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What to wear?

March 2008

I am the type of person who has to be reminded that combining plaids and stripes is never in style. So, while I do believe that one should always dress professionally, I don’t put a great deal of thought into to planning my “outfit” on any given day. Yet as part of a new hospitalist group that is being rebuilt, I’ve lately been thinking more about the subject of hospitalist attire.

Don’t get me wrong: There are plenty of issues that deserve much more attention and energy, and I don’t have physicians showing up for work in jeans, T-shirts and flip-flops. But the issue isn’t wholly unimportant for several reasons.

One is the recent article, “What to wear today? Effects of doctor’s attire on the trust and confidence of patients.” Another is the fact that the British Medical Association last year suggested that getting rid of functionless clothing could help reduce rates of hospital-acquired MRSA infections. And one final reason: I find myself more and more wearing a blue gown and gloves in the rooms of all of my patients.

Like almost any profession, it’s important in hospital medicine to make a good first impression on patients, clients and colleagues. The “What to wear” article in the November 2005 American Journal of Medicine makes a strong case for professional attire and white coats. Such attire was favored by 76.3% when compared to surgical scrubs (10.2%), business dress (8.8%) and casual dress (4.7%). That heavy preference was also significantly associated with greater trust and confidence. Finally, some evidence-based medicine to help me win over my tie-phobic colleagues!

Yet like so many “ground-breaking” articles in medicine, this is not the end of the story. According to our ER friends in the July 2005 Journal of Emergency Medicine, “Emergency physician attire does not affect patient satisfaction” when comparing white coats and formal attire vs. scrubs. Similarly, our GYN colleagues in the February 2007 American Journal of Obstetrics and Gynecology found that, “Patients are equally satisfied with physicians who dress in business attire, casual clothing, or scrub suit.”

The stakes may seem low, but not if you add the current MRSA crisis into the mix. A small study done at the New York Medical Center in Queens in 2004 found that half of the 42 physician-worn ties tested carried MRSA. On the heels of the British Medical Association’s concerns, hospitals in Britain will ban all non-functional clothing, ties included, effective this year. This will mean the demise of traditional long-sleeved white coats, neckwear, jewelry, watches and fake fingernails.

Although no formal evidence exists to suggest that not wiring a tie or watch will decrease the risk of transmitting MRSA, it make sense to eliminate any possible risk, including non-functional attire. That’s particularly true of any attire that may dangle over a patient or be worn on our hands or wrists and come into contact with those we attend.

Regardless of what we wear to work, employing good hygiene is the key to infection control. That makes it increasingly difficult to argue that we should be wearing professional clothing to work, yet such clothing has a positive impact on our interactions with patients.

So, how do we reconcile these competing demands, which turn out to be not so trivial after all? Short of wearing a scrub top fashioned like those annoying T-shirts with a tuxedo front, I am not sure what the best answer is, and I am curious to hear what other groups are doing. Do some groups allow the day-time team to round in scrubs, or are shirts, slacks and ties still de rigueur?

For now, we will probably continue to wear professional attire, but use gowns and gloves when encountering any patient with a MRSA risk. And whether or not we wear ties or scrubs, we will never go into a room or leave it without washing our hands, which is by far the most important part of our daily ritual.