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Regardless of profession, we all play out the sartorial ritual of considering colours, textures, and garments for work, school and play.

Clothing for doctors is more than just a matter of personal style: it is an emblem of their speciality, training and culture. In some cases, a physician’s attire is functional. A surgeon’s scrubs protect regular clothes from stains and patients from infection. Sometimes, it’s about creating a good first impression and projecting the more professional, conservative image often associated with medicine.

Go to a doctor’s office, for instance, and you’re more likely to find physicians donning a shirt and tie, or jacket and blouse when interacting with their patients. In almost all of these cases, the emblematic uniform of physicians – the white coat – is present and despite clear patient preferences about what doctors wear while working, even the top-ranked hospitals in the nation, only a handful offer formal guidance on attire. Many vaguely recommend that clothes be “professional,” but without defining what professional means?

In 21 of those studies, we found that patients had strong preferences about what physicians wore. And it looks like patients more often prefer for their doctors to wear formal clothing and white lab coats than not. Indeed, in 18 of the studies we reviewed, patients had a preference or positive association with this style of attire.

But as we reviewed these studies, three keys themes that suggest important variations in what patients may prefer their doctors to wear emerged. First, studies involving older patients or those from Europe or Asia all reported higher satisfaction when physicians wore formal attire.

Second, in an emergency, surgical or intensive care settings, scrubs were not only preferred by patients but also more often equated with professionalism. This makes sense, as in these more “hands-on,” procedure-oriented settings, formal suits, shirts and ties clearly seem out of place.

Finally, in doctors’ offices and outpatient clinics, scrubs were viewed unfavourably and often resulted in negative impressions. Thus, from the patient’s perspective, a “one size fits all” approach may not work for doctor attire. Rather, the context in which a patient interacts with their doctor influences what they expect to see.

What best practices can we recommend, especially for those that are entering as new residents?

When in doubt, formal attire with long-sleeved shirts and ties and jackets for men, and business attire for women, curating an office wardrobe with authority workwear pieces from the corporate to the creative, set the tone for a smart and stylish look that should prevail in nonemergency or nonoperative settings.

Yet few doctors or medical students consider the first impression they make on patients. And clothes have a lot to do with that. In an informal survey in our hospital, only two out of 30 medical students said that they actually thought about their dress when caring for hospitalised patients. Yet, over half of the medical students, we spoke to agreed that what they wear is likely to influence patient opinions about their doctors. This illustrates a larger discrepancy between what doctors ought to wear and what they do wear – one that may arise from competing concerns or lack of guidance.

This practice should hold true not just for weekdays, but also when physicians are working weekends and after typical business hours. Patients and their expectations remain unchanged, regardless of the hour or day.

While scrubs are appropriate for operating or emergency rooms, we suggest changing into more formal attire to visit patients in the hospital or the clinic. Regardless of the occasion, flip-flops, showy jewellery or jeans simply don’t belong in the hospital, just as scrubs do not belong outside the hospital environment. Especially not in the grocery store.

Making a good first impression