Published: 02/12/2004, Volume II4, No. 5934 Page 38

It is interesting that most hospital staff are recognisable by their uniform: doctors famously wear white coats while nurses and other staff wear varying types of uniform.

Managers are one of the few groups who do not wear any. There could be psychological benefits if they did - or do they already have an unofficial one?

The hospital doctor's famous white coat has a powerful psychological association with all things medical, scientific and healing, plus the attributes of purity and goodness.

When hospital doctors are asked why they wear white coats, the most popular reason is simply ease of recognition by colleagues and patients due to 'continuity of dress'. The second most popular is the ability to carry items in voluminous pockets. An intriguing 1 per cent of respondents say they wear a white coat because it acts as a 'psychological barrier'.

But a white coat might be positively bad for patients' health precisely because the whiteness lulls us into believing it is cleaner than it may really be. White coats appear to be a reservoir of virulent germs, largely because they are rarely changed as often as they should be.

So if white coats do not make much scientific sense, they may have more to do with psychology - in particular the respect the uniform commands and the control it brings to relationships.

Most uniforms bring a strong sense of identity, bonding and pride for wearers. Does the lack of a formal uniform for managers suggest they lack these qualities?

It is also intriguing that those at the most senior level in medicine frequently abandon the white coat.

Perhaps it is a way of signaling their seniority, and their expectation that they do not expect to be asked to do anything practical any more.

If managers had a uniform of some type, their role and level of integration into the hospital might be more obvious to other staff, who complain that managers seem to exist to be obstructive.

When some staff wear a uniform and others do not, we need to reconsider why we have uniforms in the first place.

Ray Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.