White Coat Still Reigns as Symbol of Trust Despite Gender Bias

Patients continue to view the doctor’s white coat as a symbol of professionalism and trust, but a new comprehensive review reveals that women physicians wearing these traditional garments face persistent misidentification as nurses or medical assistants. Published in BMJ Open, the study examined 28 research papers spanning nearly a decade to understand how physician attire influences patient perceptions across different medical specialties and clinical settings.

White Coats Win Patient Trust Across Specialties

The research confirms that patients still prefer doctors in white coats, perceiving them as more trustworthy, respectful, skilled, communicative and empathetic. The preference varies significantly by medical specialty and clinical context, with white coats favored in specialties like dermatology, ophthalmology, orthopedics, surgery, and obstetrics and gynecology.

However, the landscape is shifting in high-acuity settings. Patients increasingly accept scrubs, especially in emergency rooms and surgical environments where hygiene and practicality take precedence. During the COVID-19 pandemic, this trend accelerated as patients showed stronger preferences for scrubs and personal protective equipment, emphasizing infection prevention.

Gender Bias Persists in Healthcare Recognition

Perhaps the most striking finding reveals a troubling double standard: even when male and female doctors wear identical attire, female physicians are still more likely to be misidentified as nurses or medical assistants. This pattern persists consistently across different cultural settings and geographical regions.

The gender bias extends beyond simple misidentification. Previous research shows that about 32 percent of patients assume female physicians are nurses, while three out of four patients correctly identify male physicians as doctors.

“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians, which highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients.”

Age plays a crucial role in recognition patterns. Millennial patients (32 and younger) correctly identify female physicians 67 percent of the time, while Baby Boomers (55 and older) achieve only 54 percent accuracy. This suggests changing generational expectations may gradually reduce gender bias over time.

Specialty-Specific Preferences Shape Dress Codes

The research reveals distinct preferences based on medical specialty and clinical context:

• Emergency Medicine: Patients prefer white coats or scrubs for emergency doctors
• Primary Care: Casual dress and white coats both acceptable
• Surgery: Mixed preferences, with some favoring scrubs alone
• Palliative Care: Attire has minimal impact on patient trust

For male doctors specifically, patients show a distinct preference for suits, with accessories like watches and glasses enhancing perceived professionalism and trustworthiness. However, the UK’s “bare below the elbows” policy bans doctors from wearing white coats, watches, ties and long sleeves to minimize infection risks, creating a tension between patient preferences and safety protocols.

Surgical Attire Reveals Complex Gender Dynamics

The study uncovered intriguing differences in surgical attire preferences. Male surgeons wearing white coats over scrubs were viewed less favorably than those in suits with white coats, scrubs alone, or just suits. Conversely, female surgeons in white coats over scrubs were preferred over those in suits or casual attire.

“This preference aligns with recent evidence indicating that female physicians are often judged more on appearance than their male counterparts,” the researchers noted. “The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold.”

Global Perspectives and Cultural Context

The research team analyzed studies from 17 countries, though most came from the United States. The findings showed remarkable consistency in gender bias patterns across different cultural settings, suggesting this is a widespread rather than localized phenomenon.

What drives these persistent preferences? The white coat’s historical significance cannot be understated. In the 19th century, doctors primarily wore black for formal medical encounters. But as medicine evolved in the 20th century, white coats came to represent cleanliness and professionalism, becoming standard worldwide.

Implications for Modern Healthcare

Do these preferences actually matter for patient care? Research suggests they do. Studies show that 53% of patients consider physician attire important, and over one-third agree it influences their satisfaction with care received.

The researchers recommend that medical institutions consider adopting flexible dress codes tailored to different clinical environments and medical specialties. This approach could help balance patient preferences with practical considerations like infection control and professional functionality.

For female physicians, the findings highlight an ongoing challenge that extends beyond simple wardrobe choices. The persistent misidentification as non-physician healthcare workers represents a broader issue of gender recognition and respect in medicine that institutions must actively address.

As healthcare continues evolving, the traditional white coat maintains its symbolic power while practical considerations push toward more functional attire in specific settings. The key lies in understanding these nuanced preferences and working to eliminate the gender biases that continue to undermine female physicians’ professional identity.