The influence of physician attire on patient perceptions

What patients want... Read their views on their preferred physician attire and how their appearance influences their confidence. So, click below to read a not-so-serious article to finish the year with a smile...

A/Prof Cristina Morganti-Kossmann

Director of Lex Medicus Publishing

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Lex Medicus medico legal client in professional and casual clothing

How do patients perceive their doctors based on their attire? What level of confidence and trust is transmitted when the consulting physician or surgeon wears a white coat, a bow tie, or rather casual wear such as jeans or even shorts and thongs? Patients’ answers to these questions do really demonstrate differences in how they see the treating doctor based on their clothing.

One study in particular humorously attempts to apply a “scientifically rigorous” evidence-based medicine approach to investigate the role of doctors’ attire in the quality of patient-doctor relationship with the possibility that specific clothing will increase outcomes of healthcare delivery.
The question at the heart of the study was:

Does a doctor’s appearance constitute an important and neglected aspect of the clinical context?

The authors investigated the definition of “formal attire” through Evidence-Based Dressing or EBD in an emergency department cohort. When 275 outpatients were asked to vote for their favourite doctors’ attire, white coats, dress pants, traditional hairstyles and skirts were chosen over blue jeans, open shirts and non-traditional hairstyles.

Surprisingly, evidence also suggests that although a white coat (a staple of doctor attire) may prevent a tie from dangling into patients’ wounds and secretions, it is not considered to be hygienic as a coat will harbour microorganisms that spread from one consultation to the next. Also, bow ties and neckties have equally been found to increase contamination rates also.

A thorough statistical analysis using the Fashion Operator Characteristics curve, indicative of specificity and sensitivity of patients towards various clothing items (divided into “Zone of no confidence”, “Zone of fashion limbo”, and “Zone of trust”), showed a lack of confidence when doctors wore nose ring, and higher confidence when doctors had dress pants and shirts.

Thus, concluding that, unsurprisingly, patients’ confidence was higher with a respectable dress protocol while a white coat or a tie did not significantly diminish patients’ level of confidence.

Conversely, a nose ring was mostly deleterious for a patient’s perception with an odds ratio being “very odd” and a wide interval of “no confidence”.

The authors believe there is much potential in recognising fashion accessories as conceivable adjuvant therapies, and advocate a new specialty called PCAM (Physicians’ Complementary Accessories Medicine).

They also propose a joint venture between medical organisations and department stores in launching the Evidence-Based Wardrobe label, offering several lines of clothing, with Level 1 having most evidence for therapeutic success, to Level 3 being of minimal impact. In addition, they invite expression of interest in operating Evidence-Based Cuts (EBC) a barber hairdresser shop franchise located in hospitals thorough Australia. With adhesion to quality assurance guidelines and continued professional competence thorough Continuing Barber Education (CBE), they will ensure to remain at the cutting edge of EBC for maximal patient benefit and satisfaction.
This data is somewhat confirmed by the Hawaiian physician attire study:

Slippers and a white coat? As a result of questionnaires provided randomly at hospital presentation, patients were asked if it was acceptable for their physician to wear slippers, scrubs, short pants, blue jeans, or if they preferred them to wear a white medical coat. The second part of the questionnaire aimed at measuring levels of trust/confidence in their physician based on the types of attire.

The results showed that patients in Hawaii differ from their mainland counterparts, whereby casual clothes are generally accepted and the white coat is NOT preferred by a small majority. However, the responders were definitely clear about one thing: extreme casual attire, such as shorts and slippers were not approved as appropriate by the majority of Hawaiian patients.

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