Is it time for an evidence based uniform for doctors?

Hippocrates advised that doctors should “be clean in person, well dressed, and anointed with sweet smelling unguents.”1 Although this remains sound advice, the concept of acceptable attire for doctors is constantly evolving. Two hundred years ago doctors wore formal attire for all clinical activity, including surgery, because they had no idea that their clothing could transmit infection. The demonstration of micro-organisms by Pasteur revolutionised the way people thought about infection and paved the way for Lister’s concept of antisepsis that has shaped our modern approach towards infection control.

However, Lister did not recognise clothing as a source of infection and continued to operate in formal attire. MacEwan, a student under Lister who became professor of surgery in Glasgow, is credited with introducing the sterile surgical gown. White coats made their appearance on wards and in clinics during the 20th century and are an iconic symbol of the medical profession. They were cited as a defining factor in the emerging role of hospital based care and the acceptance of the sick role outside of the home.2

The white coat remained the status quo until 2007, when the Department of Health (DOH) released dress code guidelines that forced doctors to remove their white coats, jackets, ties, and watches and roll up their sleeves.3 These guidelines were based on the findings of two literature reviews known as TVU1 and TVU2,4 5 which were commissioned and funded by the DOH “to inform policy development.”

Critics argue that evidence to support the new dress code is lacking, and the conclusions of TVU1 and TVU2 suggest there may be some merit in their argument.6 7 8 TVU1 stated that “the hypothesis that uniforms/clothing could be …