You are what you wear

Could donning a white coat garner you more respect, trust, and compliance from clients? To find out, take a look at the data.

By Craig Woloshyn, DVM

Man, I just totally don't get it,” Dr. Tad Klewless grumbled as he picked at the mustard stain on his scrub top. “Old Rex really needed a culture to clear up that gnarly ear problem I've been messing with for the past six months. And, jeez, those teeth! But, every time I bring up the procedures he needs, his owner just stares at me, totally blank, like she can't understand English. Man, what's up with her?”

In a living room nearby, a frustrated husband asked his wife if Rex's problems would be resolved soon. “Oh, Dear, I just don't know,” his wife said dejectedly. “When that kid-doctor speaks, I can't understand a word of it. I'm not too confident that he knows his stuff, either. And, frankly, I don't even know who's who at that place. I can't tell the veterinarian from the kennel boy half the time.”

Now, at the risk of being simplistic, I have a solution that's cheap and easy and requires little effort, just a change in attitude. Here it is: Pretend you're a doctor, and wear a white coat.

The white coats are coming

Your rebuttal: Clothes don't make the man, and a white coat doesn't make the doctor. What you wear doesn't affect your clients' opinion of you or your abilities. They come to see a medical expert, not fashion model.

Well, Doctor, let's see if history and science leaves you with a blue-jeaned leg to stand on. My first premise: A veterinarian's relationship with clients mirrors that of a physician's relationship with patients. Our clients and their patients are the same people. They're the ones we have to communicate with, who must be convinced of our skills and sincerity, and who are responsible for complying with our recommendations. So in this context, the studies done in human medicine will serve us nicely. Here we go.

The history of the white coat goes back to the 19th century, when scientists were busy discovering the basic principles of medicine. At the time, doctors were quacks and charlatans out fleecing sick folks and folks with sick animals. Scientists were respected; doctors weren't. Scientists wore the coats; doctors didn't.

As doctors began to apply scientific principles to their doctoring, they borrowed the scientists' lab coat as a way to adopt science's mantle of authority. After a brief flirtation with beige short-sleeved coats in the late-19th century, the medical profession adopted the white coat.

These white coats convey that “a physician's responsibility is not only to take care of patients, but also to care for patients,” according to a historical article in The Journal of the American Medical Association. Some more poetically refer to the white coat as a cloak of compassion.

The color of that cloak of compassion holds special connotations. White, the color of purity and cleanliness, symbolizes the high purpose of medicine and the purging of infection. It's the symbol of our knowledge, the visual mark that we've accepted and hold to the traditions of the medical profession. When I wear one, it's a constant reminder of the severity and seriousness of my work.

OK, so historically we have the most powerful piece of clothing in the Western world, a little tog that displays our knowledge, compassion, and seriousness to everyone who sees us wearing it and brings us respect and attention. So who wouldn't want to wear one? Apparently, most of us doctors. Look around most veterinary practices and what do you see? Wardrobe by Rumpled Scrubs Inc.

When did white coats get tossed into the remnant pile? In the mid-20th century, sociologists declared that white coats put distance between doctors and their patients, making medical care more difficult. So out went the white, and in came the scrubs, sandals, and long hair.

Most doctors were happy to wear whatever they wanted. Sociologists were happy that everyone was now a “partner in healthcare.” But, somehow, everyone forgot to ask the patients if they were happy—until recently.

The worth of white

During the last decade or so, lots of studies have looked at human patients' attitudes toward doctors in various attires, and amazingly, they've been in close agreement. Essentially, these studies have found that more than half of patients prefer doctors to wear traditional white coats, about 15 percent are uncomfortable with doctors in white, and the rest don't care.

Piling on more evidence, an interesting study in Family Practice (October 1998), “Is Our Appearance Important to Our Patients?” had participants look at photos of doctors dressed in white coats or casual attire and asked them which doctors they'd trust more. The result: Respondents said they trusted the doctors in white more, showing that patients' initial visual perceptions of doctors in white coats may be even higher than previously thought. Never underestimate the power of first impressions.

An interesting twist: Children who've been surveyed also have a preference for doctors in white, according to a Barrett and Booth study in the British Medical Journal (December 1994). Even the young recognize that a white coat means competence and expertise.

Appearance into action

So white coats are adult- and kid-approved. But does wearing a white coat change our clients' behaviors? Does it make our clients listen better or take our advice more often?

To decide, let's look first at the conclusions from a study by Gooden et al. in The Medical Journal of Australia (August 2001): “Patients reported feeling more confident and better able to communicate with doctors who wore white coats. The recognition, symbolism, and formality afforded by a white coat may enhance communication and facilitate the doctor-patient relationship.” Basically, wearing white increases clients' trust in you. And Thom et al., in a review in Health Affairs (July/August 2004), determined that patients' trust in their doctor predicts their treatment compliance and their continued use of that physician. And an earlier Thom et al. study published in Family Practice (October 2002), found that people who don't trust their doctor are less likely to comply with medical recommendations and more likely to complain about their care.

Hmmm. In light of these findings, that white coat looks useful, doesn't it? Just putting on a white coat enhances trust and communication, and clients take us more seriously. The result: Clients more often do what we ask and feel more satisfied with the care we provide.

Maybe if Dr. Klewless had been wearing a white coat his client would have taken him more seriously. Maybe she would have believed him when he recommended getting Old Rex's stinking teeth pulled. The power to get results—not bad for a $30 piece of white cloth.

Buddy, you're out of touch

But that $30 piece of cloth doesn't fit in today's casual world, you say. Uniforms distance doctors from their clients and patients. Fine, I'll agree with the sociologists here, informal dress does make us seem friendlier to our clients. But I contend this desire to be our clients' friends is disingenuous. In fact, though you may be on a friendly basis with clients, you're not their friend—you're something much more significant. You're their doctor.

Here's why: A friend isn't responsible for the health of a family member. A friend has no liability if he or she makes a mistake. A friend can be wrong about a medical condition and be forgiven. Few people entrust their beloved pet to a friend during an illness. And it's rare that a friend is burdened with the duty to tell a client his pet is terminally ill or to talk about end-of-life issues and euthanasia.

You're never your clients' friend. You're their advisor, their teacher, their expert opinion, their hired gun, but never their friend. Your white coat is a clear symbol of your role as their veterinarian and automatically defines and reinforces the relationship between you and your patient.

The healer's habit

Of course, wearing a white coat won't solve every problem. You still have to keep up with your continuing education, be a concerned and compassionate caregiver, and put your patient above all else in order to be a great doctor. No clothing exists that can make a bad doctor a good one. But when a good, dedicated doctor wears a white coat, the coat only reinforces and strengthens the clients' trust in their veterinarian's abilities and talents.

You are what you wear. And the symbol of all that is good and powerful about our profession is yours for the wearing. So try one on for size. After all, you've earned it, something few others have accomplished. Slip this white little number on and don the mantle of learning and responsibility passed down from one generation of doctors to the next. You'll be more respected by your clients. They'll listen harder and maybe communicate better as you attempt to heal their beloved pet.

And, if they do, maybe your ability to practice excellent medicine will increase, and maybe you'll start enjoying practice a bit more. Who knew that the key to a fulfilled life lay in a piece of cloth? Well, I did, and if you don't believe me, there's only one way that I'll convince you. Go on, put on a white coat and learn what the right uniform can do for you.

Dr. Craig Woloshyn wears his white coat at Animal Medical Clinic in Spring Hill, Fla., which he owns, along with Sun Dog Veterinary Consulting, a firm that helps business owners focus on business issues and customer care. Please send your questions or comments to us at ve@advanstar.com.

References

*Annandale, E.: The theoretical origins and development of the sociology of health and illness. The Sociology of Health and Medicine. A Critical Introduction. Polity Press, Cambridge, UK, 1998; pp 4-32.

*Barret, T.G.; Booth I.W.: Sartorial eloquence: does it exist in the paediatrician-patient relationship? BMJ 309(6970):1710-1712; 1994.

*Blumhagen, D.W.: The doctor's white coat: The image of the physician in modern America. Ann. Intern. Med. 91(1):111-116; 1979.

*Gooden, B.R. et al.: Hospitalized patients' views on doctors and white coats. Med. J. Aust. 175(4):219-222; 2001.

*Lewis, L.D.: White Coat Ceremony Keynote Address presented at the Columbia University College of Physicians and Surgeons; Aug. 26, 1994; New York, NY.

*Menahem, S.; Shvartzman, P.: Is our appearance important to our patients? Fam. Pract. 15(5):391-397; 1998.

*Thom, D.H. et al.: Measuring patients' trust in physicians when assessing quality of care. Health Aff. 23(4);124-132; 2004.

*Thom, D.H. et al.: Patient trust in the physician: relationship to patient requests. Fam. Pract. 19(5);476-483; 2002.

*Van Der Weyden, M.B.: White coats and the medical profession. Med. J. Aust.174(7):324-5; 2001.