Should GPs wear uniforms?

I like a man in uniform. I like a woman in uniform. I like getting onto a plane and being able to instantly recognise the pilot. I like knowing whom to ask when I can’t find the 14x100mm galvanised timber screws in Bunnings.  I like never having to ask, “Excuse me, do you work here?”

I also like to be in uniform myself.  After over a decade as an un-uniformed GP, I now spend most of my working week as a uniformed medical educator for North Coast GP Training.  And I love it. Not just the work but the clothing in which I do it. The uniform helps me feel part of a team and gets me in the mood (for work!).  It decreases my need to go clothes shopping, which some may see as a negative but for me is a blessing. Most appealingly of all, it simplifies the what-am-I-going-to-wear-today decision made when half-awake each morning.

Meanwhile, it seems that in the clinical setting, dress standards appear to be dropping. I recently visited a practice at which a young GP was consulting in a crumpled T-shirt, frayed jeans and scuffed thongs.  Now I’m far from a snappy dresser myself and normally take little notice of or interest in what others wear, but even for the North Coast of NSW this seemed rather inappropriate. I don’t want to rant on about professionalism, hygiene and O,H&S as microbiologist Dr Stephanie Dancer did in the BMJ (1), but I have to admit that I’m partial to doctors wearing a uniform of sorts.

Since the 1800s, the “uniform” of doctors has been the white coat.  Give any Australian child a picture of a well-groomed, white-coated adult carrying a stethoscope and the response will be “Doctor!”, even though the chances of that child having ever seen an actual doctor in such attire are next to none.

As a medical student, I was not allowed on the wards without a white coat, professional attire and covered leather shoes. Another was once turned away from a ward round because he wasn’t wearing a tie.  A year later the same consultant refused him, as an intern, permission to go home sick, and three elderly patients died after contracting his respiratory tract infection; but I digress.  At the major metropolitan hospital at which I did my early training, while white coats for doctors were definitely on the way out, there were still strict dress codes.

Nowadays, both white coats and ties have been ditched by the majority.  Both have copped flack over being “unhygienic”, and ties have been deemed a safety risk by some institutions as they apparently make excellent nooses.  While fears that white coats are common vectors for nosocomial infections have been largely dispelled (2) (3), the argument that they are arrogant and egotistical ensigns which interfere with doctor-patient relationships continues to hold sway.

Anti-white-coaters claim traditional garb is worn to signify superiority of status and intellect, making wearers less able to interact meaningfully with their patients.  While this may apply in some circumstances, it is not a universal truth.  Interestingly, a study published earlier this year in JAMA Internal Medicine suggested that families of patients in ICU saw white-coated doctors as the most knowledgeable and honest, and the best providers of overall care (4). Those dressed in scrubs also fared well.  It suggested that when it came to life and death matters, people wanted to deal with clinicians who looked like the quintessential doctors portrayed on TV.

I don’t think white coats are likely to make a fashion comeback in Australian general practice anytime soon, but I would love to see uniforms take off.  Personally, I like the idea of scrubs – the clothing, not the TV show. They are comfortable, practical, hygienic (when regularly washed!), come in an assortment of colours and styles and make us instantly recognisable. They may not be the most flattering or fashionable items, but they should cut down the number of “Excuse me, do you work here?” enquiries, which has to be a good thing for patients and doctors alike.

1. http://www.bmj.com/content/346/bmj.f3211

2.  http://www.amsj.org/archives/2490

3. http://www.medpagetoday.com/upload/2011/2/11/864_fta.pdf

4. http://archinte.jamanetwork.com/article.aspx?articleid=1653992

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