White Coat or Casual? Here's What Patients Prefer
— The setting and context matter, systematic review shows
MedPage Today | By Jennifer Henderson
August 12, 2025
Physician attire -- namely, white coats -- affected patients' perceptions of professionalism, trust, and communication, a systematic review indicated.
However, patient preferences for such attire depended on clinical environment, medical specialty, physician gender, and the context of care, including the COVID-19 pandemic, reported Bo-Young Youn of Hwasung Medi-Science University in Hwaseong-si, South Korea, and colleagues in The BMJ.
They noted that a previous systematic review determined that physician attire plays a significant role in patient satisfaction, trust, and adherence to medical advice. However, it had limitations, Youn and co-authors said, "including a limited inclusion of diverse clinical settings and a need for more contemporary insights, given the evolving nature of healthcare practices and societal expectations."
In the new research, 11 studies focused on patients' preferences and evaluations of physicians' attire within varying clinical environments.
In primary care settings, patients preferred a combination of casual attire and white coats, which "reflects the knowledge that primary care environments encourage long-term patient-physician relationships and foster effective communication," Youn and colleagues stated.
As a result, wearing more "approachable and accessible" clothing aligns with these values, the researchers said. In contrast, in the emergency room, patients tended to favor physicians dressed in scrubs or white coats, they found.
Nineteen studies in the analysis indicated that patients' inclinations and assessments of physicians' attire were contingent upon the medical specialty.
For instance, patients preferred physicians in obstetrics and gynecology, as well as ophthalmology, to wear white coats, while in breast radiology the preference was for physicians in scrubs. Meanwhile, some patients preferred shirts, ties, and white coats for surgeons.
"Research indicates that patients view physician attire not only as a matter of personal style but also as a vital element in assessing trust and professionalism," Youn and colleagues wrote.
They also reported that in addition to medical specialty and patient expectations, factors such as age, gender, geographic location, and cultural background also shaped the relationship between physician attire and patient perception, signaling an "attachment to tradition and treatment environments, which influence expectations regarding professionalism and competence."
The review also found eight studies that looked at clothing perceptions related to physician gender, showing a distinct preference for male physicians to wear suits. There was also a preference for female surgeons to wear white coats over scrubs compared with being dressed 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 said.
Female physicians also were more likely to be misidentified as nurses or medical assistants than their male counterparts in the same attire.
Several studies in the review also looked at patient perceptions of physician attire during the pandemic.
Two COVID-related studies "consistently reported a shift in preference towards practical and hygienic attire, such as scrubs and face masks, reflecting patients' heightened sensitivity to infection control," Youn and colleagues noted.
Data sources for the review were PubMed, Embase, Cochrane Library, and Google Scholar, which were searched for relevant studies from January 1 to June 1, 2025.
Among the 32 studies analyzed, 17 were from the U.S.; two each were from Japan, China, and Pakistan; and one each were from Indonesia, India, Ethiopia, Korea, Germany, Malaysia, Saudi Arabia, Singapore, and Switzerland.
The study sizes ranged from 97 to 6,467 participants, with most studies having more than 100 participants. The majority consisted of participants at least 18 years old.
Overall, 18 studies were rated as having a low risk of bias, 10 as having a moderate risk, and four as having a high risk of bias.
Limitations included that most of the studies were conducted in the U.S.; that numerous studies relied on patient self-reported data; and that certain patient groups, such as pediatric and psychiatric patients, were not well represented in the studies.
Future studies should aim to gather preferences on physician attire from more diverse patient demographics and linguistic sources, the researchers said.
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