8 Nip and tuck
Gemma Pilgrim, Tatiana Gutierrez and Claire Hopkins explore whether what women wear in surgery matters and argue for the return of the white coat
Elbow” (BBE) policy in 2007 was a response to the increasing rates of healthcare associated infections (HAI) in Britain’s hospitals, in particular clostridium difficile. Trusts subsequently forbade the wearing of clothing over the forearm area, outlawed wristwatches and other jewellery, and prevented men from wearing ties when providing clinical care. This was intended to “provide a clear signal to patients that doctors are taking their safety seriously”.1 However, during the last
T
four years the healthcare profession has repeatedly had reason to question the validity of the policy. Not only are there misgivings regarding the absence of an evidence base supporting the hypothesis that doctors’ attire contributes to HAI, but there are also concerns that the abolition of a recognisable and professional working uniform renders the doctor looking scruffy and incompetent.2,3
This
has led to claims that this is eroding the doctor–patient relationship and even the reputation of the profession.4 Much of the previously- published research examining patient opinions of different styles of medical workwear have focused solely on male doctors and their dress options.5 Women now make up 59% of the medical workforce, so we repeated the exercise to evaluate how different styles of dress can affect the patient’s perception of their doctor and their ability to identify them.6
50 40 30 20 10 0 Scrubs Suits Figure 2: Graph displaying results of the study White coat Dresses Separates
he implementation of Alan Johnson’s “Bare Below the
Research We conducted a face-to-face questionnaire on 66 willing patients over a two-week period, including inpatients and outpatients. The mean age was 50.4 years (range 22-89 years) and 66% of the respondents were female. Each patient was asked to
study a card that displayed three female doctors dressed in five different dress styles: surgical scrubs, suits, BBE-compliant white coats; dresses and separates (Figure 1).
Questions The participants were asked the following questions: 1) Which job in the hospital do you think each group is likely to do based on what they are wearing?
2) Considering the different outfits shown, which group appears: a. Most/least professional b. Most senior/most junior c. Most/least trustworthy
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Figure 1: A to E – the different modes of dress adopted by the doctors
d. Most/least hygienic e. Most appropriate for outpatients
f. Most appropriate for general practice
3) Overall, how would you prefer your doctor to dress?
Results Figure 2 shows that patients associated wearing a white coat with being a doctor more than any other style of dress. However, 39% of responders did not equate the white coat with the profession of a doctor, choosing phlebotomist, lab worker, caterer and cleaner. This may be related to the decreasing use of white coats, even before the BBE policy was implemented,
and possibly the changing way in which doctors in television shows, such as Casualty, are portrayed. The next most
recognisable style of dress was the surgical scrubs (38%), which might reflect the fact that all of the patients were sourced from surgical wards or clinics. Question two was designed to show how our choice in workwear can affect the impression a patient has about us. The white coat group scored favourably, being rated most professional, trustworthy, and most appropriately dressed by outpatients. It was ranked second for hygiene behind surgical scrubs (42% v 52%), and second
Response of “Doctor” as given to the question: What do these people do in the hospital, according to their dress style?
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FEATURE
NEW DOCTOR | VOLUME 4 | ISSUE 2 | 2011 | UNITED KINGDOM
www.mps.org.uk
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