Is our appearance important to our patients?

Patient perception of orthodontists with different stereotypes: development, psychometric properties, and application of an assessment instrument

INTRODUCTION

This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, assesses whether the presence of piercings, tattoos, beards, and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope.

METHODS

The developed questionnaire had its psychometric properties evaluated and was applied to 220 young people and adults, aged 18-70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, considering the following items: hygiene, care, punctuality, experience and knowledge in orthodontics.

RESULTS

The developed questionnaire showed high acceptability, confirmed reliability and validity of the construct, and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (P <0.01), in which the orthodontist with combined characteristics (beard/loose hair, piercing, earrings, and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (P <0.01) and in total (P <0.01). Health professional (P = 0.427) and educational level (P = 0.285) status did not influence the perception; however, there was a significant difference for the age groups (P = 0.041).

CONCLUSIONS

The developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level status did not influence the perception. However, older subjects (aged 51-70 years) were more critical in judging stereotypes than younger subjects (aged 18-30 years).

Clothes Make the Man-What Impact Does the Dress of Interprofessional Teams Have on Patients?

Physicians’ attire seems to play an important role in the success of patient treatment. The classic doctor’s white coat initiates a strong signal to the patient and can have a determining effect on a successful doctor–patient relationship. In a quantitative online questionnaire study comprising 52 questions, participants were shown four photos of an interprofessional German family medicine team in varying attire. One important study feature relating to the ongoing coronavirus pandemic was that the team was portrayed wearing FFP2 masks in one photo. We measured core values regarding the team’s perception in terms of sympathy, competence, trust, choosing the practice as a personal health care provider, and wanting to participate in the team. The questionnaire was posted online between March and May 2021. It was accessed 1435 times and 906 sheets were qualified for statistical analysis. For the first time in this field of research, a practice team’s attire was investigated. We found a significant influence of different clothing on the perception of sympathy, competence, trust, elective practice, and team participation. Wearing an FFP2 mask promotes feelings of security and competence. The study shows that in times of fast social changes due to rapid digitalization and an ongoing pandemic, we should present ourselves in different ways as a medical team depending on the patient groups we are targeting and the feelings we want to evoke.

International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents

OBJECTIVE

The patient-physician relationship impacts patients' experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings.

SETTING

20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA.

PARTICIPANTS

Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices.

PRIMARY AND SECONDARY OUTCOME MEASURES

The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics.

RESULTS

The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only.

CONCLUSIONS

Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.

Dress to Impress: Public Perception of Plastic Surgeon Attire

BACKGROUND

Physician attire has been shown to impact patients' perceptions of their provider with regards to professionalism, competency, and trustworthiness in various surgical subspecialties, except in plastic and reconstructive surgery.

OBJECTIVES

The authors sought to address this knowledge gap and obtain objective information regarding patients' preferences.

METHODS

A survey was distributed to adult, English-speaking participants in the United States using the Amazon MTurk platform from February 2020 to December 2020. Participants were asked to evaluate with a 5-point Likert scale 6 attires (scrubs, scrubs with white coat, formal attire, formal attire with white coat, casual, casual with white coat) in terms of professionalism, competency, and trustworthiness for male and female plastic surgeons during their first encounter in clinic.

RESULTS

A total of 316 responses were obtained from 43.4% men and 56.6% women. The mean age of participants was 53.2 years. The highest scores across all metrics of professionalism, competency, trustworthiness, willingness to share information, confidence in the provider, and confidence in surgical outcomes were given to the formal attire with white coat group, with average scores of 4.85, 4.71, 4.69, 4.73, 4.79, and 4.72, respectively. The lowest scores across all metrics belonged to the casual attire group with scores of 3.36, 3.29, 3.31, 3.39, 3.29, and 3.20, respectively. Patients preferred formal attire for young plastic surgeons (P = 0.039).

CONCLUSIONS

This study suggests that physician attire impacts patients' perception of plastic surgeons regarding their professionalism, competency, and trustworthiness. White coats continue to remain a powerful entity in clinical settings given that attires with white coats were consistently ranked higher.

A survey of Japanese physician preference for attire: what to wear and why

Many studies have examined the impression made on patients by physicians' attire. Regardless of practice location, many patients express most confidence in physicians who wear white coats. The number of physicians in Japan who choose not to wear white coats in practice has been increasing, particularly in primary care settings. However, very few studies have examined physician preference for attire. To clarify Japanese general practitioners' preference for attire by practice setting, we conducted a survey of physician preferences and reasons for attire selection. Subjects were 794 general practitioners certified by the Japan Primary Care Association and recruited from a mailing list. We conducted a web-based questionnaire survey. Physicians were asked to choose one of four different dress styles (semi-formal, white coat, scrubs, and casual) for different practice settings and state the reasons for selection. The response rate was 19.3% (n = 153; men 112). Most subjects chose white coats as usual attire for hospital practice (52%), mainly because of custom and professionalism. In contrast, most subjects chose non-white coats for clinics (59%) and home care (hospital-provided, 58%; clinic-provided, 71%). More subjects chose casual dress for clinic and home care practice, mainly to appear empathic. Most subjects chose white coats as the most appropriate hospital attire (54%), mainly because of patient perceptions of this attire being professional. Most subjects considered non-white coat attire more appropriate for clinic and home care practice. The findings indicate that general practitioners choose their clothes depending on practice location.

What Should I Wear to Clinic? A National Survey of Pediatric Orthopaedic Patients and Parents

BACKGROUND

A number of factors have been shown to affect how surgeons are subjectively viewed, including their appearance in clinic. Patient preference for pediatric orthopaedic surgeon attire has not previously been studied, nor has its influence on initial perception of the surgeon.

METHODS

At 5 pediatric regional sites across the United States, parents and patients presenting to the pediatric orthopaedic clinic were given anonymous surveys showing 8 photos of surgeons in different clinical dress including in business or scrub dress, each with or without white coat (WC). Subjects reported their demographics, single preferred photo, rated characteristics of the surgeons in each photo on a 5-point Likert scale, and answered specific questions on scrubs and WCs. The first consecutively completed 100 parent and 100 patient surveys were included from each site.

RESULTS

One thousand surveys were collected from patients (500) and parents (500). The majority felt a surgeon's clinical dress would not affect how they are cared for (83%), and that it was ok to wear scrubs in clinic (90%). Overall, WC was preferred to those without no matter the age, but there was no difference between scrub and business choices. Of those stating a preference, woman in business and WC (24%) and woman in scrubs and WC (21%) were most selected, with the only geographic difference being the midwest's preference for man in business and WC. Females were more likely to prefer women photographs (P<0.0001).

CONCLUSIONS

In general, pediatric orthopaedic patients and parents do not have a strong specific preference toward what their surgeon wears to clinic, including whether or not we are dressed in scrubs, but some initial biases exist. When asked to choose, the traditional WC worn over any attire is preferred, and female patients and parents uncover a preference for a surgeon of their own sex.

LEVEL OF EVIDENCE

Level III.

What attributes do patients prefer in a family physician? A cross-sectional study in a northern region of Portugal

OBJECTIVES

To determine which modifiable and non-modifiable attributes patients prefer in a family physician, as well as to analyse participants' characteristics associated with their choices.

DESIGN

Cross-sectional study.

SETTING

Family healthcare units (FHU) in the city of Braga and Barcelos (Northern Portugal).

PARTICIPANTS

Adults aged 18 years or more, enrolled in the selected FHU.

MAIN OUTCOME MEASURES

The preferred attributes were assessed with a questionnaire delivered in the FHU. These attributes included gender, age and nationality and the importance of being Portuguese, of greeting with a handshake, of welcoming in the waiting area, of using an identification badge and of wearing a white coat.

RESULTS

A total of 556 questionnaires were included in the analysis; 66% and 58% of the participants had no preference for the gender or age of the family physician, respectively. Using a multinomial logistic regression, male participants were 3.8 times more likely to have a preference for a male physician than having no preference, in comparison to female participants (OR 3.864, 95% CI 1.96 to 7.61). More than 69% of the participants considered greeting with a handshake, using an identification badge and wearing a white coat important or very important. There was a statistically significant association between being Portuguese and the major importance given to the use of an identification badge (β=0.68, 95% CI 0.23 to 1.12).

CONCLUSIONS

Our data show that modifiable attributes of the family physician (greeting, presence of an identification badge and wearing a white coat) are important for patients. Potential changes in family physician attitude in consultation could ultimately affect patient-physician relationship.

The Effect of Male Physicians' Outfits on the General Population's Perception in Saudi Arabia

Overview

Successful medical care depends on the trust developed between a physician and his patient. Professionally dressed doctors are likely to achieve a higher level of trust from their patients than those with a non-professional appearance.For many years, the physician’s famous white coat has been the standard professional wear around the world.

Few studies in Saudi Arabia have been conducted to analyze what kind of physician outfits patients prefer and whether the choice of attire affects the patient’s level of trust. These studies were either done in a single health institute, or in few primary healthcare clinics in one city.

This study aims to analyze whether the type of clothing worn by a physician improves the level of trust between a patient and a doctor. Participants were asked about different styles of clothing, including Western business attire, traditional Saudi outfits, and surgical scrubs, and whether wearing the white coat was preferred. Moreover, we sought to establish if differences in age, gender, nationality, or educational background affected the responses.

Methods

This cross-sectional study was carried out in August and September 2018. Participants living in Saudi Arabia anonymously filled out an electronic questionnaire, distributed by social media, which measured the effect of male physicians’ outfits on the general population's perception in Saudi Arabia. Participants were shown photographs of possible dress styles for physicians. Data were collected on the participants’ demographics, their most and least preferred doctor’s outfits, and the effect of the physician’s attire on their level of trust.

Results

A total of 8231 participants were included in the survey: 53% males, 87.9% with university-level education or higher, and 93.5% of Saudi nationality; 76.1% of the participants responded “yes” saying that the outfit would have an effect on how a patient might receive medical advice and follow the doctor’s recommendations. The most preferred outfits chosen by the participants were surgical scrubs with a white coat (39.3%), followed by a Western shirt and tie with a white coat (30.3%). The least preferred outfit was the full (traditional) Saudi outfit with a white coat (25.4%), followed by a Western business suit without a white coat (23.2%). The choices of most and least preferred attire were found to be impacted by different demographic factors, such as age, gender, and nationality, but not the educational background.

Conclusion

Physicians practicing in Saudi Arabia should note that their attire will earn the patient’s trust and encourage compliance with advice or treatment. The most preferred outfits were surgical scrubs with a white coat and a Western shirt and tie worn with a white coat, whereas the least preferred ones were the traditional Saudi thobe, with and without shemagh or ghutra, and the Western business suit without a white coat.

The Effect of an Orthopedic Hand Surgeon's Attire on Patient Confidence and Trust

Background: Multiple studies have concluded that patients are more likely to understand and trust physicians who dress in more formal attire (shirt and tie) as opposed to casual attire (t-shirts and jeans). The white coat has repeatedly been reported as a major source of trust and confidence in a patient's eyes. Methods: This study explores the effect an orthopedic hand surgeon's attire has on a patient's perception of their surgeon's clinical values. All patients 18 years of age and older who visited our orthopedic hand surgeon's suburban outpatient practice were asked to participate in our survey-based study. Results: Ninety-seven surveys were completed and included. A majority of our responders are female (n = 59, 60.8%), Caucasian (n = 83, 85.6%) between the ages of 55 and 74 years (n = 40, 41.2%), currently employed (n = 59, 60.8%) with private health insurance (n = 69, 71.1%), and married (n = 64, 66.0%). Patients rated male and female hand surgeons wearing a white coat highest using the Likert scale and when asked about their perceived clinical qualities. Patients consistently poorly rated their surgeons wearing casual attire. Patients did note that the white coat, or any specific attire, was not necessary during the initial encounter to build a strong patient-surgeon relationship. Finally, goatees and beards do not positively or negatively impact a surgeon's patient-constructed image. Conclusions: Combining strong clinical skills with appropriate clinical attire highlighted by the physician wearing a white coat appears to be an effective way to enhance patient satisfaction while ultimately gaining the trust and respect needed to properly care for patients.

Orthopaedic Physician Attire Influences Patient Perceptions in an Urban Inpatient Setting

BACKGROUND

Prior research suggests that physician attire has an important effect on patient perceptions, and can influence the patient-physician relationship. Previous studies have established the effect of specialty, location, and setting on patient preferences for physician attire, and the importance of these preferences and perceptions on both the physician-patient relationship and first impressions. To date, no studies have examined the influence of attire in the inpatient orthopaedic surgery setting on these perceptions.

QUESTIONS/PURPOSES

(1) Do differences in orthopaedic physician attire influence patient confidence in their surgeon, perception of trustworthiness, safety, how caring their physician is, how smart their surgeon is, how well the surgery would go, and how willing they are to discuss personal information with the surgeon? (2) Do patients perceive physicians who are men and women differently with respect to those endpoints?

METHODS

Ninety-three of 110 patients undergoing orthopaedic surgery at an urban academic medical center participated in a three-part survey. In the first part, each patient was randomly presented 10 images of both men and women surgeons, each dressed in five different outfits: business attire (BA), a white coat over business attire (WB), scrubs alone (SA), a white coat over scrubs (WS), and casual attire (CA). Respondents rated each image on a five-point Likert scale regarding how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and the patient's willingness to discuss personal information with the surgeon. In the second part, the respondent ranked all images, by gender, from the most to least confident based on attire.

RESULTS

Pair-wise comparisons for women surgeons demonstrated no difference in patient preference between white coat over business attire compared with white coat over scrubs or scrubs alone, though each was preferable to business attire and casual attire (WS versus WB: mean difference [MD], 0.1 ± 0.6; 95% CI, 0.0-0.2; p = 1.0; WS versus SA: MD, 0.2 ± 0.7; 95% CI, 0-0.3; p = 0.7; WB versus SA: 0.1 ± 0.9; 95% CI, -0.1 to 0.2; p = 1.0). The same results were found when rating the surgeon's perceived intelligence, skill, trust, confidentiality, caring, and safety. In the pair-wise comparisons for male surgeons, white coat over scrubs was not preferred to white coat over business attire, scrubs alone, or business attire (WS versus WB: MD, -0.1 ± 0.6; 95% CI, 0-0.1; p = 1.0; WS versus SA: MD, 0 ± 0.4; 95% CI, -0.2 to 0; p = 1.0; WS versus BA: MD, 0.2 ± 0.8; 95% CI, 0-0.4; p = 0.6). WB and SA were not different (MD, 0.0 ± 0.6; 95% CI, -0.1 to 0.2; p = 1.0), though both were preferred to BA and CA (WB versus BA: MD, 0.3 ± 0.8; 95% CI, 0.1-0.5; p = 0.02; WB versus CA: 1.0 ± 1.0; 95% CI, 0.8-1.2; p < 0.01). We found no difference between SA and BA (MD, 0.3 ± 0.7; 95% CI, 0.1-0.4; p = 0.06). We found that each was preferred to CA (SA versus CA: 0.9 ± 1.0; 95% CI, 0.7-1.2; p < 0.01; BA versus CA: 0.7 ± 1.0; 95% CI, 0.5-0.9; p < 0.01), with similar results in all other categories. When asked to rank all types of attire, patients preferred WS or WB for both men and women surgeons, followed by SA, BA, and CA.

CONCLUSIONS

Similar to findings in the outpatient orthopaedic setting, in the inpatient setting, we found patients had a moderate overall preference for physicians wearing a white coat, either over scrubs or business attire, and, to some extent, scrubs alone. Respondents did not show any difference in preference based on the gender of the pictured surgeon. For men and women orthopaedic surgeons in the urban inpatient setting, stereotypical physician's attire such as a white coat over either scrubs or business attire, or even scrubs alone may improve numerous components of the patient-physician relationship and should therefore be strongly considered to enhance overall patient care.

LEVEL OF EVIDENCE

Level II, therapeutic study.

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study

OBJECTIVES

We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician-patient relationship.

SETTING

The 900-bed University Hospital Zurich, Switzerland.

PARTICIPANTS

A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents' ratings of how the physician's attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided.

RESULTS

Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively).

CONCLUSIONS

Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.

Patients' preferences regarding age, sex, and attire of orthodontists

INTRODUCTION

We investigated whether patients in different age groups are influenced by the age, sex, and attire of an orthodontist.

METHODS

The opinions of 360 patients regarding 4 orthodontists and 3 types of attire (from photos) were investigated using a questionnaire. Patients were classified as children (8-11 years; n = 120; group 1), adolescents (12-17 years; n = 120; group 2), and young adults (18-25 years; n = 120; group 3). The chi-square test was used to evaluate age- and sex-based preferences for orthodontists and attire types, and a statistical test of proportion (significance level, 5%) was used for multiple comparisons.

RESULTS

Young female orthodontists were preferred (41.1%). A white coat was the preferred attire (48.1%), followed by social clothing (31.7%) and a thematic pediatric coat (19.7%). Groups 1 and 2 preferred a young female orthodontist, whereas group 3 had no apparent age and sex preferences. Regarding attire, group 1 preferred social clothing, whereas groups 2 and 3 preferred a white coat.

CONCLUSIONS

Patients of all ages consider appearance to be an important factor when choosing an orthodontist. The participants largely preferred younger professionals who dressed in white coats, because this type of attire was considered clean and hygienic.

Patient perceptions and preferences of physicians' attire in Saudi primary healthcare setting

Background: Since the time of Hippocrates, dress of the care-giver has been known to influence patient’s perception about the physician.

Objectives: To explore patient’s preference about physician’s dress in Saudi primary healthcare, and how it influences their perception, regarding professionalism, competence, and confidence in the physician.

Methods: A cross sectional study conducted in primary care clinics in Riyadh, enrolling 443 patients, who filled a self-administered Arabic questionnaire, enquiring about physician clothes such as white coat, scrubs and ‘thob (white-robe) shomagh (head cover)’ for males, ‘veil-skirt’ for females, and shoes.

Patients’ preferences about physicians’ dresses were explored and influence of favorable dress on professionalism and trustworthiness were explored, using Chi-sq, Mann Whitney, with p ≤ .05 as significant. Principle component analysis was used to search themes in attire commonly used.

Results: Over 80% of patients visiting Saudi primary care, liked seeing their physician in white coat. Traditional dress ‘thob and shomagh’ was approved by 47% whereas ‘veil and skirt’ got acceptance of 62%. Dress of physician was significantly (p < .005) more important to patients, who were male (Chi-sq 14.95), working (Chi-sq 9.39), educated (Chi-sq 9.84), urbanites (Chi-sq 18.34) and married (Chi-sq 7.89). Patients who valued physician attire (70%) perceived it positively influencing doctor-patient relationship: Mann Whitney U score = 6879, p-value <0.001. Four dress-themes emerged: ‘Professional modest’, ‘Expensive modern’, ‘Traditional formal’ and ‘Casual shoes’.

Conclusion: Patients preferred white coats for their doctors. Half of participants accepted traditional dresses. Majority valued physician’s attire as a positive influence.

Medical communication: the views of simulated patients

CONTEXT

Simulated patients (SPs) are extensively used in the teaching of medical communication, both for students and doctors. They occupy a unique middle ground between patients and physicians: although free from the prejudices that medical training brings, they work closely with clinical tutors to promote the principles of patient-centred consulting. Despite this, there is relatively little research around their views on what makes for good communication practice. This study aims to address this gap in the literature through a qualitative analysis of SPs' opinions, especially in the context of medical student communication.

METHODS

Eighteen SPs from two medical schools, Hull York Medical School and Durham, were interviewed, using an in-depth, one-to-one, semi-structured approach. Data, transcribed verbatim, were thematically analysed.

RESULTS

Three global themes were identified: (i) listening and empathy and showing it, (ii) continual human connection and (iii) information flow from the patient. These three themes, termed the communication triad, form a type of virtuous circle, each facilitating the other. Listening and empathy were facilitated through attributes, including attentive non-verbal communication, and through responding to cues, including making effective empathetic statements. Continual human connection was facilitated through successful beginnings, including preferring open questions to 'robotic' tick-list questions and allowing patients time to have their say. Mirroring, professional appearance, appropriate physical contact and a human approach were amongst other factors facilitating connection with patients. Information flow was encouraged by factors including showing an interest in the patient and use of silence; flow was curtailed by undesirable attributes, including interrupting, dismissive communication and making assumptions about aspects such as sexuality.

CONCLUSION

This first in-depth study of SPs' views on medical consulting identifies a communication triad that both affirms and builds on the current literature base. Five novel teaching points emerge, with clear relevance for best practice communication teaching and curricula design.

Physicians' Attire Influences Patients' Perceptions in the Urban Outpatient Orthopaedic Surgery Setting

BACKGROUND

Previous work has established that physician attire influences patients' perceptions of their physicians. However, research from different specialties has disagreed regarding what kinds of physician attire might result in increased trust and confidence on the part of patients.

QUESTIONS/PURPOSES

The purpose of this study was to investigate how surgeon attire affects patients' perceptions of trust and confidence in an urban orthopaedic outpatient setting.

METHODS

Eighty-five of 100 patients solicited completed a three-part questionnaire in the outpatient orthopaedic clinic at an urban teaching hospital. In the first section, participants viewed eight images, four of a male surgeon and four of a female surgeon wearing a white coat over formal attire, scrubs, business attire, and casual attire, and rated each image on a five-level Likert scale. Participants were asked how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and how willing they would be to discuss personal information with the pictured surgeon. The participant ranked all images from most to least confident in the second part and the last section obtained demographic information from the patients. Surveys were scored using a five-level Likert scale and a Friedman test was used to detect statistical significance when comparing all attires. For multiple pairwise comparisons, a Bonferroni correction was applied.

RESULTS

The white coat on the male surgeon elicited modestly higher ratings in confidence (mean difference [MD], 0.367 ± 0.737; 95% CI, 0.202-0.532; p < 0.001), intelligence (MD, 0.216 ± 0.603; 95% CI, 0.077-0.356; p = 0.027), surgical skill (MD, 0.325 ± 0.658; 95% CI, 0.175-0.474; p < 0.001), trust (MD, 0.312 ± 0.613; 95% CI, 0.173-0.451; p < 0.001), ability to discuss confidential information (MD, 0.253 ± 0.742; 95% CI, 0.087-0.419; p = 0.023), caring (MD, 0.279 ± 0.655; 95% CI, 0.124-0.432; p = 0.006), and safety (MD, 0.260 ± 0.594; 95% CI, 0.125-0.395; p = 0.002) compared with business attire. Similarly, the white coat was preferred to casual attire in all categories (confidence: MD, 0.810 ± 0.921; smart: MD, 0.493 ± 0.801; surgical skill: MD, 0.640 ± 0.880; ability to discuss: MD, 0.564 ± 0.988; trust: MD, 0.545 ± 0.836; safety: MD, 0.581 ± 0.860; caring: MD, 0.479 ± 0.852; p < 0.001 for all comparisons). For the female surgeon, white coat and scrubs were not different, however the white coat was preferred to business attire in four of seven categories. Casual clothing was widely disliked in all categories for surgeons (men and women). When attire was compared for confidence on a scale, the white coat ranked higher than business (MD, 0.439 ± 1.491; p = 0.006) and casual attire (MD, 1.043 ± 2.054; p < 0.001), but not scrubs (MD, 0.169 ± 1.230; p = 1.000).

CONCLUSIONS

In this urban outpatient orthopaedic practice, patients' preferences varied based on the sex of the pictured surgeon in the survey. Overall, however, modest preferences were observed for the white coat in terms of confidence, intelligence, trust, and safety. Furthermore patients are more willing to discuss personal information and believe that their surgery will go better if the surgeon wears a white coat or scrubs. These results are consistent with those of several studies in other settings and therefore may be generalizable in other locations and specialties. Given the increasing awareness and concern for physician-spread hospital infection, this study lends support to scrub attire over business or casual attire if physicians do not wear a white coat.

LEVEL OF EVIDENCE

Level II, therapeutic study.

The Psychological Attitude of Patients toward Health Practitioners in Lebanon

BACKGROUND

Patients often complain about their doctor's attitude toward them. They describe the interaction that they have with some doctors as quick, cold, discourteous, or hardhearted. Although this does not apply to all Lebanese doctors, it does apply to some.

AIMS

The purpose of this study was to (1) examine the general perception of satisfaction, trust, and openness that Lebanese patients hold toward the work, office, personal, and social characteristics of their doctors - physician or dentist; and (2) identify the aspects on which a Lebanese health practitioner should focus to improve his/her practice.

MATERIALS AND METHODS

A convenient sample of 450 individuals from an area housing nine hospitals and hundreds of private clinics in Greater Beirut were surveyed regarding the qualities of their health practitioners. They were asked to complete a nine-page, 85-item, anonymous, and voluntary questionnaire that dealt with the medical and dental practice in Lebanon. Participants were older than 18 years and mentally competent. None was physicians, dentists, or nurses. The questionnaire was open-ended and initially pretested and piloted among a random sample.

RESULTS

Four hundred-fifteen (92%) individuals responded. Participants were from different ages, genders, geographical areas, educational backgrounds, and professions. The doctor traits most preferred by the Lebanese public were found to be: Empathy (90%), professionalism (87%), miscellaneous traits (86%), and academics (81%).

CONCLUSION

The results support the conventional wisdom that the idealized perception of a doctor as a care-giving, compassionate, knowledgeable, well-appearing, and healthy role model still holds true within the Lebanese community.

Position of the physician's nametag--a randomized, blinded trial

Background

The patient-physician relation begins when the physician introduces himself with name and function. Most institutions request a nametag with name and function to be worn. Although nametags are consequently worn, the optimal position for the nametag is unknown. It was the purpose of this study to identify whether positioning the nametag on the right or the left chest side provides better visibility to the patient.

Method and Material

One hundred volunteers, blinded to the experimental setup, presented for an orthopedic consultation in a standardized manner. The nametag of the physician was randomly positioned on the left chest side and presented to 50 individuals (age 35 years (range 17 to 83)) or the right chest side and then presented to 50 other individuals (35 years (range 16 to 59)). The time of the participant noticing the nametag was documented. Subsequently, the participant was questioned concerning the relevance of a nametag and verbal self-introduction of the physician.

Results

38% of the participants noticed the nametag on the right as opposed to 20% who noticed it if placed on the left upper chest (p = 0.0473). The mean time to detection was 9 (range 1–40) seconds for nametags on the right and 25.2 seconds (range 3 to 49, p = 0.006) on the left. For 87% of the participants, a nametag is expected and important and nearly all participants (96%) expected the physician to introduce himself verbally.

Conclusion

It is expected that a physician wears a nametag and introduce himself verbally at the first encounter. Positioning the nametag on the right chest side results in better and faster visibility.

White coat, patient gown

Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. By contrast, the medical literature has paid almost no attention to the patient gown. In this article, we argue that in order to understand the full implications of the white coat in the doctor-patient relationship, we must also take into account patients' dress, and even undress. We explore contemporary artistic images of white coat and patient gown in order to reveal the power differential in the doctor-patient relationship. Artistic representations capture some of the cultural ambivalence surrounding the use of the white coat, which confers professional status on its wearer, while undermining his or her personal identity. At the other end of the sartorial spectrum, hospital gowns also strip wearers of their identity, but add to this an experience of vulnerability. Although compelling reasons for continuing to wear the white coat in circumscribed settings persist, physicians should be mindful of its hierarchical implications. Ample room remains for improving patients' privacy and dignity by updating the hospital gown.

What to wear? The influence of attire on the perceived professionalism of dentists and lawyers

Using a sample of 201 participants and a between-subjects design, the perceived professionalism-suitability, capability, ease to talk to and friendliness-of male and female dentists and lawyers in various attires was examined. Results showed an absolute preference for male dentists and lawyers in professional and formal attire, respectively. Male dentists and lawyers in professional and formal attire were further rated as more suitable, capable, easier to talk to, and friendlier than female professionals, and than those dressed in smart or casual attire. Results are discussed in terms of positive dental outcomes and legal representation. Limitations are considered.

Patients' attitudes toward the attire of male physicians: a single-center study in Saudi Arabia

BACKGROUND AND OBJECTIVES

The doctor-patient relationship has been influenced by the appearance of physicians, and there is an association between a physician's physical appearance and the patients' initial perceptions of physician competence. This study aims to explore patients' preferences toward the attire of a male physician, and to examine if a physician's choice of uniform influences the degree of trust, confidence, and follow-up care among respondents.

DESIGN AND SETTINGS

A cross-sectional survey conducted among patients of the Alwazarat family medicine center in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

A self-administered questionnaire was completed by 300 patients (50% were male and 83.6% had received a secondary education; the mean age was 33.4 [10.1] years) in the Alwazarat family medicine center in Riyadh. The questionnaire was also customized for the local setting with the inclusion of photos of a male doctor in Saudi Arabian national costume, and 3 other dress styles (Western dress with white coat, scrubs with white coat, and scrubs only).

RESULTS

Overall, across all questions regarding physician dress style preferences, participants significantly preferred Western dress (39.9%, P < .001), followed by Saudi national dress (26.3%), a scrub suit with a white coat (22.3%), and scrubs only (11.5%). Respondents reported that they were more likely to follow medical advice and would return for follow-up care if a physician wore Western dress. They were significantly more willing to share their social, sexual, and psychological problems with a physician wearing Saudi national dress (P < .001). The importance of a physician's appearance was ranked significantly higher by older patients (P=.002).

CONCLUSION

Respondents were more likely to favor a physician wearing Western attire with a white coat. However, Saudi national dress, followed by Western dress, is the preferred attire when physicians are dealing with social, sexual, and psychological problems.

Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare

BACKGROUND

Trust is a forward-looking covenant between the patient and the doctor where the patient optimistically accepts his/her vulnerability. Trust is known to improve the clinical outcomes.

OBJECTIVES

To explore the factors that determine patients' trust in doctors and to segment the community based on factors which drive their trust.

SETTING

Resource-poor urban and rural settings in Tamil Nadu, a state in southern India.

PARTICIPANTS

A questionnaire was administered to a sample of 625 adult community-dwelling respondents from four districts of Tamil Nadu, India, chosen by multistage sampling strategy.

OUTCOME MEASURES

The outcomes were to understand the main domains of factors influencing trust in doctors and to segment the community based on which of these domains predominantly influenced their trust.

RESULTS

Factor analysis revealed five main categories, namely, comfort with the doctor, doctor with personal involvement with the patient, behaviourally competent doctor, doctor with a simple appearance and culturally competent doctor, which explained 49.3% of the total variance. Using k-means cluster analysis the respondents were segmented into four groups, namely, those who have 'comfort-based trust', 'emotionally assessed trust', who were predominantly older and belonging to lower socioeconomic status, those who had 'personal trust', who were younger people from higher socioeconomic strata of the community and the group who had 'objectively assessed trust', who were younger women.

CONCLUSIONS

Trust in doctors seems to be influenced by the doctor's behaviuor, perceived comfort levels, personal involvement with the patient, and to a lesser extent by cultural competence and doctor's physical appearance. On the basis of these dimensions, the community can be segmented into distinct groups, and trust building can happen in a strategic manner which may lead to improvement in perceived quality of care.

Perceptions of patients, physicians, and Medical students on physicians' appearance

OBJECTIVE

To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students and other physicians in Brazil.

METHODS

Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians' pictures covering the following styles: white clothing; white coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders.

RESULTS

Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercing, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported to shorts, blouses exposing the belly, facial piercing, multiple rings, extravagant hair color, and heavy makeup.

CONCLUSION

Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country.

Parents' preferences regarding appearance and attire of orthodontists

Objective:

To evaluate parents' preferences regarding the appearance and attire of orthodontists.

Materials and Methods:

Parents attending their child's first orthodontic appointment were asked to choose from among sets of photographs of potential orthodontic providers. Selected factors were varied within the sets, including sex and age of the provider as well as attire (casual, formal, white coat, or scrubs), hairstyle (loose or tied back for women, facial hair or clean shaven for men), and presence of a nametag.

Results:

A total of 77 parents participated. There were significant differences in choice of provider in terms of the provider's sex (P &lt; .0001), age (P  =  .0013), dress (P &lt; .0001), hair (P &lt; .0001), and nametag (P  =  .0065). There were no significant differences in preference attributable to parent characteristics (P &gt; .05).

Conclusion:

Parents of orthodontic patients demonstrated clear preferences for choosing a provider related to factors that are not within the control of the practitioner (sex and age) as well as factors that can be changed by the practitioner (attire, hairstyle, and wearing a nametag).

How to dress as a paediatrician?

AIM

Do different clothing styles have an influence on the doctor-patient-parent relationship and which kind of outfit is preferred by children and parents.

METHODS

One hundred and seven children and 72 parents were visited by a paediatrician randomly wearing one of the three different outfits (casual, semiformal, formal) during a hospital stay. Parents and children between 6 and 18 years were then interviewed about their opinion by use of a semi-structured questionnaire, while children between 0 and 6 years were observed concerning their behaviour during the examination.

RESULTS

Using a 'likert scale', the casual outfit received the best mark by 95.5% of parents (58.3% in the semiformal, 30.8% in the formal group). The degree of the parents' trust in the paediatrician was comparable in all three groups. In children between 6 and 18 years, the casual dress was rated highest in 100%. In children between 0 and 6 years, the outfit had no significant influence on the patients' behaviour.

CONCLUSION

Apparently, parents do not only tolerate a casual outfit, but even prefer it without any loss of trust. The same holds true for children between 6 and 18 years. For younger children, the paediatricians' outfit seems to play no major role.

Doctor's attire influences perceived empathy in the patient-doctor relationship

OBJECTIVE

This study investigated whether doctors' attire influences the perception of empathy in the patient-doctor relationship during a therapeutic encounter.

METHODS

A total number of 143 patients were divided into four groups when they were consulting a Traditional Korean Medicine doctor. Depending on the group, the same doctor was wearing four different attires--Casual, Suit, Traditional dress, White coat--when having a clinical consultation with the patients.

RESULTS

The patients preferred white coat and traditional dress more than other attires, giving highest scores to white coat in competency, trustworthiness and preference of attire and to traditional dress in comfortableness and contentment with the consultation. The "Consultation and Relational Empathy (CARE)" score was significantly higher in the "White coat" and "Traditional" groups, compared to the "Casual" and "Suit" groups.

CONCLUSION

The strong association between the patients' preference of doctors' attire and the CARE score indicates that the doctor's attire plays not only an important role for establishing confidence and trustworthiness but also for the perception of empathy in the patient-doctor relationship.

PRACTICE IMPLICATIONS

The doctor's attire can function as an effective tool of non-verbal communication in order to signal confidence, trust and empathy and establish a good patient-doctor relationship.

Effect of physician dress style on patient confidence

BACKGROUND

We lack data on how physicians can instill confidence in patients.

OBJECTIVES

We aimed to determine whether dress style (professional white coat or formal, semiformal or casual attire) affects confidence in the physician by patients (children, teenagers, adults) with dermatology complaints consulting in the hospital or private practice.

METHODS

Design. Descriptive prospective cross sectional study carried out from July 1, 2008 to July 1, 2009. Setting. Outpatients in the department of dermatology of a French tertiary care hospital, and two dermatological private consulting rooms. Participants and design. Consulting patients were ≥ 7 years and classified as children 7-11 years old, accompanying parents, teenagers (12-17 years), and adults ≥ 18 years consulting alone. Subjects viewed two iconographic boards containing 4 photographs in a random order of a male physician on 1 board and a female physician on the other board in 4 different dress styles: professional (white coat and stethoscope), formal (shirt and tie for men), semiformal, and casual (T-shirt, jeans). Subjects then completed a questionnaire asking them to rate, on a scale of 0-10, their confidence in the physicians portrayed and answered whether they considered physician dress important. Main outcomes and measures. The main outcome was subjects' ranking of photos of physicians by dress style, according to the confidence they felt. For children 7-11 years old, we considered the frequency of the chosen dress style. The secondary outcome was whether physician dress was important to patients.

RESULTS

We included 329 patients. Children at the hospital most frequently chose the photo of the physician, both male (62%) and female (64%), with the white coat. Teenagers' choices were professional dress, then semiformal, formal, and casual attire. Accompanying adults and adults consulting alone had the same ranking.

CONCLUSIONS

In France, patients of all ages who consult for dermatology complaints in hospital and in private practice have the most confidence in a physician who wears a professional white coat.

Evidence for preferences of Italian patients for physician attire

BACKGROUND

The relationship between patient and physician is a complex interaction that includes multiple factors. The objective of this study was to explore Italian patients' preferences regarding physician appearance.

METHODS

A questionnaire was developed to survey patients in different medical and surgical settings; each subject was asked to choose one picture of either a male or female physician from a selection of different attires (professional, casual, surgical scrubs, trendy, and careless). Patients were also surveyed about issues such as the presence of a name tag, hair length, trousers on women, amount of makeup, presence of tattoos, and body piercing. Statistical analysis was performed using a Chi-square test.

RESULTS

A total of 765 questionnaires (534 completed from patients waiting for an internal medicine visit and 231 for other subspecialties) were completed. The majority (45%) of patients preferred the gastroenterologist to wear a surgical scrub with a white coat. For the other specialists, patients accepted either scrubs or formal dress under a white coat (P ≤ 0.05), with a name tag. Trendy attire was preferred by nine patients (1.1%). The entire sample judged it inappropriate for clinicians to have long hair, visible tattoos, body piercing, and, for women, to wear trousers and use excessive makeup.

CONCLUSION

This is the first study conducted in Italy regarding physician attire. As in other Western countries, Italian patients favor physicians in professional attire with a white coat. Wearing professional dress is part of "etiquette based medicine" and may favorably influence clinician-patient relationships and patient compliance.

An evidence-based approach to physician etiquette in pediatric ophthalmology

PURPOSE

Little objective evidence exists to guide physician etiquette in pediatric ophthalmology. This article describes the preferences of families visiting a pediatric ophthalmology clinic for the first time.

METHODS

Review of 149 questionnaires completed by the families of patients visiting a pediatric ophthalmology clinic in a tertiary care center. The Fisher exact and chi-square tests were used to compare subpopulations.

RESULTS

Most respondents preferred that their physician wear a white coat. Men preferred a handshake to a verbal greeting (P = .0264) and professional to business casual attire for both male and female physicians (P = .01, both). African-American parents were more likely to prefer being addressed by surname than other races (P = .008). No statistically significant differences were found comparing the preferences of parents with an advanced education (bachelor and graduate degrees) to those without.

CONCLUSION

Pediatric ophthalmologists may wish to consider wearing white coats and business casual attire in clinic and addressing parents informally as "mom" or "dad" or by their first name, although etiquette should ultimately be determined on an individual patient basis.

What to wear when practicing oriental medicine: patients' preferences for doctors' attire

OBJECTIVES

The patient's impression of the doctor is an important factor in a clinical consultation, and the doctor's attire also plays a great role in promoting trust and confidence in the patients. Previous studies have shown that a doctor in a white coat will appear more professional, confident, and trustworthy. The objective of this study was to investigate whether the influence of a doctor's attire applies for both Western and Oriental medical doctors.

METHODS

Before a clinical consultation, 153 patients were asked to assess photographs showing an identical doctor wearing four different dress styles. The patients were divided into two groups: One group was told that the doctor in the photograph was a Western doctor, whereas the other group was told that the doctor was an Oriental medical doctor. Patients' ratings of preference for competency, trustworthiness, comfortableness, and treatment choice were then measured and compared.

RESULTS

Patients preferred a doctor in a white coat the most, giving highest ratings for competency and trustworthiness, while reporting to feel most comfortable with a doctor in traditional dress. No difference was found between Western and Oriental medical doctors. Patients prefer their doctors to wear white coats, regardless of whether the doctor is a Western or Oriental medical doctor, even though patients feel more comfortable with doctors wearing traditional dress.

CONCLUSIONS

The preference about doctors' attire symbolizes the perception of patients regarding their doctor's image. Taking the historical and symbolic meaning of the doctor's white coat together, this clear preference of patients for the white coat might imply that patients require a more scientific and professional image, regardless of whether the doctors are Western or Oriental medical doctors.

Patients' perceptions of doctors' clothing: should we really be 'bare below the elbow'?

INTRODUCTION

In September 2007, the Department of Health published Uniforms and Workwear: an Evidence Base for Guiding Local Policy. Following this, most National Health Service trusts imposed a 'bare below the elbow' dress code policy, with clinical staff asked to remove ties, wristwatches and hand jewellery and to wear short-sleeved tops. There is currently no evidence linking dress code to the transmission of hospital-acquired infection. We designed the current survey to assess patients' perceptions of doctors' appearance, with specific reference to the 'bare below the elbow' policy.

MATERIALS AND METHODS

A questionnaire showing photographs of a doctor in three different types of attire ('scrubs', formal attire and 'bare below the elbow') were used to gather responses from 80 in-patients and 80 out-patients in the ENT department. Patients were asked which outfit they felt was the most hygienic, the most professional and the easiest identification of the person as a doctor. They were also asked to indicate their overall preference.

RESULTS AND ANALYSIS

Formal attire was considered most professional and the easiest identification that the person was a doctor. Scrubs were considered most hygienic. Respondents' overall preference was divided between scrubs and formal clothes. 'Bare below the elbow' attire received the lowest votes in all categories.

DISCUSSION

This finding raises significant questions about the Department of Health policy in question. The authors suggest that an alternative policy should be considered, with scrubs worn for in-patient situations and formal attire during out-patient encounters.

Patients' preferences for doctors' attire in Japan

OBJECTIVE

Physicians' attire is one important factor to enhance the physician-patient relationship. However, there are few studies that examine patients' preferences for physicians' attire in Japan. We sought to assess patients' preference regarding doctors' attire and to assess the influence of doctors' attire on patients' confidence in their physician. Furthermore, we examined whether patients' preferences would change among various clinical situations.

METHODS

Employing a cross-sectional design, Japanese outpatients chosen over one week in October 2008 from waiting rooms in various outpatient departments at St. Luke's International Hospital, Tokyo, were given a 10-item questionnaire. A 5-point Likert scale was used to estimate patient preference for four types of attire in both male and female physicians, including semi-formal attire, white coat, surgical scrubs, and casual wear. In addition, a 4-point Likert Scale was used to measure the influence of doctors' attire on patient confidence.

PATIENTS

Japanese outpatients consecutively chosen from waiting rooms at St. Luke's International Hospital in Tokyo for one week in October 2008.

RESULTS

Of 2,272 outpatients enrolled, 1483 (67.1%) of respondents were women. Mean age of subjects was 53.8 years (SD 16.2 years). Respondents most preferred the white coat (mean rank: 4.18, SD: 0.75) and preferred casual attire the least (mean rank: 2.32, SD: 0.81). For female physicians, 1.4% of respondents ranked the white coat little/least preferred while 64.7% of respondents ranked casual wear little/least preferred. Among respondents who most preferred the white coat for physician attire, perceived hygiene (62.7%) and inspiring confidence (59.3%) were important factors for doctor's attire. Around 70% of all respondents reported that physicians' attire has an influence on their confidence in their physician.

CONCLUSION

This study confirms that Japanese outpatients prefer a white coat. Furthermore, this study strongly suggests that wearing a white coat could favorably influence patients' confidence in the relationship with their physician in all types of practice.

Are we dressed to impress? A descriptive survey assessing patients' preference of doctors' attire in the hospital setting

This study investigated patients' attitudes to doctors in different attires in a hospital setting. A cross-sectional descriptive survey asked 586 adult patients to rate and rank photographs of a doctor in each of the following attires: scrubs, professional informal, professional formal, smart casual, casual and white coat. They were also asked to choose the single most important feature of a doctor's appearance out of six predetermined choices. Patients had most confidence in doctors wearing the white coat, followed by professional informal. Casual attire was the least confidence inspiring. No two attires were deemed to be equally rated or ranked. Varying demographic groups within the hospital rated and ranked some attire differently. Daily laundered clothing was considered to be the most important feature. With patients' clear preference for white coats, its reintroduction should be given consideration and education regarding the cleanliness of scrubs may increase patient confidence.

Aspectos de biossegurança relacionados ao uso do jaleco pelos profissionais de saúde: uma revisão da literatura

O estudo objetivou analisar a literatura publicada a respeito dos aspectos da biossegurança relacionados ao uso do jaleco pelos profissionais da saúde. Trata-se de uma revisão narrativa da literatura publicada no período de 1991 a 2008. Utilizou-se as bases de dados MEDLINE, LILACS e SciELO, sendo selecionados 22 artigos que foram agrupados para análise considerando os enfoques priorizados em: infecções cruzadas causadas por jalecos; jalecos contaminados; flora bacteriana em jalecos dos profissionais de saúde. O jaleco foi abordado como fonte de contaminação e como equipamento de proteção individual na prevenção das infecções. Portanto, são necessárias campanhas educativas no sentido de orientar os profissionais de saúde sobre o uso de jaleco.

Perceptions of outpatients regarding the attire of physiotherapists

PURPOSE

This study investigated perceptions of patients regarding physiotherapists' attire.

METHODS

Three hundred patients in three publicly funded outpatient physiotherapy clinics were asked to complete a questionnaire, ranking four photographed modes of attire (lab coat, tailored dress, "scrubs," and jeans) in terms of professionalism, preference, and appropriateness and rating their level of agreement with four statements about physiotherapists' attire.

RESULTS

Response rate was 63.7 %. The lab coat was ranked most professional, tailored dress most preferred, and jeans least professional and least preferred. Although jeans were deemed inappropriate (p < 0.001), strong support was shown for wearing jeans on "casual day" (p = 0.001). Age of respondents influenced the perception of the appropriateness of wearing jeans (p = 0.007 for male therapist; p = 0.017 for female therapist); only the cohort <36 years considered jeans appropriate apparel. Overall exposure to physiotherapists (number of lifetime visits) affected patients' perceptions of the importance of attire (p = 0.039) and the appropriateness of wearing jeans (p = 0.018): as number of visits increased, perceived importance decreased and perceived propriety of jeans increased.

CONCLUSION

The findings of this study, the first to examine patients' opinions of physiotherapists' attire, suggest that outpatients made clear distinctions between what they perceived as professional and what they preferred, as well as between the appropriateness of physiotherapists' wearing jeans in general and the appropriateness of their doing so on "casual day." Age and exposure to physiotherapists influenced patients' perceptions of attire.

Desiderata or dogma: what the evidence reveals about physician attire

INTRODUCTION

Physician-patient interactions are complex and depend on multiple factors including common cultural definitions and evolving social norms. The once purely philosophical debate over what constitutes appropriate physician attire can benefit from a growing evidence base in the literature.

DISCUSSION

Although this literature is commonly regarded as supporting traditional attire, the data actually represent a more balanced distribution of opinions held by patients and by physicians. Perhaps interpretations favoring a conservative approach are expected given the history and tradition of the physician-patient relationship.

CONCLUSION

Nevertheless, in the age of evidence-based medicine, it is difficult to argue against scrutiny of the available literature. Evidence that challenges the importance of traditional physician attire is reviewed.

Assessor Status Influences Pain Recall

Anecdotal clinical reports suggest that patients report differing levels of pain, depending on the status within the medical hierarchy of the individual gathering the pain rating. This observation has clinical relevance, given the practice of delegating the assessment of pain to lower status clinic staff members. In this study, both pain and mood were assessed in 70 patients diagnosed with low back pain at pretreatment, immediately after epidural lumbar injection, and again 2 weeks later by phone. At the 2-week follow-up, patients were also asked to recall the postprocedural rating that they had given immediately after the injection. This rating was obtained by either the treating physician or by a research assistant who was present at the time of injection, on a randomly determined basis. Current ratings of pain and mood did not differ for either group before the epidural injection, after the epidural injection, or at the 2-week follow-up. Two-week recall of postprocedural pain did, however, differ depending on assessor status. Those called by the physician provided recalled pain ratings that closely matched the ratings provided immediately after the procedure. Those called by the research assistant provided ratings that were 86% higher (that is, worse) than their original ratings. This status-driven bias in recalled postprocedural pain reporting is discussed in the context of social demands inherent in the physician-patient relationship, with implications for assessing treatment effectiveness in clinical practice and research.

PERSPECTIVE

Accurate assessment of patients' pain is critical to effective pain management and treatment planning. This study found evidence of a status-based bias in which physicians elicited lower ratings of previously experienced pain associated with treatment procedures than did staff members of lower status.

Does physician attire influence patient satisfaction in an outpatient obstetrics and gynecology setting?

OBJECTIVE

The purpose of our study was to determine whether physician attire played a role in patient satisfaction after a new obstetrician/gynecologist encounter.

STUDY DESIGN

Over a 3-month period, 20 physicians were randomly assigned to dress in business attire, casual clothing, or scrub suit each week. One thousand one hundred sixteen patients who had an office visit with a new obstetrician/gynecologist for at least 10 minutes completed a satisfaction survey, which assessed patient comfort as well as perception of the competency and professionalism of the physician. Patients were blinded to the physician attire manipulation.

RESULTS

There was no difference in the mean overall satisfaction score among the 3 physician attire groups. No differences existed in satisfaction scores when analyzed by individual survey item or by demographic factors, after controlling for attire.

CONCLUSION

Patients are equally satisfied with physicians who dress in business attire, casual clothing, or scrub suit.

First impressions in complementary practice: the importance of environment, dress and address to the therapeutic relationship

The aim of the study was to explore patients' views of the importance of environmental and social factors within a complementary and alternative medicine (CAM) practice. A cross-sectional patient survey was conducted in 37 CAM practices across nine geographical areas of the UK using a structured questionnaire. The 219 responders (response rate 59%) were 65% female. The most common treatment modalities were osteopathy and acupuncture. Patients rated telephone manner, practitioner appearance and explanatory literature as very important factors in shaping first impressions and influencing their confidence in the complementary practice. Patients' preferences for practitioner dress code were highly variable. Overall 65% preferred a white coat to casual dress. A multivariate analysis revealed that this preference was statistically significantly greater in two geographical regions and in patients over 70 years old. It was not influenced by gender or treatment modality. Further research is recommended in order to understand how the complex verbal and non-verbal communication implicit in the CAM setting may affect the therapeutic relationship.

The physician's attire and its influence on patient confidence

Although physician appearance has been a topic of discussion in the medical literature for many years, no objective research has been performed on this topic in the field of podiatric medicine. Our primary objective was to examine patient confidence in physicians as it relates to professional clinic attire versus casual or scrub outfits. We also assessed the influence of other variables, such as white coat, name tag, age, and sex, on patient confidence. We surveyed 155 podiatric medical patients from a private practice and a hospital-based clinic. The results indicate that 68% of patients surveyed felt that professional attire inspired the most confidence. Ninety-six percent of all patients either preferred white coats or were indifferent to their presence. We conclude that professionally dressed podiatric physicians may inspire more confidence in a significant percentage of their patients.

How should psychiatrists dress?--a survey

Personal attire is an important part of being a professional. This survey is an attempt to determine the patient's and psychiatrists view point about how a psychiatrist should dress to work. A human subjects research board approved survey of seven questions was offered to patients and a similar survey of nine questions was offered to psychiatrists. The replies obtained were combined and tabulated. One hundred patients and 77 psychiatrists responded to the survey. Both the patients and psychiatrists considered dress to be an important part of the doctor-patient relationship. The psychiatrists appear to be more concerned and critical about their dress as compared to patients.

What to wear today? Effect of doctor's attire on the trust and confidence of patients

PURPOSE

There are very few studies about the impact of physicians' attire on patients' confidence and trust. The objective of this study was to determine whether the way a doctor dresses is an important factor in the degree of trust and confidence among respondents.

METHODS

A cross-sectional descriptive study using survey methodology was conducted of patients and visitors in the waiting room of an internal medicine outpatient clinic. Respondents completed a written survey after reviewing pictures of physicians in four different dress styles. Respondents were asked questions related to their preference for physician dress as well as their trust and willingness to discuss sensitive issues.

RESULTS

Four hundred respondents with a mean age of 52.4 years were enrolled; 54% were men, 58% were white, 38% were African-American, and 43% had greater than a high school diploma. On all questions regarding physician dress style preferences, respondents significantly favored the professional attire with white coat (76.3%, P <.0001), followed by surgical scrubs (10.2%), business dress (8.8%), and casual dress (4.7%). Their trust and confidence was significantly associated with their preference for professional dress (P <.0001). Respondents also reported that they were significantly more willing to share their social, sexual, and psychological problems with the physician who is professionally dressed (P <.0001). The importance of physician's appearance was ranked similarly between male and female respondents (P=.54); however, female physicians' dress appeared to be significantly more important to respondents than male physicians' dress (P <.001).

CONCLUSION

Respondents overwhelmingly favor physicians in professional attire with a white coat. Wearing professional dress (ie, a white coat with more formal attire) while providing patient care by physicians may favorably influence trust and confidence-building in the medical encounter.

Patient Evaluations of Pharmacist Performance with Variations in Attire and Communication Levels

OBJECTIVE

To determine whether the attire of a pharmacist has any effect on how he is evaluated when a patient also considers the pharmacist's performance and to assess whether attire and performance interact to influence patients' evaluations.

DESIGN

Randomized, cross-sectional, three-factor design.

SETTING

Community pharmacy settings were portrayed.

PARTICIPANTS

179 university staff members.

INTERVENTIONS

Videos of pharmacist-patient interactions were encoded and placed on a Web site to be viewed by participants.

MAIN OUTCOME MEASURES

Service encounter satisfaction, perceptions of overall service quality, trust in the service provider, and behavioral intentions based on two levels of pharmacist communication performance (high or adequate), three levels of dress style (casual, business casual, formal), and two levels of white coat (wearing or not).

RESULTS

Of the three independent variables, only communication performance was found to significantly influence the dependent variables. High communication performance resulted in higher satisfaction scores, higher perceptions of quality, higher levels of trust, and behavioral intention scores that reflected a greater willingness to use and recommend the pharmacist.

CONCLUSION

Style of dress or whether the pharmacist was wearing a white coat did not significantly influence participants' evaluations of the pharmacist in this study. Rather, the level of the pharmacist's communication performance was the most important cue used by participants in their ratings of service encounter satisfaction, perceptions of overall service quality, and trust in the service provider.