From the Guidelines
For physicians working in acute inpatient settings, the evidence suggests that either business-casual attire or scrubs can be appropriate depending on the specific clinical context, with scrubs generally being more practical in high-acuity environments. In med-surg floor settings, business-casual attire (slacks, button-down shirts, blouses, and closed-toe shoes) can help establish professional identity and may improve patient confidence in their physician's competence, as studies have shown that many patients associate formal attire with greater physician competence and trustworthiness 1. However, in rapid response or medical emergency team settings, scrubs offer practical advantages including improved mobility, protection from bodily fluids, and immediate recognition by patients and staff during emergencies. For transitional care between med-surg and ICU, a hybrid approach may be optimal, with physicians potentially wearing scrubs when performing procedures or managing unstable patients, while switching to business-casual when primarily conducting rounds or family meetings. The key considerations across all settings include:
- Infection control (scrubs can be changed more frequently and laundered at higher temperatures)
- Patient perception (which varies by patient demographics and cultural context)
- Practical functionality (scrubs allow greater range of motion and are more easily replaceable if soiled), as discussed in the guidelines for clothing in the operating theatre 1. White coats worn over either attire remain controversial due to potential pathogen transmission, though they provide pockets for carrying equipment and help with professional identification. Ultimately, institutional policies, the specific clinical demands of the day, and individual physician comfort should guide attire choices, with cleanliness and professionalism being paramount regardless of the specific clothing worn. It is also important to consider the environmental impact and economic cost of attire choices, as well as user comfort, as highlighted in the guidelines for clothing in the operating theatre 1. In the absence of strong evidence supporting one type of attire over another, a pragmatic approach that balances these factors is likely the best course of action, as suggested by the French Society of Hospital Hygiene (SF2H) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) 1.
From the Research
Hospitalist and Internist Attire
- There is no direct evidence to support the use of business-casual attire versus scrubs for hospitalists and internists in med-surg floor/ward settings, RRT/MET settings, and transitional care between med-surg and ICU 2, 3, 4, 5, 6.
- The provided studies focus on the role of hospitalists in patient care, quality improvement, and medical education, but do not address attire specifically.
Infection Control and Patient Outcomes
- A study on nosocomial infections in the ICU found that prior antimicrobial therapy, urinary catheterization, and length of ICU stay were significant risk factors associated with nosocomial infection 2.
- Hospitalist care models have been shown to improve patient outcomes, including reduced in-hospital mortality, ICU admission rates, and hospital length of stay 5, 6.
- However, these studies do not provide evidence on the impact of physician attire on patient outcomes or infection control.
Hospitalist Role and Responsibilities
- Hospitalists play a crucial role in quality improvement initiatives, including the development of protocols and outcomes measures for patients with acute coronary syndrome 5.
- The hospitalist care model has been associated with improved patient outcomes, including reduced in-hospital mortality and ICU admission rates 6.
- However, the provided studies do not address the specific question of physician attire in different settings.