“The dress code is at least business casual. Make sure that your earrings aren’t too big, and your makeup is not too loud.” These were the instructions I received from a young production assistant during a mandatory audio-visual check. I was presenting as an expert at a virtual national medical conference – and I was taken aback by these details. I politely thanked the representative, and proceeded back to my day of patient encounters and virtual meetings.
Patients and colleagues comment to me frequently on my clothing; to my great relief, it is mostly complimentary. I take careful note of the fact that people not only notice my sartorial choices, but feel the need or desire to comment on them as well. I observe, for example, that my male colleagues receive far less commentary on their clothing, but not because they dress any less notably or professionally than I tend to. The recommendation from my production colleague before a virtual presentation to particularly pay attention to my jewelry and makeup not only irked me because of its specifically gendered nature, but due to the fact that it came at all.
Does it matter what physicians wear? A 2018 BMJ Open Study, which surveyed more than 4,000 U.S. patients across 10 tertiary care centers, suggested that in the realm of patient satisfaction, physician attire indeed matters.1 More than 50% of patients indicated that this made a difference in their experience of care and overall satisfaction. Preferred attire in the primary care setting was formal attire (collared shirt and slacks for both men and women, with tie for men); in the emergency department, scrubs; and in the inpatient setting, formal attire. White coats with these options were preferred everywhere except for with surgeons; there was no significant difference for female surgeons to wear or not wear a white coat, whereas male surgeons were preferred to wear scrubs alone. The study was notably limited by the fact that all physicians pictured were young, slim and Caucasian.
Perhaps just as tellingly, there was acknowledgement of variations in attire: The female and male counterparts are dressed in the same limited attire. But attire is always gendered; in a separate 2020 study of orthopedic surgeons, it was found that female surgeons who wore feminine business attire instead of scrubs were perceived as significantly less likely to excel at performing the physical part of surgery than female surgeons in scrubs.2
In the grand scheme of priorities for physicians, where does attire rank? A physician’s ability to complete their professional responsibilities is of clearly greater import than what they wear. But attire, just like all contexts of medical encounters, is a traditional part of the patient experience.
For male physicians, iconic representations of physician attire are available going back through the ages. Norman Rockwell paintings, representations of country doctors visiting sick children, images of surgical theaters – almost all contain only representations of men. A piece in the Gentleman’s Gazette even offers helpful tips on obtaining the classic physician wardrobe.3 For women, there are fewer historical visual representations. Though television is making headway in its representation of female physicians, the true diversity of ages, races, shapes and sizes present in the female physician workforce is at best only partially represented.
So, it comes back around to the question: What to wear? Many corporate health care organizations maintain general guidelines mostly aimed at trainees but inclusive of employees that include ideas of modesty and appropriateness (avoid: tight-fitting clothing, bare midriffs, low necklines, strapless tops and miniskirts), and encouragement for appropriate grooming is included. Interestingly, the United Kingdom’s National Health Service additionally offers the caveat that skirts are not to be higher than 5 cm above the knee.4 Advice from peers on this subject is highly varied in both content and quality. The blog Corporette (a self-described blog for “overachieving chicks”) maintains a conversation about appropriate female physician attire, which focuses on the experience of several individual physicians and their preferences for casual knits or certain brands of flat shoes.5 The not-incorrect-but-hardly-helpful advice is offered to maintain a neat hairstyle. In short, there is a vacuum of guidance on a subject of great import for the everyday experience of female doctors.
The reality is that the female physician workforce is growing constantly – and increasing in relative proportion every year. The choice – or preconceived notion – of what female physicians should wear has not been already circumscribed or dictated by generations of female physicians in front of us. Female physicians – many of us the first in our families – are living a bit of an experiment, trying on clothing every day that speaks to our professionalism and capabilities, but that seeks also to express some of who we are and how we steered our course to this profession.
The multitude and competing nature of many societal expectations for professional women makes the choice of attire particularly difficult. Sartorial choices for all physicians convey a tone to patients, other providers and academic audiences that are important and individual all at once. Ability and knowledge remain the core substance of the foundation of any physician role. What we wear remains an essential signal about who we are, particularly so as women continue to establish standards for generations of physicians yet to come.
Dr. Evans Phillips is associate editor of the ACMS Bulletin and assistant professor of Gastroenterology at UPMC; her research is focused on pancreatitis and genetic cancer syndromes. She can be reached at [email protected].
References
1. Petrilli, C. M., Saint, S., Jennings, J. J., Caruso, A., Kuhn, L., Snyder, A., & Chopra, V. (2018). Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA. BMJ Open, 8(5), e021239.
2. Goldstein, S. D., Klosterman, E. L., Hetzel, S. J., Grogan, B. F., Williams, K. L., Guiao, R., & Spiker, A. M. (2020). The Effect of an Orthopaedic Surgeon’s Attire on Patient Perceptions of Surgeon Traits and Identity: A Cross-Sectional Survey. J Am Acad Orthop Surg Glob Res Rev, 4(8), e20 00097-00011.
3. Schneider, S. R. (2017). Dressing the Doctor: A Physician’s Guide to a Classic Wardrobe. Retrieved June 13, 2021, from https://www.gentlemansgazette.com/dressing-the-doctor-classic-wardrobe/
4. National Health Service Foundation Trust Uniform and Dress Code Policy. (2020). Retrieved June 13, 2021, from https://www.ncic.nhs.uk/policies/navigate/6904/339
5. Griffin, K. Fashion for Doctors. Retrieved June 13, 2021, from https://corporette.com/fashion-for-doctors/