Washington, DC, United States
How do doctors dress? It depends on whom and when you ask. Just like other forms of clothing, the history of medical garb has been subject to the trends of time. While this has changed drastically in the past century, doctors’ dress profoundly reflects the societal expectations of their role.
Perhaps the most iconic uniform was that of the “plague doctor.” French Charles de Lorme is credited with designing it during the 1619 Paris Bubonic Plague Pandemic.1,2 Similar to physicians’ donning tightly fitting N-95 masks, eye shields, and long disposable plastic gowns during the COVID-19 pandemic, de Lorme fashioned a functional outfit to fight a disease ravaging Europe in the 17th century.1,3 Before the germ theory and the hygiene hypothesis, de Lorme’s garb covered the doctor head-to-toe in waxed leather to prevent air and fluid contamination of doctors by their patients.4,5
While the characteristic beak of the costume might seem absurd, the shape and function match that of today’s duck bill-shaped N-95 masks.6 The beak, holding perfumes and scents, was thought to purify the air of the “essence” of the plague before being inhaled by the physician.4 Unlike today’s surgical masks, this achieved little.
In non-pandemic times, such a get-up is not likely to be useful for doctors or comfortable for patients. In following eras, doctors went through an array of fashion choices molded by their societal position and their understanding of science.
Before the exclusivity of medicine and the sense of belonging to a unified scientific fraternity were emphasized, doctors dressed like everyone else. However, hierarchies in the type of “doctor” began to emerge and be reflected in dress. Apothecaries, the most basic of medical providers, acted as “druggists” of sorts, selling herbs, oils, and mixing concoctions. They were clothed like the “common man.”7
There was also a distinction between physicians and surgeons, the latter often associated with butchers and tradesmen. On the other hand, physicians, with university degrees, were esteemed as “gentlemen” or “officers.” Emphasizing this distinction, they often wore gold lace on their sleeves, flowing academic robes, and hoods.8,9
However, by the 19th century, probably with the advances in medical science and surgery and the creation of the first medical societies, most physicians and surgeons had adopted black or dark blue frock overcoats.1 This might have been rooted in a desire to showcase the somberness and respectability of this evolving profession, or perhaps to hide the ghastliness of antiquated operating rooms, in which blood and often stained the physicians’ precious clothes.10 With limited understanding of the importance of cleanliness and at a time when the death rate after surgery was more than 80% (likely due to infection), these fluid-soaked outfits often went unwashed.11 It was not until the late 19th century that Dr. Gustav Neuber of Kiel became the first surgeon to use a sterilized surgical gown.10
The shift to white occurred during the nascent antisepsis movement of the 20th century, Following the devastation by the Spanish influenza, physicians began to wear a simple white coat over professional clothes to emphasize their level of cleanliness and reputability.11 Gloves, masks, and surgical caps became commonplace, and drapes were introduced to protect the patient.10 This white uniform seemed to be here to stay, only modified by the introduction of standard, usually green, scrubs for surgeons. This color counteracted the eyestrain caused by the bright lights of an operating theater accentuating the white get-up.10
In an era of evidence-based medicine, the clean white coat over professional garb perfectly fit societal expectations and doctors’ righteous self-image. The dedication to science and data was so great that some male doctors refused to wear neckties, an essential part of the wardrobe of a professional working man, given concerns of spreading germs, which have also been renewed in recent years.12 Bow ties became fashionable.
In 1849, Elizabeth Blackwell, the first American female medical graduate, broke social barriers.13 As more US women graduated in medicine and became influential physicians and surgeons in the 20th and 21st centuries, the images of physicians and their dress changed. Skirts, frocks, and even pantsuits under the classic white coat became commonplace for females. The face of medical fashion was forever changed.
Today, we find remnants of the past. The white coat is so iconic that newly-minted medical students might have a ceremony around the garb.14 If you were to ask any lay person to imagine a doctor, a white coat, scrubs, and stethoscope would come to mind.
However, things are changing. The white coat, ironically, seems to be the first to go. Many modern hospital teams prefer the grey zip-up Patagonia jacket with matching labels signifying name and department.15 White coats are often worn as an afterthought before entering a patient’s room, almost like an actor readying him or herself before a performance.
Some patients prefer traditional professional clothes and a white coat over more casual outfits and scrubs.16,17 However, medical fashion seems to be heading in a different direction. After the Covid-19 pandemic, scrubs became a staple for younger doctors, and many might not switch back.3
Similarly, scrubs were limited to what the hospital provided and cleaned. It still is for those in the operating room. However, for those in clinics or the hospital floors, a multitude of scrub companies such as Jaanu, Figs and Care+Wear seem to prioritize fashion, comfort, and style.18 Now, instead of just relying on hospital-grade formless, oversized, and starchy scrubs, physicians can pick styles, colors, and specific pockets for their necessary supplies.
Individuality and revolution seem to have entered the space in the form of fashion, reflecting the profession’s ever-increasing diversity. With the recent development of physician-advocates, the doctor’s role is no longer confined to clinics, operating rooms, or hospitals—as is evident in the ways doctors choose to present themselves.
- O’Donnell VR, Chinelatto LA, Rodrigues C, Hojaij FC. A brief history of medical uniforms: from ancient history to the COVID-19 time. Rev Col Bras Cir. 2020;47:e20202597. doi:10.1590/0100-6991e-20202597.
- Kalmykov AA, Aminev RM, Korneev AG, Polyakov VS, Artebyakin SV. [From Leonardo Da Vinci to present days; from the history of antiplague costume]. Voen Med Zh. Jan 2016;337(1):76-80.
- Nordrum OL, Aylward P, Callaghan M. Hospital doctors’ attire during COVID-19 and beyond: time for a permanent change. Ir J Med Sci. Dec 2022;191(6):2445-2447. doi:10.1007/s11845-022-02922-1.
- Blakemore E. Why plague doctors wore those strange beaked masks. National Geographic, 2020. https://www.nationalgeographic.com/history/article/plague-doctors-beaked-masks-coronavirus.
- Paranque E. The celebrity physician and the plague. Wellcome Collection, Jun 23, 2020. https://wellcomecollection.org/articles/XvBkkhAAACIAu44I.
- Steinmetz AR, Rabinowitz R. The Plague Doctor, the Pandemic Doctor, and Surgical Protective Clothing. International Journal of Urologic History 2023;2(II):52-59. doi:10.53101/IJUH.2.2.01052304.
- Corfield PJ. From Poison Peddlers to Civic Worthies: The Reputation of the Apothecaries in Georgian England. Social History of Medicine. 2009;22(1):1-21. doi:10.1093/shm/hkn096.
- Loudon I. The nature of provincial medical practice in eighteenth-century England. Medical History 1985;29(1):1-32. doi:10.1017/S0025727300043726.
- Bishop WJ. Notes on the History of Medical Costume. Ann Med Hist. May 1934;6(3):193-218.
- Buicko J, Lopez M. From formalwear and frocks to scrubs and gowns: A brief history of the evolution of operating room attire. American College of Surgeons Oct 2016. https://www.researchgate.net/publication/308688977_From_Formalwear_and_Frocks_to_Scrubs_and_Gowns_A_Brief_History_of_the_Evolution_Operating_Room_Attire.
- Isaac S. Frock coats to scrubs: a story of surgical attire. Royal College of Surgeons of England, 2018. https://www.rcseng.ac.uk/library-and-publications/library/blog/frock-coats-to-scrubs/.
- Day M. Doctors are told to ditch “disease spreading” neckties. BMJ Feb 25 2006;332(7539):442. doi:10.1136/bmj.332.7539.442-b.
- Ellis H. Elizabeth Blackwell: a pioneer female medical graduate. Br J Hosp Med (Lond). May 2010;71(5):281. doi:10.12968/hmed.2010.71.5.47909.
- Gillon R. White coat ceremonies for new medical students. West J Med. Sep 2000;173(3):206-7. doi:10.1136/ewjm.173.3.206.
- Ostfeld-Johns S. New interns: Get ready to be fleeced. KevinMD, Aug 11, 2018. https://www.kevinmd.com/2018/08/new-interns-get-ready-to-be-fleeced.html.
- Christopher MP et al. Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA. BMJ Open. 2018;8(5):e021239. doi:10.1136/bmjopen-2017-021239.
- Xun H et al. Public Perceptions of Physician Attire and Professionalism in the US. JAMA Network Open 2021;4(7):e2117779-e2117779. doi:10.1001/jamanetworkopen.2021.17779.
- Friedman V. Health Care Workers Deserve Fashion, Too. The New York Times, Jun 9, 2021. https://www.nytimes.com/2021/06/09/fashion/healthcare-workers-scrubs-fashion.html.
SHEFALI SOOD, MD, MPA, is a second-year resident in Ophthalmology at Georgetown University/Washington Hospital Center in Washington, DC, USA.
Highlighted in Frontispiece Volume 15, Issue 4 – Fall 2023