The fascinating—and important—effects of the white coat in patient treatment

“It's all in the mind.”

George Harrison

Psychology describes and explains our perceptions, our preferences, how we act and think, and ultimately how we identify. It maps out our emotions and filters them through our experiences into the unique individuals we all are. Different emotions like satisfaction, security, fear, and anxiety all shape our perception of “self,” not to mention the way we interact with our environment, others around us, and our health.

The ins and outs of our psychology peek through in high-stress situations, like those we encounter in clinics and hospitals. Patients will come in for general exams, but they also come in when emergencies strike or when some aspect of their health is suffering. Their mental state is often at stake, because they often don’t know yet what exactly they’re suffering.

What could it be? What treatment options will be available?

As a result, emotions like fear and anxiety are common.

This reality of fear and doubt has empowered healthcare providers to reconsider certain aspects of delivering care. According to a recent study on the psychology of hospitalized patients by Arthur R. Henderson, both the technical and the psychological aspects of patients diagnoses are important for treatment in its totality.

The white lab coat is an element present in every medical setting. The symbol of this uniform is universal; it emits medical expertise and distinguishes the wearer from other people in the field.

However, how does the white coat look through patients’ eyes? Do they look like the superhero that a patient can trust, or do lab coats actually make patients feel more anxious?

The debate around the importance of lab coats has been growing in recent years. In this article, we’ll take a look at the psychology of the patient and ask seriously if lab coats play a positive or negative role in keeping patients not only healthy, but happy. We’ll dive into recent studies and break each argument down fact-by-fact, because, in the end, anyone who wears a white lab coat will want a sober look at the data behind it.

Positive psychology and emotions

According to studies (and common sense), supporting positive thinking and holistic emotional health in medicine can bolster doctor-patient communication, can enhance relationships and self-confidence, can clear our decision-making and boost our careers, and—most importantly—can make it easier to maintain our health. Research has shown that physical and mental health are not just important components for complete health, but interconnected with a clear correlation (NCBI).

According to the broaden-and-build theory by Barbara Fredrickson, positive thinking and “pleasure” emotions (joy, confidence, sociability, etc.) fuel psychological and physical well-being. Positive emotions can sharpen attention and cognition, too, resulting in an even greater variety of positive thoughts. When we feel that bubble or thrill of positive emotions, they can quickly promote creativity and flexibility, which further allow us to be more open to opportunities and relationships.

But back to physical health, a 15-year study by Koopmans et al (2010) has shown that positive psychological characteristics may be beneficial for organ function and overall health, and can thereby increase life-span. The results have shown that perceived happiness, combined with physical activity in particular, were inversely associated with mortality.

Defining happiness will have to be a blog unto itself, but we can agree in general terms that we know what it is when we feel it.

Negative psychology and emotions

On the other hand, negative emotions like anger, stress, and anxiety can also affect how we feel and act—and how our bodies feel and react. Specifically, these emotions can bring the exact opposite of positive emotions: they bust our confidence first, resulting in debilitated communication and perceptions of our environment and.

Most of us have read by now that negative emotions affect our physical health in real and measurable ways, starting with stress. Other emotional hurdles like helplessness or hopelessness even promote chronic stress that upsets the body’s hormonal balances, damaging the immune system and making us age more quickly.

Stress can actually decrease our lifespan.

Another big one, anger, is associated to health conditions like high blood pressure, cardiovascular disease, digestive disorders, and infection (UoM blog). At an NEI congress in 2017, professor Mary D. Moller went so far to state that “the potential effects of chronic fear on physical health include headaches turning into migraines, muscle aches turning into fibromyalgia, body aches turning into chronic pain, and difficulty breathing turning into asthma.”

The psychology of patients

Clearly, when a patient is coming in for other health concerns or even a general check-up to make sure everything’s “good-to-go,” how they feel emotionally is not only relevant but important to take into account. Especially in the case of hospitalization or the operation room, we all risk picturing some dreadful routine, treatment or intervention that we might face.

Most patients feel the tingles of anxiety even before passing through the door of a hospital, and the reason is simple: they either don’t know what they have yet, or they do and they’re walking in for treatment…and neither experience is a walk in the park.

Let’s put this into extra-sharp focus for a moment: before you even see patients, before they’ve checked in and their name’s been called, they’ve undergone at least some degree of fear or anxiety that’s set their bodies out of whack.

And sometimes, that same anxiety can alter how patients perceive the issues they’re dealing with, which makes diagnosis a more complex process for practitioners. “There are patients who are so laden with neurotic anxiety that they can interpret a swelling of the big toe or an unimportant wart on the elbow as a sure sign that gangrene or cancer is developing” (Psychology of Hospitalized Patients study).

The same study above is also the very same that highlights one of the biggest factors contributing (for better or worse) to the anxiety and fear of patients: how approachable the medical staff looks to them. Patients have to feel comfortable, and their confidence needs to be firmly intact for them to sidestep fear and talk openly about what symptoms they have and answer practitioner questions.

We’ve summarized how negative psychology impacts self-esteem, and we’ve spelled out how low self-esteem can hinder diagnoses and the overall doctor-patient relationship. Another shock to the patient ego in the sterile environments of clinics and hospitals is the sensation that an otherwise independent person can’t fix a given problem him or herself. To give a patient the sense of confidence needed, in him or herself as well as in the doctor, nurses and medical staff, we need all the elements in place to set the scene of a comfortable and confidence-inducing environment.

How lab coats affect the psychology of a patient

The white lab coat is a symbol that emits medical expertise and distinguishes medical professionals from other people in any medical setting. However, the debate about the importance of lab coats over standard office attire has gotten interesting recently. Some medical institutions have even ditched lab coats all together with the argument that “white coat anxiety” has made patients suffer unnecessarily.

However, a study on the patient preference for physician attire has shed light on the importance and benefits of lab coats well over standard office attire. This in-depth and engrossing study has shown how lab coats can actually improve a patient’s perception of the trustworthiness and approachability of medical staff.

Let’s take a look at how the study was conducted.

Many studies before this one have measured and shown how an “improved patient experience” is associated with higher patient satisfaction as well as better clinical outcomes. Based on this, other studies came along to get to the heart of the patient preference for physical attire of practitioners. These studies set out to investigate whether physician attire can affect the patient experience, because after cleanliness of the institution, the way medical staff is dressed is the second most distinguishable element of a clinic or hospital experience for a patient.

In this newest study, patient preferences for attire were calculated based on survey responses across five “classifiers:” knowledgeable, trustworthy, caring, approachable and comfortable.

This study was conducted in 10 academic hospitals around the U.S. and had a sample of 4,062 patients. The study took place over the course of 15 months. In order to test empirically for patient preferences, a team of psychometricians, research scientists, choice architects, survey experts, and bioethicists developed a questionnaire that consisted of questions coupled with photographs of physicians in carefully-segmented outfits.

The outfits tested were:

• Casual outfit only
• Casual outfit under a white coat
• Scrubs only
• Scrubs under a white coat
• Formal outfit only
• Formal outfit under a white coat

The study’s data clearly showed that all outfits including lab coats were preferred by patients over outfits without a lab coat in the “primary care” and “hospital physician” fields. For surgeons and professionals in emergency settings, patients preferred scrubs only.

Lab coats can improve the patient experience in a real and valuable way; and that patient experience will ultimately mean better diagnoses and improved health. Patients feel comfortable and cared for with a stronger doctor-patient relationship, and that relationship is stacked on top of the advantages the white lab coat brings.

Can white lab coats negatively affect patients?

Clearly there’s another side to the argument, or there wouldn’t be the recent cases of hospitals and clinics who ditched the coat. The possible negative effects a white lab coat can bring to patients speak to two factors: anxiety and hygiene.

According to another study in 2015, “white coat hypertension” or “white coat syndrome” is an experience characterized by a variation of in a patient’s blood pressure between a physician’s office and the patient’s home environment. A patient with this syndrome has higher blood pressure in a physician's office. In this context, higher blood pressure means anxiety—and we already stressed how anxiety can wreak havoc on a patient.

However, the same study stated that previous research had shown that improving the relationship between a patient and their health care provider can decrease the patient’s anxiety and the likelihood of white coat syndrome altogether.

Now, about hygiene…there are concerns that white lab coats are an inviting home for germs, namely those that can be transferred from patient to patient. However, while another study showed that bacteria can be concentrated in white coats, this is equally true of any other attire worn by a provider. The solution? Stock your supply of preferred, designer lab coats so you can always wash the ones that have been worn.

Final thoughts

To recap, we’ve examined how positive and negative emotions actually shape patient psychology, which ultimately impacts every aspect of a life and well-being. The former makes the delivery of medical care easier, and the latter makes it harder.

Patients come to you in need of help. And from a place of fear and vulnerability, they will often be overwhelmed by anxiety (that comes with all its physical side-effects). Through the studies we’ve mentioned, we saw how both the technical and the psychological aspects of treatment are essential for comprehensive care. And to support approachability, trustworthiness, and a sense of expertise and attention, one crucial element is the white lab coat.

We did examine negative effects of the white lab coats on patient psychology as well. In the uncommon case of white coat syndrome, the stronger the doctor-patient relationship becomes, the greater the chance that the patient will no longer suffer from anxiety in your practice.

We also talked about hygiene, and remain convinced that the right collection of designer lab coats will give practitioners all the flexibility they need to wash lab coats regularly.