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Dr. Hospitalist: Your Hospital Medicine Questions Answered


 

What’s up with the dress code in hospitals these days? Some of my colleagues wear white coats, some wear ties, some have short-sleeved shirts. Some even wear scrubs in the daytime, and they swear they are right as to “the most clinically appropriate attire.” Any thoughts?

Attirely Concerned in Los Angeles

Dr. Hospitalist responds:

There are a lot of suggestions out there regarding attire. The United Kingdom’s National Health Service is probably most famous for instituting a “bare below elbows” (BBE for short) dress code in 2007.

Although lots of studies have shown bacterial colonization on the items doctors wear or carry (e.g. pagers, pens, neckties, coats, scrubs), none of them truly show causality. The Journal of Hospital Medicine just published a study on scrubs versus white coats, which showed no real difference in contamination.1

Even the BBE policy was meant to promote hand-washing more than anything else. On that point, there is little disagreement, as there is a substantial amount of data to show that good hand hygiene is a patient-care imperative. We all should spend more time thinking about “clean in/clean out” when it comes to patient rooms than deciding which article of clothing carries the fewest bacteria.

There is another issue at play here, though, and that is the question of how hospitalists are expected to dress. Certainly, there is some regional variation. I don’t think you’ll find that physicians at the Mayo Clinic in Rochester, Minn., are going to dress the same as physicians in San Diego or Hawaii.

So, setting aside the cultural expectations for your region, I do think it’s a good idea for your group to agree on some standards. These policies might vary from white coats for everyone to scrubs after hours, or that blue jeans are OK only on weekends.

Why bother?

Well, for starters, a little consistency will promote the professionalism of your group, and it also sets some baseline expectations for everyone involved. Think about how many healthcare providers wander into a patient’s room during the day: You want to be readily identifiable as the treating physician. No, it’s not just how you dress (a voice, a name badge, and putting your name on the white board also count), but it is part of the picture.

As a hospitalist, not only are you a professional, but, by definition, you are going to meet patients with whom you have no prior relationship. Like it or not, perception matters, and when you need to quickly gain the trust of a patient (and a family) to make urgent clinical decisions, being dressed professionally will help. Looking like a slob won’t.

My advice? First, wash your hands where the patient can see you. If you have to use that gel 40 times a day, you might as well make a show of it. Two, dress professionally within the parameters that your group outlines.

Beyond that, I don’t think you need to autoclave your peripherals and go through a decontamination room just yet.

Reference

  1. Burden M, Cervantes L, Weed D, Keniston A, Price CS, Albert RK. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: A randomized controlled trial. J Hosp Med. 2011;6(4):177-182.

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