Australian doctors have all but completely abandoned white coats, with business casual clothing becoming the main visual identifier to distinguish them from other health workers, at least in the minds of medical students, research has found.

But while the shift in dress may appear to have blurred lines between health professions on the surface, more subtle signifiers like different coloured security lanyards have taken on outsized importance, the researchers say.

The finding is based on six years’ of  qualitative interviews, conducted annually with a pair of medical students on their perceptions of ‘becoming’ doctors from the start of medical school through to internship.

Even early in their degrees, each said they were quickly able to distinguish between doctors and other hospital staff – despite, or even perhaps because of, their lack of overt professional uniform.

This often simply came down to what shoes someone was wearing, with the famously expensive RM Williams boots often an immediate identifier of a doctor, they reported in Medical Teacher (link here).

“There is a language… and it’s not even always spoken language… it’s your body language,” said one of the interviewees, according to the article.

“My friend did orthopaedics and she went out and bought RM Williams shoes because everyone in orthopaedics wears RM Williams shoes.”

“They’re not cheap shoes by any stretch but she got instantly more recognised. She got complimented on them multiple times.”

RM Williams boots are apparently an easy identifier of a doctor in hospital. Source: Shutterstock

Meanwhile, stethoscopes – ubiquitous at AMA protests and when doctors appear in the media – had limited value as a professional symbol, particularly among doctors who rarely used them for their intended purpose, the researchers said.

Both interviewees said they were initially uncomfortable carrying a stethoscope around their hospitals out of a feeling their was ‘no legitimate reason’ to do so.

“Students and junior doctors (interns) generally wore or carried stethoscopes so they could be borrowed by consultants,” the researchers said.

“Interestingly, for [one of the interviewees], the stethoscope was a physical ‘pain in the neck,’ causing a headache, which may reflect a neuropathy caused by the compression of the tube and auricular pieces on the cervical spine.”

Moreover, the other interviewee described feeling that dressing ‘professionally’, rather than wearing a stethoscope, was the key to fitting in.

“In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with ‘professional attire’ distinguishing medical students and doctors from other team members (uniform),” the researchers wrote.

On the other hand, lanyards “were probably more important for identifying team members, particularly in situations where there are no uniforms,” the researchers said.

They added: “While wearing ‘professional clothes’ may be a positive step towards reducing the technical and performative element, allowing for a more relational message of empathy, it might also be construed as perpetuating elitism amongst health professionals.”

“Without white coats or stethoscopes, doctors in ‘professional clothes’ may, however, be confused with visitors and patients and so need other forms of identification.”

“It would appear that in Australia at least, lanyards (colour and design), which carry security cards, are now symbolic identifiers, perhaps even ‘treasured material possessions’ that differentiate students from interns and other health professionals.”

“In some instances, they are being used to differentiate different medical ‘tribes.’”