As social and professional missteps go, mine was memorable.
It was a spring day in Anaheim, California. Thousands of surgeons had gathered for the American Urological Association Annual Meeting. I was a resident at the time and felt privileged to attend such a major conference. The most important lesson I learned that day, however, had nothing to do with surgery.
Upon entering the convention center, my heart sank. I was the only person not wearing a necktie, or, for women, a business suit. It got worse. A mentor spotted me and began introducing me to several of his colleagues. Their body language conveyed obvious disapproval of my business-casual attire. That’s when I learned what everyone else already seemed to know: Casual attire may be acceptable in the hospital, but professional meetings call for semiformal dress, unless they’re held in Hawaii.
After residency, I noticed the same contrast again and again. The same physicians who wore scrubs and fleece jackets during the workweek were impeccably dressed at professional gatherings. One colleague told me the ACS Clinical Congress was his once-a-year opportunity to pull a suit out of the closet. This unspoken expectation of semiformal attire seemed to hold true regardless of specialty or season. I was particularly struck by it last year at an early summer meeting in Las Vegas. Among the tourists and Elvis impersonators were crowds of physicians looking uncomfortable in dark wool suits.
I don’t mean to imply that dressing up is somehow wrong. If semiformal attire is appropriate for weddings and funerals, it is certainly appropriate for medical meetings. After all, these are the places where physicians network, interview for fellowships, meet future employers, and celebrate their specialty.
My concern is the sartorial double standard that has become increasingly common in surgery. In the hospital, casual attire is now widely accepted. It’s common to see physicians in polo shirts, khakis, and even sweatshirts. Scrubs are routinely worn outside the operating room. The white coat, once ubiquitous, has often been replaced by the fleece jacket. Neckties have fallen out of favor, partly because of concerns that they may serve as vectors of infection. Dress shoes? Sneakers increasingly seem to be the footwear of choice.
Etiquette experts have long argued that clothing reflects the importance we attach to an occasion.¹ Attire communicates respect and consideration for others. By that measure, what could be more important than caring for a patient? It is a privilege to be a surgeon and to earn our patients’ trust. We owe it to them to demonstrate that respect not only through our words and actions, but also through our appearance.
What message are we sending when we wear fleece jackets at the hospital but suits at professional meetings? Could radically different dress codes unintentionally suggest that patients are less important than our colleagues? Research on physician attire suggests that patients have greater confidence in physicians who wear white coats.² They also associate more formal dress with competence and professionalism. In general, patients prefer physicians to dress more formally.³ Unfortunately, many of us do not seem to be listening.
Professional dress in medicine wasn’t always this relaxed. At The University of New Mexico, medical students in the Class of 1968 were simply told to “come dressed appropriately” at the start of the school year.⁴ No further explanation was needed: the men wore neckties, and the women wore professional dresses. Things were not much different when I was a medical student in the 1990s. At the start of my surgery rotation, we were told that scrubs were not appropriate outside the OR. In clinic, professional attire and a short white coat were expected. Even Surgical Recall, my indispensable companion during that rotation, reminded students that “...appearance is so important [because] the patient sees only the wound dressing, skin closure, and you!”⁵
In the early 21st century, workplace norms began to shift. Society as a whole became more casual. Silicon Valley embraced sneakers and T-shirts as part of its corporate culture. Iconic retailers such as Brooks Brothers, long associated with presidents and business leaders, declared bankruptcy. Comfort and convenience increasingly became the priorities.
Scrubs also took on a new role as the wardrobe of the entire hospital. Pharmacists, radiology technologists, internists, and many others began wearing them. For some, scrubs even became a form of branding, embroidered with practice logos and names. Physicians also began wearing scrubs beyond the hospital—in grocery stores and other public settings. Television shows such as Grey’s Anatomy helped normalize some of these trends. Another series, Dr. 90210, even featured a California plastic surgeon whose scrub sleeves were cut off like a muscle shirt.
Many professions with significant public responsibility have largely resisted the trend toward increasingly casual dress. Pilots, members of the military, and law enforcement officers continue to wear uniforms that reflect the importance of their roles. Medicine has not been entirely immune to this shift, but traces of more traditional standards remain. At many hospitals, there is still the occasional physician wearing a bow tie or making rounds in a bespoke suit. The Mayo Clinic, in particular, is well known for its culture of professional dress. The suits that define “Mayo wear” are considered a “...way of showing respect and honor at being able to serve patients.”⁶ Although that standard may not be practical for every institution, the principle behind it is worth considering.
I would encourage my colleagues to be more intentional and consistent in how we present ourselves. A more professional appearance can only strengthen the public image of surgery. Patients value it, and we already recognize its importance when we gather for professional meetings. Will it require a little extra effort? Perhaps. But the benefits are worth it.
Professional attire has also become easier to wear. Modern fabrics are more comfortable, require less maintenance, and are available at a wide range of price points. Dressing professionally need not be expensive or impractical.
Physician attire should not be guided solely by comfort and convenience. Professionalism and patient perception matter as well. Professional attire need not mean returning to outdated norms, but it should reflect the same respect for patients that we naturally convey to colleagues at professional meetings. Our patients deserve that same level of respect, and a more professional appearance can only strengthen the patient-physician relationship.
Disclaimer
The thoughts and opinions expressed in this article are solely those of the author and do not necessarily reflect those of the ACS.
Dr. Satyan Shah is a professor of surgery and urologist at The University of New Mexico School of Medicine in Albuquerque.
References
- Post P. Emily Post’s Etiquette. New York: HarperCollins Publishers, 2004.
- Xun H, Chen J, Sun AH, Jenny HE, et al. Public perceptions of physician attire and professionalism in the US. JAMA Netw Open. 2021;4(7):e2117779.
- Petrilli CM, Mack M, Petrilli JJ, Hickner A, et al. Understanding the role of physician attire on patient perceptions: A systematic review of the literature—targeting attire to improve likelihood of rapport (TAILOR) investigators. BMJ Open. 2015;5(1):e006578.
- Wang DL, Carter SL. The Daily Practice of Compassion: A History of the University of New Mexico School of Medicine, Its People, and Its Mission, 1964–2014. Albuquerque. University of New Mexico, 2014.
- Blackbourne LH. Surgical Recall, Second Edition. Baltimore: Lippincott Williams & Wilkins, 1998.
- Streed J. Mayo wear. July 1, 2009. Available at: https://newsnetwork.mayoclinic.org/discussion/mayo-wear. Accessed June 9, 2026.
