Ophthalmologists and the White Lab Coat

For almost 150 years, the white lab coat has been more than just standard attire for science and health care professionals. It has so much symbolic value in the eyes of patients, in particular, that it can literally fill them with feelings of peace and the perception of greater care when they see providers wearing them.

In the wider sense, the lab jacket has long been a universally recognized symbol of scientific expertise. Back in the day, it even marked the transition from “old timey” medicine (that relied on external factors like religion) to the new, now expected way of treating disease (based purely on science and sterilization).

So, why ophthalmologists?

When you think of an ophthalmologist, you probably think of a specialist in a lab coat (just like you picture every other doctor). Did you know, however, that the white doctor jacket is also deeply rooted in the psychology of the ophthalmologist?

You’re sort of our proof. If you imagined an ophthalmologist in a white coat, you can bet soon-to-be students of ophthalmology were driven by that image, too. For some, this is the “visual root” of what inspired them to become ophthalmologists in the first place—at least, what the white lab coat stands for inspired them.

The white lab coat is not just about symbolism, of course. It also plays an important and practical role for ophthalmologists. First, provides them with all the breathability and comfortability they need to be productive in their workspace. (A sweaty ophthalmologist is a cranky ophthalmologist.) Then, it allows them to carry valuable tools. (Hello, tablet-sized lab coat pockets.) It also distinguishes them from other staff members, protects their clothes underneath, and prevents contaminants from leaving the healthcare setting.

The most important role of the white lab coat for ophthalmologists, however—and any type of doctor—is the effect it has on patient treatment. Because, like we said, the white doctor jacket is perceived by patients to be a symbol that boosts their positive perception of the treatment they receive.

According to a study on the psychology of hospitalized patients by Arthur R. Henderson, not only the technical but also the psychological aspects of patients’ treatment are important for optimal care. Even without this research data, we can imagine how positive psychology can help patients in treatment by alleviating fears. And guess what? This effect is pronounced when we’re talking about our eyes.

Yes, we humans are especially sensitive about eyes.

The debate

Although the white coat plays an important role in modern medicine, there’s a growing debate around its practicality in the science of ophthalmology. We just read one study that claimed patients do not care if ophthalmologists wear white or not. We’ve read general studies that show that lab coats actually make patients feel more anxious. And we’ve seen studies that state that white lab coats can harbor germs and microbes.

In this Dr. James article, built up by our own deep dig into recent research, we will talk about patient preferences for physician attire in ophthalmology, how white coats influence patient experience and satisfaction, and the effect of the white lab coat in patient treatment in general. Because, for all those ophthalmologists reading, we know your priority is getting your patients the best care possible.

Let’s begin!

We’ll shed some light on whether patients prefer ophthalmologists to wear white lab coats by considering two specific studies. Both focus on patient experience and satisfaction in the domain of eye care delivered by ophthalmologists, specifically to examine if their attire—and especially the white lab coat—is an influencing factor for better or worse.

Study #1

The first study was conducted in January 2019 by J. Acad Ophthalmol on the Patient Preferences for Physician Attire in Ophthalmology Practices. The objective of the study was to understand patient preferences for physician attire in ophthalmology practices in the United States, and also to determine if those preferences can influence patient experience and satisfaction.

The study was conducted by providing a total of 1,826 questionnaires to patients of four ophthalmology practices in the U.S. between June 1, 2015 and October 31, 2016. The questionnaire included photographs of a male and a female ophthalmologists wearing seven different types of attire:

• Casual
• Casual with white lab coat
• Scrubs
• Scrubs with white lab coat
• Formal
• Formal with white coat
• Business formal attire

The questionnaire consisted of 22 questions, divided into four sections:

• In the first section, participants were asked to rate the physician in the photograph across five domains: trust, care knowledge, approachability, and how comfortable the physician made them feel.
• In the second section, participants were shown the same photographs and asked to select their preference for physician attire.
• The other two sections focused on general opinions about physician attire, demographic data, and more.

The survey findings showed that, for both male and female physicians, formal attire with a white lab coat was the most preferred attire for ophthalmologists. Even other types of attire with a white coat (such as casual and scrubs) were significantly preferred over casual, formal or business attire without a white coat.

Interesting? We thought so.

Formal attire with a white lab coat also got the highest scores on how knowledgeable, trustworthy, caring and approachable the ophthalmologist was perceived by respondents, as well as how comfortable the physician would make patients feel.

Finally, when participants were asked: “overall, which clothes do you feel your doctor should wear,” 52.3% of them answered “formal attire with a white coat.”

It’s also worth mentioning that:

• 4% of participants said how their ophthalmologist dresses is highly important to them
• 8% of participants answered that their doctor’s attire influences how happy they are with the care they received
• 8% of participants preferred their ophthalmologists to wear white coats when they see a patient in their office
• 5% of participants believed that doctors should wear a white lab coat when seeing patients in the examination room

The findings of this study reflect how patients prefer their ophthalmologists to dress: always in a white lab coat. The findings also show how an eye doctor’s attire influences patient experience and satisfaction.

Study #2:

The second study was conducted in June 2016 by Indian J. Ophthalmol on the preferences of ophthalmic plastics patients and their caregivers toward the doctors’ attire and initial communications. The basic aims of this study were to determine the acceptable levels of different doctors’ attire and the expectations right out of the gate at the first physician-patient encounter.

The study was performed using a survey method on all new patients and caregivers of specific ophthalmic plastics institutes. After the first clinical encounter, the patients were shown three sets of photographs with ophthalmologists and were required to answer a survey consisting of five questions on how they prefer to see their physician dress.

The first set of four photographs showed male physicians in four different types of attire: casual, scrubs, formal, and a white lab coat. The second set of photographs showed female physicians in similar attire. The third set of photographs was unrelated to attire and showed different examples of greetings to identify how patients preferred the physician address them verbally.

 The survey was given to 300 participants. Among them, a staggering 87.6% and 90.3% preferred their male and female ophthalmologist, respectively, to wear a white lab coat. The second attire preference was scrubs for both the male and female physicians. It’s also worth noting that the survey also showed that patients preferred their physicians to smile and address them by their name.

The study concludes by stating that the way ophthalmologists dress and initially communicate are of crucial importance for patients and play a central role in enhancing their satisfaction.

Psychology and patient treatment

Do you remember the study on the psychology of hospitalized patients by Arthur R. Henderson we mentioned earlier? The truth is, psychological factors are undeniably important in patient treatment. Another recent study has swept in to back that up, showing that both physical and mental health are interconnected and equally important components for total health. A 15-year study by Koopmans et al (2010) has shown the same with some truly fascinating findings.

On the other hand, emotions like anxiety and stress can affect our psychology, too, and in turn our physical health and perception of care. Feelings of helplessness, hopelessness and anger are directly linked to cardiovascular disease, for example.

There is such a thing as “white coat anxiety.” At least, that’s what some studies have suggested. Is this the core of the argument against the white coat? What percent of people are affected?

Let's take a look.

The debate about lab coats and infections

What patients want their doctors to wear is undoubtedly important. Another extremely important factor, however, is the carrying of microbes and the possible transmission of infection. This is the central concern in the debate about the practicality of white coats—not only for ophthalmologists but doctors in general.

A number of doctors and studies have stated that white lab coats can be a shelter for potentially dangerous microbes and germs, especially in the folds and seams of the lab coat and around the cuffs and pockets.

However, most of these studies fail to mention germs in other types of labwear, or regular office wear. Wouldn’t it make sense that any type of attire worn in a clinical setting will end up riddled with microbes?

Even if white coats and, in turn, any type of attire worn in a clinical setting becomes a harbor for microbes, rigorous laundering and just rolling up your sleeves (or going for a short-sleeved white coat option) can eliminate the risk of infections.

Click here to read more on that matter, as well as to learn about the symbolism of the white lab coat (and what it has in common with priests’ collars)!

Conclusions

The scope of this article is straightforward. We don’t need bells and whistles. Our aim is to allow ophthalmologists to make the right decisions for professional so their patients can benefit. Moreover, we want to debunk any concerns about the white lab coat and hygiene.

As we’ve seen in the two studies above, ophthalmologists’ attire can (and does) influence patient experience and satisfaction. Patients believe doctors’ attire is an important factor in care, and they actually prefer the white lab coat over any other type of attire.

Since the white lab coat can positively influence the perception of care, approachability and how a patient feels (hence nurturing positive psychology), we can safely say that the ophthalmologist’s white coat not only increases patient satisfaction but overall health.

Finally, in terms of hygiene, if a white lab coat is a home for germs and microbes, this is equally true for any other attire worn in a medical setting. Tell us honestly—when was the last time you washed a necktie?

The takeaway here is clear: ophthalmologist attire is important for patients, and the white lab coat is their preferred option. The white lab coat can also increase the positive psychology of patients and, in turn, their overall health and perception of (and success with) treatment by enabling them to feel comfortable and cared for.

As a great healthcare professional, your first priority is the satisfaction, positive experience, and ultimately the successful treatment of your patients. Your expertise plus a designer lab coat and proper hygiene can be your compass to keeping your patients and their eyesight clear!

In honor of 2020, the year of perfect sight, share this article today to help your peers and friends “see.” And happy new year!