component of patient-centered care. The findings underscore a broader imperative: confronting implicit biases and adapting institutional norms to reflect both scientific evidence and patient values in a rapidly transforming world.
Subject of Research: People
Article Title: Patient perception of physician attire: a systematic review update
News Publication Date: 12-Aug-2025
Web References: http://dx.doi.org/10.1136/bmjopen-2025-100824
References: Not explicitly listed in the source content
Image Credits: Not provided
Keywords: Health care
