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Medical school fashion

We asked medical students around the world what they wear

United States

A US study reported that 19% of white coats were contaminated with meticillin sensitive Staphylococcus aureus (MSSA) and 4% with meticillin resistant Staphylococcus aureus (MRSA)¹ but despite risk factors associated with MRSA and MSSA contamination white coats continue to be worn in the United States.

This begins with a “white coat ceremony” in more than 90% of US medical schools.² The ceremony typically takes place during medical school orientation and requires students to (a) communicate their medical responsibilities in the presence of faculty, family, and friends; (b) don a white coat as a pledge of commitment and rite of passage into the medical profession; (c) listen to a well known physician role model’s discourse; (d) and celebrate the event at a reception.^{2 3 4}

The short length white coats worn by medical students and the full length ones worn by most practising physicians is a matter of tradition at US hospitals^{5 6} and remains a mechanism used by some patients to identify physicians.⁷ White coats are so ingrained in medical culture that elevated blood pressure experienced by certain patients when they visit a doctor has been nicknamed the “white coat phenomenon.”⁸ A question that remains to be addressed is whether the length of the white coat can influence the medical consultation.

Anecdotally, most medical students have experienced a “white coat length phenomenon” in which patients modify their medical complaints or history between the medical student interview and the ultimate examination by the student’s physician mentor.

To maintain societal trust in the scientific basis of medical practice, clinical evidence should take precedence over tradition. In this regard, as scientists, modern US physicians must assess and further research the clinical value of the white coat in the context of MRSA and MSSA and their length in the context of the medical interview in order to determine whether wearing a white coat benefits or “contaminates” the medical interview, medical training, and ultimately patient care.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Daniel J Kelley fellow in the medical scientist training programme University of Wisconsin School of Medicine and Public Health, Madison, WI 53705-2221, USA
djkelley@wisc.edu
Student BMJ 2009;17:90 | March

1. Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination of health care workers’ white coats. Am J Infect Control 2008 9 July.
2. Arnold P Gold Foundation. White coat ceremony. 2008. www.humanism-in-medicine.org.
3. Huber SJ. The white coat ceremony: a contemporary medical ritual. J Med Ethics 2003;29:364-6.
4. Gillon R. White coat ceremonies for new medical students.J Med Ethics 2000;26:83-4.
5. Kowalczyk L. Doctor, nurse, or student? Consult the white coat. Boston Globe 2007 Apr 10. www.boston.com/yourlife/health/other/articles/2007/04/10/doctor_nurse_or_student_consult_the_white_coat.
6. Khan I. Are white coats going out of fashion? Student BMJ 2007;15:89-132.
7. Douse J, Derrett-Smith E, Dheda K, Dilworth JP. Should doctors wear white coats? Postgrad Med J 2004;80:284-6.
8. Verdecchia P, O’Brien E, Pickering T, Staessen JA, Parati G, Myers M, et al. When can the practicing physician suspect white coat hypertension? Statement from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Am J Hypertension 2003;16:87-91.

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United Kingdom

The dress code for doctors, medical students, and all healthcare workers should adhere to a fundamental ethos of the Hippocratic oath—do no harm. The National Health Service’s rules about removing white coats and demanding health workers to be bare below the elbows aim to prevent the spread of iatrogenic complications. But such policies are already being discredited, and the removal of the wristwatch has been criticised for hindering accurate readings of respiratory rate and pulse, potentially jeopardising patient safety (BMJ 2008;337:a938).

Whether dress acts as a barrier to doctor-patient communication is more difficult to ascertain. In Manchester Medical School such a line of argument bans T shirts with slogans, visible body art, nail varnish or extensions, extreme hair styles, body and face jewellery (except small stud earrings and wedding rings), wrist bands, revealing clothing, open toed sandals, and footwear with heels.

I have no objections to these prohibitions: it is important to dress with pride. Special attire shows that the job you do is worthy and that you are worthy of performing the job. Everyday clothes show no effort and imply that your job is mundane. Most male UK medical students dress in a respectful way—nice shoes, trousers, shirt, and even a tie. Furthermore, students who dress less conventionally do not share any common characteristic apart from being less conventional medical students in general, and I find that refreshing. The scope for variation and controversy is far greater among my female colleagues, with overly revealing attire seen as distasteful.

Although more traditional consultants may think the 12 o’clock shadow utterly unprofessional, it is viewed by many people in today’s society as acceptable. A doctor with a nose stud may encourage communication rather than alienation in younger patients. These and many other nuances in physical presentation that may conflict with traditional ideas need to be re-evaluated.

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

Daniel Bye medical studentintercalating student in international health
Daniel.Bye@student.manchester.ac.uk
Student BMJ 2009;17:90 | March

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NIGERIA

If you wear cowboy boots, you'll have a hard time on a ward around. Everything else, with a little bit of cunning, is much easier to wing. My sister's medical school in Ibadan has a dress code that frowns on female students wearing trousers; even female doctors are not spared."It's irresponsible," the heads of the school say.

But my school, at the University of Lagos, is a lot more liberal, thank goodness, although the dress code states that student should not wear revealing clothes or T shirts with inscription(any, whatsoever).Men must wear a shirt and matching tie, socks, and tailored trousers. Women are expected to wear a tailored blouse and skirt, or tailored trousers that must be ironed and not too tight. Hair must be decently maintained and headgear can only be worn for religious reasons

Students discover early on that the clinical coat is a good friend, which can hide a multitude of sins-last night's party top with official looking trousers, the rather low cut front of a summer frock, the fashionable wide leather belt with disco metal studs; the list goes on.

This is not to say that anything goes. Many students have been cought out on the coat ruse, and made to returns to their dorms to "change that outfit Ms X"

The thing that most controls how we dress is simply what other people wear. The dress code is a more or less informal one, where students look up to interns, interns in turn look up tp their favourit registerar, and so on, each adding their own pizzazz as they go along.

Friday day is a national informal dress day. In the medical field, people become more brightly coloured, using traditional fabrics

I personally would draw the line at body piercing and visible tattoos, as I feel patients feel more comfortable with someone who is neatly turned out and well presented.

But I also think that asking doctors not to be able to express themselves as human beings robs patients and doctors of the opportunity to relate on an engaging, interesting level.

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

Adepeju O Adeniran medical student, College of Medicine University of Lagos, Lagos , Nigeria
kpeju@gmail.com
Student BMJ 2009;17:90 | March

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Greece

In Greece, the medical profession is strongly tied to the white coat. A visit to a Greek hospital will help you understand the extent of this phenomenon: almost every doctor, regardless of specialty or position wears a white coat.

The earliest photos of the Athens medical school, the oldest of the seven in Greece, show medical students wearing white coats in hospitals and labs so it is an important tradition to us.

We have three pre-clinical and three clinical years, and during the clinical years we are educated exclusively in the university hospitals. Thus, the first thing that every medical student does on entering the clinical setting is to wear their white coat.

Our dress code is very strict. Medical students will not be accepted in a clinic if they are not wearing white coats. They cannot observe the daily rounds or carry out any medical procedure. No excuse is acceptable and the student will miss the day’s clinic. Under the coat, however, students and doctors can wear anything they like, although consultants generally dress more formally.

In my opinion, the white coat creates a mental distance between the doctor and the patient. But is this what we want? Can we gain the patients’ trust if we keep a distance from them and their problems? Wouldn’t the patients feel better and more comfortable if they had a “normal” person next to them rather than a white-dressed professional? The coat can also give a false message of being clean. I don’t really agree with our current dress code, although a dress code is definitely needed. Inappropriate and informal clothes go against the sense of the patients’ aesthetic and may lower their expectations. Our dress really matters and we shouldn’t forget that it shapes the first impression we make on the patient. A dress that is formal enough to show our respect to the patient and that denotes our identity is sufficient. No excess is needed. As an ancient Greek saying goes, “All in good measure.”

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

Panagiotis Ath Dimitriadis undergraduate student National University of Athens, Athens, Greece
pankyp13@yahoo.com
Student BMJ 2009;17:91 | March

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Burma (Myanmar)

“Lining in basket, dressing in human,” a famous Burmese saying equivalent to “dress makes a man,” has not only influenced the general population but the medical world too. Burmese doctors and medical students have, as in other countries, a dress code that enforces dignity and a high professional standard.

The white coat is a lifelong companion for doctors and teaching staff. Without it we cannot distinguish ourselves from patients as there is no rule about wearing identity badges. Wearing a white coat all the time can be very hot, however, and many doctors just hang their stethoscopes around their necks as an identity tag.

Students must dress smartly and according to Burmese culture. Ladies are advised to wear longyis (the long traditional wrap around skirt) or fixed longyis, and trousers and skirts are totally unacceptable. Longyis are not very practical on clinical wards, however. They can easily become loose, which is a truly awkward experience when you’re trying to do something like collect a blood sample.

Tradition stops with the facial veil, and medical students are not allowed to wear these. It is simpler for men, who are required to wear a shirt, trousers, and boots.

Our dress code raises the dignity of our profession. Appearance has a big influence on patients’ response to professional advice and treatment. Although a doctor who has body piercings, dyed hair, wears jeans, and smokes cigarettes may have a certain style, how can he or she educate patients about the disadvantages of smoking and of healthy living?

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

Sun Tun graduate doctor University of Medicine, Yangon, Burma
suntun1@gmail.com
Student BMJ 2009;17:91 | March

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India

“Know first who you are; and then adorn yourself accordingly.”

Euripides (480-406 BC)

In India, the dress code for medical students varies from institute to institute, but the basic principle remains the same. It has to be impressive enough so that patients respect you and sober enough to be acceptable to the professors. Jeans and T shirts are not allowed.

Dressing for the ward is harder for female students. The right compromise between the traditional saree or salwar-kurti with all their inconvenience, and Western dresses with their advantages, is difficult to reach. In reality the problem isn’t that bad because the upper half of our clothing is hidden behind the white coat that signifies our existence. It is no wonder that every semester we need to discard our white coats and get new ones because they cease to be white.

Men stick to formal shirts and trousers while women often wear the indigenous salwar-kurti or a fusion of executive dress. Accessories beyond bare necessity do nothing more than get in the way so they are usually saved for a more social setting.

Doctors’ dress is indistinguishable from students, except that doctors, unlike us, do not always wear a name tag. We are white blots on the hospital landscape.

Dressing well remains a key component of gaining patients’ trust. A scruffy person is less likely to be given the same camaraderie and warmth as a well dressed, washed, starched, pressed boardroom executive lookalike. This is only skin deep, however, and unless one has the necessary skills, being dressed to kill does just that, nothing more.

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

Pranab Chatterjee final year medical student Medical College, Kolkata, India
pranabchatterjee@hotmail.com
Student BMJ 2009;17:91 | March

   

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