Considerations in Clinical Office Attire

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Transcript

Welcome back to Podiatry Today Podcasts where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the Assistant Editorial Director for Podiatry Today. And today we are so happy to have two really great thought leaders with us to talk to us a little bit more about what the current trends and observations are in appropriate office attire, how this impacts patient care, and how this impacts practice management. Today we have with us Dr. Priya Parthasarathy who's an American Podiatric Medical Association spokespersonand has participated in numerous podiatric surgical mission trips abroad. She serves on multiple boards and committees and is the current president of the Maryland Podiatric Medical Association. She is a frequent lecturer at the national level and is board certified by the American Board of Podiatric Medicine. Dr. Nicole DeLauro, our next guest, is also board certified by the American Board of Podiatric Medicine and the American Board of Foot and Ankle Surgery. She serves on multiple leadership boards and committees as well and is a Fellow of the American College of Podiatric Medicine, and the American Society of Podiatric Surgeons.

I think what we are talking about is what should clinicians, specifically physicians, be wearing in their clinical environments? Does work attire matter? Does a more professional, more formal look have advantages over a more casual, practical plan? So I'd really love to hear some of your insights on this debate, But why don't we quickly review a little bit about why this is even a consideration and what do you feel are some of the current current mindsets and outlooks on this?

So I personally feel that things have changed significantly since COVID when we were talking about, you know, infection protocols, washing your clothing. And I was at the APMA House of Delegates and as we know we have a diverse group of individuals that join us there. So I was able to discuss this with several of my older colleagues as well as my younger colleagues. And I can mention my husband who is a podiatrist as well. So prior to COVID, especially my male colleagues and the older physicians that I was able to interview at the HOD wore a shirt and tie and they had done that for 35, 40 years. And since COVID, their variations have been scrubbed, scrubbed tops and chinos or in general washable clothing. So I found that that was an interesting observation since COVID itself. I don't know if it's actually a COVID thing or not. I think in general work environments are just more relaxed, whether that's a result of COVID or just a change in our day to day lives. Training is now geared towards many hours in an operating room and in that scenario you are wearing scrubs and I think that that association then carries through once the residents are working as attendings. I personally don't dress any differently than I did pre -COVID. I do notice more of the younger doctors that are being hired generally do wear scrubs and the older physicians in our group generally are dressed.

So that's been my perception whether or not it's a COVID thing or not. I think it potentially has to do with the attire during your training and then moving forward. It's interesting because I took a look at the studies And the clinical research behind the professional wear versus scrubs, it was very dated. I found a lot of studies from 2004 and 2009, but I feel like we're in a very different healthcare environment now. So the most recent one I found was a JAMA survey, a study in 2021, which was public perceptions of physician attire and professionalism. And the survey respondents were restricted to individuals age 18 years or older, US residents and identified English as their primary language. So in the study, they actually surveyed 487 respondents and they found that physicians wearing white coats were perceived as significantly more experienced, professional and friendly compared with those utilizing a fleece or softshell jackets. I mean, that's a big thing that was even when I was a resident, you know, I used to put a little hoodie on top or like my little North Face fleece or something like that. So they preferred white coats. Now, interesting, they photographed female models were rated as appearing less professional than their male models and were more likely to be mistaken as a medical technician, physician, assistant, or nurse. Finding suggests that individuals prefer that physicians wear white coats, but sadly, gender biases in the perception of professional physician attire exist. And they looked, you know, multiple factors were involved, such as age, gender, geographic location and exposure to healthcare. And these were associated with, I guess, their survey responses. But I found that this was really interesting, right? Females at a disadvantage with not wearing a white coat or not in professional gear. And then the white coat showed much more-- it held a lot of weight.

So you mentioned this a little bit already, but I'm curious to hear a little more of your thoughts. Do you feel there is a generational difference in perception among clinicians on this topic? What have you specifically observed?

So as I mentioned--perspective. I do a few brand partnerships and social media posts and I was recently at a luxury marketing event. I was speaking to a social media influencer that specifically worked with physicians and she was discussing how important it is to wear a white coat in your social media posts. It signifies importance and authority. So it's interesting that if it carries over to social media, Should we be wearing the white coats in the office? Are older patients used to seeing their doctors in white coats and there's been maybe a shift into more scrubs? But does that whitecoat still hold the weight that professional attire used to? Because I think that that's what they're used to. I definitely do not wear a white coat. I find it restricting. And I find it hard to get to the dry cleaners. But if the studies are showing that it screams authority, if I'm throwing on my white coat for my social media posts to show that I'm a leader, I think I may start to reconsider. And so, you know, the white coat was very varied amongst my colleagues. Some also use it as like a bacterial shield. So, you know, just to keep everything clean underneath. And some felt that their colleagues also expected them to wear it.

I agree with wearing one. You can't see me now, but I have mine on. I always wear a white coat. And actually, I was polling patients today, just knowing that this was going to be a discussion and saying, you know, to the majority of your other doctors wear a white coat or not. And then I asked them, is it a younger doctor versus an older doctor? And it seemed to be that other specialists were also wearing white coats. And if they were not in a white coat, they were not in scrubs, they were actually dressed. So again, I think it's all potentially based on your age group, what is your subspecialty? You know, what are you going to be exposed to while you're actually working? Again, you know, the younger doctors in our group seem to not wear a white coat. They do think it's kind of restrictive to their motion. But I think it does kind of signify you as the physician. Being a female, you And I think it actually separates me from the other staff members who are also females. And I just remember, you know, your white coat ceremony at school, you were so excited to be getting this white coat to signify your importance and the level of education that you've gotten to in order to put that on. So I think it's an honor to be wearing one and I'm proud to actually be able to do so so I as a side note with a laundering and keeping them clean I actually keep a spare coat in each office so that if one gets dirty or one is at the dry cleaner it is getting getting cleaned regularly because you don't want to have a yellow white coat you want it to actually stay clean and I think that if it looks dirty, it's just as bad as if potentially your clothes are dirty. So, you know, you want to make sure that you maintain your white coat, but I think people should wear them. I think it does make you stand out a little bit.

Yeah, and it seems to be that the research is also supporting you on that. And again, as both of us being females and, you know, we always face gender biases and I wonder if you know I had started wearing one from the beginning earlier if I would have been taken you know everyone always asks how long have you been out or you know oh okay 13 years I can now proudly say but you're one and two or six months sometimes it can boost even your confidence and you know give you that sense of authority. And so I think it's very important to consider consider the white code and what you wear underneath as well.

So based on everything that you've shared today and these insights have been really interesting to hear, what considerations on this topic do you hope that doctors will adopt or evaluate in their own practices?

Nicole, I think you touched on that earlier about, you know, if you choose to wear your scrubs or you choose to wear a white coat, they have to be in good shape. So the state of your scrubs is very, very important. There is a difference between hospital scrubs and a practice setting. So I feel the state of your scrubs is very important. You shouldn't look like you just rolled out of bed, which I've seen, wrinkled scrubs, not in the best shape. And we do do procedures as we discussed, right? Like abscess, ingrowns,  all that kind of stuff. So I find wearing scrubs really easy for me and I can just throw them in the wash. I don't even touch my children until I take my scrubs off and change my clothes. But I do feel that they have to fit well and it just exudes confidence, respect, and authority. So something to really keep in mind, because as we were talking about those generational differences, I have been finding that some of my younger colleagues are sometimes just a little too casual. And I wonder how that affects them in practice. So the other thing that I think is really important to keep in mind is I love to highlight my shoe gear as well. So I wear different types of shoes. So my patients are able to see that they have different options. They tend to skew more casuals, such as like New Balance, Hoka, or Brooks. And the days that I'm operating, I'm usually in clogs. And I really love the conversation that that starts as well with, oh, Dr. P, what shoes are you wearing? So again, I feel like you project what your patient wants to see and your patient wants to see your podiatrist in good supportive shoe gear. So that's really important to keep in mind as well.

I couldn't agree with you more. The shoes are a very big thing. I mean, I'm usually dressed for work. I do wear a more dressed shoe. I like that I can show my patients that outside of sneakers, they have dress options. And I do think that again, right, your shoes need to be clean looking and not excessively worn, you know, you're telling your patients that they have to have properly sized and properly fitting shoes and they should be changed regularly. And you want to make sure that you're leading by example and doing the same thing. So I couldn't agree with you more on on the shoes. I do think a lot of times that your first impression is still going to carry through with patients. And if you want to assert yourself as the physician, I think that that comes a lot of times, not only in whatever you're going to say to the patient, but also how you're going to look. And if you want to be taken seriously, you should dress the part. And maybe this is, again, a little bit of the gender bias, right? Because females, a lot of times, aren't necessarily thought of as the physician. But I think that if you're kind of dressing the part, that is something that, you know, people tend to look at you a little differently. Interestingly, I'm a second -generation podiatrist. My dad actually trained under McGlamry, and he told me a story about how when he was a resident, he had come to work with a wrinkled shirt and a tie, and he was pulled over to the side by one of the other attendings who said, do you think McGlamry would want you walking around the halls this way? And he actually made my dad go home, iron his shirt, and come back to the hospital.

And my dad always told me that story, and it just stuck with me. Because that was 40 -plus years ago, and podiatrists were nowhere near the level that they are now as physicians. And we've worked so hard to get to this level, but sometimes you have to play the part and you have to look a certain way in order to gain that respect. And so that story just kind of stuck with me and I think that's probably why I am dressed most of the time, But I do think it makes a difference in how patients perceive you. Yeah, and I think that it's a challenge, right?

So in summary, kind of like what we discussed today, two different practices, private practices. You know, you dress for work, I wear scrubs, but I think that it kind of comes down to playing the part, looking, you know, assertive and authoritative and making sure that you are not being faced with even more gender bias, as we see by the research. So, you know, I challenge other podiatrists to maybe change their outfits for a week or two and see if they're perceived differently by their patients. I know I'm definitely gonna put a white coat on tomorrow.

Thank you so much to both of you for sharing your experience and observations with us today. We hope that you'll join us again for another episode of Podiatry Today Podcasts, where you can find this and previous episodes at podiatrytoday com, SoundCloud and your favorite podcast platforms.