Why Johns Hopkins physician interns won't wear short white coats anymore

As the healthcare industry and society have changed, so have hospitals' dress codes.

For instance, Ohio-based Summa Health stopped requiring female employees to wear pantyhose with dresses or skirts in 2017. And the year prior, a patient survey resulted in the creation of a new dress code for nurses at Danville, Pa.-based Geisinger Medical Center.

Hospitals change their dress codes for a variety of reasons, even after the policies have been in place for years or even decades. Most changes come amid staff concerns and/or efforts to improve patient experience and outcomes.   

Becker's Hospital Review recently talked with multiple healthcare organizations to gain further understanding into why they implemented dress code changes and their goals in doing so.

Johns Hopkins

The Johns Hopkins Hospital in Baltimore will retire short white coats traditionally worn by physician interns, effective in July. First-year residents have donned the short white lab coats after entering Johns Hopkins' Osler Medical Training Program for more than 40 years. The length of the coat identified interns and set them apart from all other physicians wearing long white coats.

Sanjay Virendra Desai, MD, director of Johns Hopkins' Osler Medical Training Program and associate professor of medicine, said that distinction was made purposely based on the premise physician interns have the letters "MD" after their names, but have not fully learned to take care of patients' health.  

Interns have "continue[d] to wear the [short white] coat because it indicates the theme of being a learner," he said. "The intern, through the course of the [intern] year, learns the skills of a physician and how to be a clinician."

The interns receive the long white coats after they complete the training program.

Dr. Desai, who went through this process himself, called it "a very proud moment [for the interns] to feel you're a doctor." He said wearing the short white coats with a group of 40 or 50 other interns also represents the shared experience between the interns and their colleagues who went through the year together.

"I think because of the meaningfulness of that year, that shared experience is really incredibly formative in your life," he said. The experience creates lifelong bonds between the interns who go through the training program together, according to Dr. Desai.

But over the last decade, the interns have showed a different emotional reaction to the dress code tradition, and raised questions and concerns about it.

Dr. Desai said this is because they see the short white coats as a symbol of hierarchy, which makes them visibly and physically distinct, and don't see as much the aforementioned premise, rationale or values behind the dress code.

"At least in my anecdotal experience, it's similar to what you read about the generational changes that have occurred in society as a whole over the last decade," he said. "And that may be with the generations of younger people that are now becoming adults. It may also be related to the idea that in our society we're discussing symbols differently and I think that's in the press and in our external life. There have been discussions of symbols that have meant something else generations ago that are being reinterpreted in today's context."

Overall, Johns Hopkins Hospital seeks to promote symbols, traditions or processes that represent the organization's core values. "And, the short white coat was never the value," said Dr. Desai. "It was this idea that we need to teach people how to take care of patients.  It happened to be an expression of it that worked, but if it feels like a distraction from that value, the decision is simple. The value is what's important to us."

Hospital leaders decided to change the dress code primarily because of feedback from recent interns, as well as some past interns who said they felt isolated in the short white coats. Johns Hopkins hopes new physicians coming in will see the hospital is being responsive to generational and societal changes.

"Certainly we hope by making these changes and being responsive that we will be able to recruit the best of the best in the future," Dr. Desai said.

Long Beach Medical Center/MemorialCare Health System

Long Beach (Calif.) Medical Center, a subsidiary of Fountain Valley, Calif.-based MemorialCare Health System, made a dress code change in 2014 regarding standard uniform for patient care providers.

The change requires these providers wear different colored uniforms based on their clinical expertise and education levels. Previously, they could wear any color or pattern. For instance, registered nurses wear one color, while dieticians wear another color and respiratory therapists wear another. The uniforms are also embroidered with the worker's job title.

The original goal with the dress code change was to make it easier for hospital staff and patients to identify workers and their roles, according to Adam Abrahms of Epstein Becker & Green, the hospital's outside legal counsel.

"Back then, the change was instituted because of studies that proved patient care results [improved] when employees are easily identifiable by expertise," he said. If "patients know by color of uniform [the worker is] a nurse, [the patient] will feel more comfortable than if they don't know the role of the person. So part of it was recognizing that having people be easily identifiable in [a] crisp, clean manner has positive patient care results."

Hospital spokesperson Richele Craveiro Steele said LBMC also saw the move as beneficial from a marketing perspective, since patient care providers have a branded look and patients have another reminder of where they are receiving care.

LBMC implemented the dress code change in 2014, and as of last year, it was implemented across the MemorialCare system. And so far, the hospital reports positive feedback.

Marcie Atchison, vice president of human resources at Long Beach Medical Center, said she believes the dress code change has helped staff developed a sense of pride and confidence.  

Still, Mr. Abrahms, who has worked with hospital systems in California that have implemented similar plans and programs as LBMC, acknowledged that generally speaking, anytime hospitals institute a uniform change, employees want to know why the uniform change is occurring and the potential economic impact for them.

He said those issues were apparent in 2014 at LBMC, although minor since the uniforms were paid for by the hospital. Once staff understands the uniform change, their anxiety over it, in his experience, usually subsides.

"Once instituted, it usually works really smooth. People know what they're going to wear, they feel comfortable with it," said Mr. Abrahms.

Mayo Clinic

Rochester, Minn.-based Mayo Clinic now allows physicians and staff to show their tattoos, effective Jan. 1, 2018.

There is a caveat: They may only show the tattoos "if the images or words do not convey violence, discrimination, profanity or sexually explicit content. Tattoos containing such messages must be covered with bandages, clothing, or cosmetics. Mayo Clinic reserves the right to judge the appearance of visible tattoos."

Mayo declined to provide specifics about its dress and decorum policy, but it did provide a statement from Margot S. Peters, MD, chair of the Dress and Decorum Committee at Mayo to Becker's Hospital Review.

"Mayo Clinic staff represent one of the largest and most well-respected healthcare organizations in the world. The professional appearance and conduct of our employees are important parts of the Mayo Clinic experience for patients, their families and visitors in clinical and nonclinical areas," the statement reads. "Dress and Decorum guidelines help Mayo Clinic staff understand expectations concerning appearance and conduct, to ensure that our patients feel welcome, respected, comfortable and safe. While aspects of the policy change periodically, employees are still expected to project a professional appearance and demeanor."

Mayo has made other dress code changes in the past. In 2015, the organization eliminated its requirement for women to wear nylon stockings.




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