Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

The Clothing Dilemma
in Medicine: What Not To Wear?

Lately, I've found myself in a bit of a funk when it comes to getting dressed for work. It's been quite some time since I've made significant changes to my wardrobe, and I've reached that point where I'm bored with my clothes.

My funk was made even worse the other day when my wife, who had just finished one of her reorganizing binges (she does these about every 3-4 months), came up to me and casually said, "I don't like your ties." She had taken some of my ties and rolled them up as a display in one of her little boxes. During medical school and residency, she had worked as a retail merchandiser for a few different companies and still has that penchant for display in her blood. As such, she seemed to find it important to display my ties. The first time I saw her work, I thought it was very nice. The next day, though, as I was dressing for work, I looked a bit more critically at the display. As I viewed the ties, with their varying patterns, I started to see what she was talking about: I stopped liking the ties. Blah. Boring. Humdrum. Same old same old.

The funk worsened.

Figure 1. The infamous tie display in question.

Then, as usual, I started thinking about my clothing from a medical perspective. For most of the population, choosing what clothes to wear each day is a matter of personal choice and style, a type of communication that says, "Hey, look at me. This is my style." Although this may be true for those of us in the medical field, there's a bit more to our dress than that. Our clothing has ramifications beyond simple fashion.

Let's take those ties I was complaining about. From a social standpoint, the tie increases the level of formality which may be important in my role as an assistant professor at a university. If I'm giving a lecture to a large group of people, the tie – and it's implicit formality – may appear more professional. Similarly, when I meet with university administration, as I do sometimes as part of my job, the tie may be necessary to again impart that professionalism.

As with many academic centers, at Western University, the white coat has a certain significance. Because we have many different professional programs and levels of medical professionals (students, residents, technicians, nurses, and attendings), the white coat serves to demonstrate the hierarchy of the University. It also functions to identify the various programs and levels of training.

But what happens in the clinical realm? Clothing now takes on an augmented role. A relatively recent 2005 study from the Medical University of South Carolina found that doctors dressed in professional attire and white coat were viewed as more trustworthy in discussing sensitive issues (Rehman, et al 2005). Interestingly, this was more significant for women than men. A similar study found that patients in an OBGYN clinic preferred the resident physicians to be dressed in white coats (Cha, et al. 2004). This view has apparently not changed since the 1980s to 1990s, as noted in a 1991 study in which patients were found to prefer their male physicians to dress in professional attire and white coat (McNaughton-Filion, et al. 1991). If you believe these studies, you should be dressing in tie or dress clothes and white coat.

But there's another face to the clothing dilemma: infection. One study found that 28.46% of white coats were colonized with microbial flora, predominantly Staphylococcus aureus and Escherichia coli (Pathey, et al. 2010). Similar numbers where found by Treakle, et al in Baltimore, Maryland. They found 23% of white coats were contaminated with Staphylococcus aureus, 18% of which were MRSA (Treakle, et al. 2009). This has become such a concern in England that they created the "bare below the elbow" policy in which ties and long sleeves are not allowed in the clinical setting.

It seems pretty obvious that white coats and ties are likely to be highly contaminated, and this is especially true in the podiatric realm. For many of us, dealing with lower extremity issues is a dirty business. I can't even count how many wounds of various types I've seen and treated over the past seven years. While treating a foot ulcer or abscess the last thing I want is a tie falling into the wound. Yuck. This problem is compounded by the fact that white coats and ties are laundered on an irregular basis. Double yuck.

Each of us has to make our own choices when it comes to dress. Whether you're formal with a tie, less so with slacks and a shirt, or going with scrubs, is up to you. But shouldn't the risk of infection outweigh the possible patient preference? I'll echo the fine words of one of my colleagues that says, we in podiatry should wear scrubs to work. I agree with him. Medicine is a dirty business, and we should do what is necessary to stay clean and halt the spread of disease. As such, I'm planning to boycott the tie during all of my clinical days. It may not be as clean as scrubs, but it's a start.

Maybe I'm no longer in such a funk. A little medical perspective always lightens the mood. Of course, this could all be a sophisticated ruse to justify the boredom with my wardrobe. Ho hum…