Enclothed/Embodied Cognition: How the White Coat Effects Cognitive Processes

Medelita Lab Coat

In April of 2012 the New York Times published an article on Enclothed Cognition that not only caught our interest here at Medelita, but it reinforced what most people intuitively understand:  what you wear impacts your level of self confidence. The thought process behind the common phrase 'the clothes make the woman/man,'  has been applied to situations throughout our lives, especially when we're striving to succeed.  Job interviews, special occasions; when there is a moment of importance in our lives, we step up our appearance to signify that importance. The New York Times article focused specifically on how wearing a white coat effected the cognitive process and made people  "think like doctors," citing that
physicians tend to be careful, rigorous and good at paying attention.
In the  Study on Enclothed Cognition, Hajo Adam and Adam Galinksy introduced the term “enclothed cognition to describe the systematic influence that clothes have on the wearer's psychological processes."  Three experiments were conducted with the following results:

1. Physically wearing a lab coat increased selective attention compared to not wearing a lab coat.

2. Wearing a lab coat described as a doctor's coat increased sustained attention compared to wearing a lab coat described as a painter's coat, and compared to simply seeing or even identifying with a lab coat described as a doctor's coat.

Testing the White Coat

The British Psychological Society's Blog describes how researches came to their conclusions about Enclothed Cognition; here is a quick snapshot of their post describing the tests:

58 students took part in a test of their powers of selective attention known as the Stroop Test

Half the students performed the task in a scientist's white lab coat

The other students just wore their own clothes.

The Key Finding: - students in the lab coats made half as many errors on the critical trials of the Stroop Test.

Next researches tested whether enclothed cognition effects depended upon the meaning or the wearing of the clothes.

The results?  Participants who donned a lab coat performed  far better than those who only  saw a lab coat on the desk or those who wore a coat but believed it belonged to a painter.

Doctors Who Choose Not to Wear a White Coat

Last week I spoke to an MD in his 3rd year of residency in relation to what the White Coat means to a young MD.   This doctor has a friend who is a chiropractor and had some insight into the chiropractor's practice, where the white coat is not standard uniform.  Our conversation centered on doctors who choose not to wear a white coat and why.

 My immediate question was: Why would a doctor choose not to wear a white coat?

There is a school of thought and some evidence that individual patients, especially children, find the white coat intimidating and therefore some doctors choose not to wear them.  Examples of a patient's blood pressure rising upon seeing their white coat-clad physician are fairly common.

This condition, sometimes known as "White Coat Hypertension," was once thought to be a purely temporary condition, but is now being considered as a possible indicator of future issues.  Perhaps that momentary spike in blood pressure brought on by the white coat can signal that special care in regards to blood pressure should be taken.

Why the White Coat Matters to Patients

In seeking out opinions on what the white coat means to those working in the profession, I came across this post by Dr. Michael EdmundProfessor of Internal Medicine and Chair, Division of Infectious Diseases, VCU Medical Center,  describing his stance on why it is ok for Physicians to shed the white coat.  I considered how I (a layperson and non-medical professional) would feel as a patient if my doctor walked into an appointment in jeans and a sweater.

At the beginning of his post, Dr. Edmund cites a paper from  JAMA Internal Medicine, where hundreds of people whose family members were ICU patients viewed photographs of physicians dressed in a variety of attire, casual, business, and in white coats.

Then the subjects matched  the doctors images with with specific characteristics.   Dr. Edmund writes, "...in a nutshell, they found that families deemed the doctors in white coats to be most knowledgeable, most honest, and best overall. Doctors in scrubs and white coats were deemed equally most competent and most caring."    Dr. Edmund rejects the findings based on his own interaction with patients, stating that he " never met a patient who chose their doctor on a sartorial basis."

I respect Dr. Edmund's experience and opinion of course, but needed to understand more.  In reading on the study I found that it was based on the experience of ICU patients. One note that stood out for me was "Patients admitted to the ICU typically do not have a preexisting long-term relationship with their ICU physician, and therefore trust needs to be established over a short time frame.7 "

A Patient's Perspective

I am not a doctor; I write this post clearly from a patient and layperson's perspective.  Because of my work with Medelita, I am in close and constant contact with many people who do work in the medical profession on a daily basis, which gives me a small insight into what life is like for them, and of course we talk constantly about 'the white coat' because it is one of Medelita's key products.

We found the Enclothed Cognition study interesting not only because it is impressive, but because it carries with it a sort of deja vu, or deep familiarity.  The idea that the clothes you wear impact how you feel reinforces something many of us understand: to look good, and to dress smartly, changes how we feel about ourselves, and how others perceive us.

The extra layer of depth that the study brings is that we now know is it isn't only about perception, but wearing a professional white lab coat actually effects the way we think; it directly impacts our cognitive process.  Considering that there are differing views on the topic, we'd love to hear your thoughts and experiences about the white coat and how it impacts your perception of the profession.

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