Patients still trust white coats, but gender bias lingers

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Patients continue to associate the physician’s white coat with professionalism and trust, but new research finds that gender bias and clinical context significantly influence perceptions.

A research paper published August 12 in BMJ Open examined 32 studies from 2015 to 2024 across multiple countries, including the United States, Japan, China and Pakistan. The analysis found that physician attire strongly shapes patient impressions of competence, communication and empathy, but expectations vary by setting, specialty and physician gender.

Context shapes perceptions

In primary care, patients often preferred a combination of casual attire and a white coat, a look seen as approachable yet professional.

In contrast, emergency and surgical settings drew strong preferences for scrubs or white coats, associated with preparedness and hygiene.

Palliative care patients had no strong preference, while outpatient and inpatient hospital patients tended to rate white coats highly for conveying professionalism and cleanliness.

Specialty also influenced views. White coats were favored in orthopedics, dermatology, ophthalmology, obstetrics and gynecology, and neurosurgery. Scrubs were preferred in anesthesiology, gastroenterology and breast radiology.

Persistent gender bias

The review found consistent misidentification of female physicians as nurses or medical assistants, even when male and female physicians wore identical clothing. Male physicians were more often associated with authority when wearing suits or formal attire, sometimes enhanced by accessories like watches or glasses.

Patients tended to favor male surgeons in suits or scrubs without white coats, while female surgeons were rated more favorably in scrubs with a white coat.

“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians,” the authors wrote. “[This] highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients.”

The COVID-19 pandemic accelerated acceptance of practical and hygienic attire. During and after the pandemic, both patients and physicians increasingly favored scrubs and masks, especially in high-risk environments.

Many patients reported that scrubs and masks conveyed safety and infection control, though some found masks impeded emotional connection.

While the white coat remains a symbol of medicine, this review suggests that its meaning is neither fixed nor universal, but contextual. As medicine continues to adapt, so too will the garments that determine the first impression between physicians and patients.