Skilled? Trustworthy? Caring? Your Scrub Color Matters to Patients

A healthcare professional’s scrub color denotes certain qualities to the patients under their care, a new survey shows. Green scrubs struck many respondents as befitting a surgeon, while blue scrubs more often evoked a more caring demeanor.

The results were published online this week as a research letter in JAMA Surgery.

Lead author Casey A. Hribar, BS (University of North Carolina at Chapel Hill), set to graduate with her MD and MBA degrees this spring, said the researchers sought to better understand patients’ experiences when encountering healthcare professionals in the hospital. As earlier studies have shown, white coats can be perceived as more professional compared with casual attire.

What effects a physician’s wardrobe might have on patient perceptions took on fresh meaning as the COVID-19 pandemic wrought changes, Hribar pointed out to TCTMD. “Everyone is starting to transition toward scrubs, especially in procedural settings. You see patients kind of expect that scrubs are going to be commonplace for doctors, as opposed to traditional formal dress.”

But with that shift, Hribar and colleagues wondered, how would scrub color be perceived?

“We recognize that there’s much more to the doctor-patient relationship than just what color scrubs someone is wearing,” she stressed. But given that clothing is so modifiable, and might have extra impact on impressions during the often brief interactions that take place in a hospital, “we were just curious,”  she said. “Do people care?”

This isn’t to say these opinions should result in a new dress code, stressed Hribar. “We’re not saying tomorrow every hospital should change the way they order scrubs or every physician should change the way they dress. But what we are wondering is: what do providers prefer, and what do patients prefer, and what changes can we make in between to meet that in the middle?”

Knowing these nuances could be especially useful in places like the operating room or emergency department “where a quick visual cue might make a big difference.”

A quick visual cue might make a big difference. Casey A. Hribar

Hribar and colleagues surveyed 113 adult patients and visitors at the University of North Carolina Medical Center in Chapel Hill over a 2-month period in 2019. Most (53%) were 31 to 60 years old, while 21% were 18 to 30 years old and 26% were older than 60.

The researchers presented participants with eight images: four each of a male and female clinician wearing either light blue, navy blue, green, or black scrubs. “We picked the scrub colors based on popular medical television shows, because a lot of times for patients this might be their first time in the hospital,” so they may have few preconceived ideas about what clinicians wear, Hribar explained.

The survey takers were asked to choose, for both the male and female pictures, who they most strongly recognized as a surgeon. They also were asked to rank the images according to who appeared most and least knowledgeable, skilled, trustworthy, and caring.

The color most frequently chosen as indicating a surgeon was green (chosen by 45.1% of respondents for the male image and by 41.6% for the female image). Black scrubs, on the other hand, were most frequently thought of in connection with negative traits related to knowledge, skill, trust, and level of caring, though the answers varied by age: the youngest participants identified the green and blue images as least trustworthy.

Blue scrubs were thought to be most caring (chosen by 56.6% of respondents for the male image and by 48.7% for the female image), no matter the survey taker’s age. For the images of the female clinician, blue was linked to being most trustworthy and green was linked to being least caring.

A few of the study participants pointed out that the green scrubs resemble a janitor’s clothing, while a few also “asserted that the black scrubs looked deathlike or like a mortician’s uniform,” the paper notes.

“Given the increasing use of scrubs and the magnitude of expenditures dedicated to them, color choices should be purposeful and data-based,” the investigators conclude. “Although rapport depends on both tangible and intangible factors, scrub color is an easily modifiable feature that may be a factor in the clinician-patient relationship, and thus, clinical outcomes.”

Whether these patterns extend across medical specialties, hospital types, regions, and patient populations is yet to be seen, said Hribar. In other words, the impression given by color might vary not only based on who’s wearing the scrubs but also based on who’s on the receiving end of healthcare.

Clinicians, too, have preferences for what they like to wear, she noted, and these may not match up with what their survey respondents chose. “It could be based on how old you are, or what gender you are, or how you dress yourself, or whatever it might be, but [many of us] were really surprised because we thought: if you were to ask us what [color] we were to prefer, we probably always pick the black or the navy,” darker colors that might hide stains and be more flattering, Hribar said. “How do you find that balance?”