What should a clinician wear when consulting with a patient? For many years the answer was simple: a white coat. A long one, if you were qualified, and a short one if you were in training. The white coat symbolized the clinician’s authority; until authority became a non-starter for some clinicians, such as psychiatrists and paediatricians, whose patients had white coat issues.

Patients perceive female surgeons having the same authority regardless of whether they wear white coats or scrubs.

In the United Kingdom, white coats became the enemy. Filthy infection carriers and symbols of unapproachable authority, they were banned from hospital wards. Doctors were also asked to wear short-sleeved shirts and remove their  watches, jewellery and pens. Ties were outlawed but whether that was an act of gender equity or infection control remains unclear.

White coats were to be replaced by a dress code that was supposed to help patients to identify clinical staff on the wards and facilitate good communication. The logic had some imperfections. Rather than banning white coats, banning clinicians from picking their noses would have made more sense as Staphylococcus aureus is a frequent inhabitant in the nasal passages of one in four doctors.

In countries where the white coat is not outlawed it still remains a deity, especially for surgical patients, where formal attire correlates with higher patient trust and confidence. A minimum threshold of a white coat plus two items of formal attire, for example trousers and a button-down shirt, are necessary to inspire a reasonable amount of confidence. That is only for the males on the surgical catwalk. For female surgeons, patients perceive no difference between a white coat or scrubs.

A South African research group used photographs to identify a particular set of clothing that was appropriate for clinicians. Anything non casual was alright in the clothing department. In the footwear arena, flat pumps for women and smart shoes for men were the clear winners.

What we wear should not define whether we are competent. How we interact is key. Differentiation of workers by the clothing they wear, however, has been a contentious issue for many client- facing occupations. Clinical work is no different. Patients still hold men and women clinicians to different standards. The neutralizing effect of a white coat should not be underestimated.