White coats

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iStock_000022757669_Double_PPThe way you look and present to your patients could be helping or hindering your business. Natasha Shaw explains further

Traditionally, when people think of a dentist, an image of a clean-cut professional springs to mind, sporting a perfect smile with dual rows of perfect pearly whites … and wearing the obligatory white coat, of course.

But perhaps this image needs updating. Sure, the pearly whites are still evident, but what about the overall appearance? That crisp white coat, or those freshly laundered scrubs? Unfortunately (or fortunately, as your opinion may be), more and more dentists are opting not to wear them. So, are dentists starting to appear, dare we say, sloppy?

Despite the fact the white coat ‘uniform’ has been worn for more than 150 years (a look borrowed from lab technicians in order to gain a credible appearance) and, more recently, scrubs, many dentists of today are choosing to wear everyday clothes when seeing patients. A 2013 study in the IOSR Journal of Dental and Medical Sciences, for example, showed dentists are almost equally split in their views regarding uniforms, with 51.6 per cent in favour of the white coat, compared to 48.4 per cent who aren’t.

“Everyone in our practice wears a uniform. The front-desk people have a formal uniform (blouse/shirt) and the medical staff—dentists, hygienists and DAs—wear scrubs,” says Dr Emily Lockley, associate dentist at Sailors Bay Dentistry in Sydney. “It is an easy way for patients to identify the staff and shows us as a team. I do not believe dentists’ appearance is slipping or looking sloppy and I do not think scrubs impact negatively.”

Dr Lockley says scrubs were introduced when she was a student due to cost and comfort. “Students on limited incomes found it very expensive to maintain the clothing expected of them while treating patients, and scrubs were a professionally accepted uniform that was cheap to maintain,” she explains.

Comfort clothing

Despite this, dentists wearing zero uniform is slowly rippling through the field of dentistry. One of the main reasons why many are shedding the white coat/scrubs is they say it breaks down the barrier between patient and dentist.

“I wear casual clothes because of my experience when I was young,” says dentist and senior lecturer at the University of Sydney’s Faculty of Dentistry, Dr Ky-Anh Nguyen. “Most dentists I saw back then wore uniform/scrubs, so as a kid I knew that the dental surgery is a different place—people do serious things there—so I was more anxious, nervous and with fear of the unknown of what was going to happen next.

“On one occasion, however, I saw a lady orthodontist who dressed in street clothes and spoke to me like an individual about what I wanted, rather than bypassing me to talk to my parents. That really made an impression that stuck with me for the rest of my life, so now that I’m on the other side, I would like to emulate a similar feeling to my patients,” says Dr Nguyen.

Dr Lockley wears scrubs for a similar reason. “Despite what people may think, dentistry is a physically demanding job. Some procedures can be quite long and messy so it’s important to be in a outfit that is comfortable, unrestrictive and can be cleaned easily. Scrubs have been designed to fit those requirements and they are also less frightening for the patients and make them feel more comfortable,” she explains.

Are uniforms a health hazard?

Another reason for wearing no uniform is the possibility of transferring infections. In the study mentioned earlier, what is really interesting is that 51 per cent of dentists believed white coats transmitted hospital-acquired infections. However, fewer than one per cent of patients agreed white coats could be a health hazard, while 6.5 per cent even said they helped prevent infections.

White was the colour originally chosen for medical coats as it represents both purity and cleanliness. In 2007, however, the UK banned white coats used in medical professions that went below the elbow due to the increased risk of cross-patient infection.

The Australian Government National Health and Medical Research Council (NHMRC) hasn’t agreed. It published the Australian Guidelines for the Prevention and Control of Infection in Healthcare in 2010, stating that, “uniforms should be laundered daily, whether at home or at the hospital, and that the literature has not shown a necessity to ban white coats or other uniforms, as there is no evidence that they increase transmission of nosocomial infections.”

“At our practice we have a ‘no scrubs outside’ rule. When staff leave the building they get changed and at the end of the day, scrubs are collected and laundered within the practice,” explains Dr Lockley. “In this way I think it is less hygienic to wear street clothes, especially because not everyone has the same standard when washing their clothes.

“At our practice, we can ensure all clothing worn when treating patients is washed and kept to the highest standard,” she says.

Despite being an advocate for casual wear, Dr Nguyen agrees hygiene is important. “You definitely don’t want to wear your street clothes from the surgery to go outside and back home,” he says. “God knows what kinds of potentially infectious materials have been splashed onto your clothes during the day, and you go home to hug your wife and kids!”

The patients’ view

Younger generations don’t seem to mind dentists in everyday clothes. After all, they’re more used to wearing casual attire to work. What used to be ‘casual Friday’ now runs all week in many professions. Older generations, on the other hand, are more likely to sway towards their dentists looking the traditional way. In a recent study, while 67 per cent of patients said they prefer their dentists in a white coat, nearly a third of these people were over the age of 60.

While Dr Nguyen acknowledges some patients may not like the casual look, he says: “I think the younger generation prefers to have greater power in their choices/decisions and would prefer to interact as peers rather than as patients.”

Ease of identification seems to be the primary reason for patients wanting their dentists to wear a uniform, closely followed by the fact a white coat, in particular, just looks more professional and is tradition. A study published in The Ochsner Journal in 2013 paralleled the patients’ preference for a white coat, with 69.9 per cent wanting the comfort and confidence of their medical professionals wearing one.

Dr Lockley agrees dentists should appear professional. “Dentistry is within the medical field and the treatment we provide is not unlike a surgeon in a hospital. The possible expectation we should dress like we are in an office setting is unrealistic and lacks an understanding of what dentists do.”

What’s in a uniform?

Researchers from Northwestern University in Illinois, USA, recently conducted an interesting experiment with a white coat. They found wearing a white lab coat described as a doctor’s coat increased the attention of the wearer, when compared to when the coat was described as simply a painter’s coat.

In 2007, researchers Joy V. Peluchette and Katherine Karl found wearing formal business clothing can change how you even feel at work. It seems people “felt most authoritative, trustworthy and competent when wearing formal business attire but friendliest when wearing casual or business casual attire”.

To wear a uniform, or not to wear a uniform, is clearly a debate that’s here to stay. And there are great arguments in both camps. Dr Lockley sums it up nicely when she says: “I believe if you are a good, honest and caring dentist, and your patients trust you, it doesn’t matter what you are wearing.” Perhaps there is merit in that.

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