Challenging the Status Quo of Physician Attire in the Palliative Care Setting

Abstract

Background, Aim, and Hypothesis This randomized controlled trial aimed to compare the impact of a physician's attire on the perceptions of patients with cancer of compassion, professionalism, and physician preference. Our hypothesis was that patients would perceive the physician with formal attire as more compassionate than the physician wearing casual attire. Materials and Methods One hundred five adult follow‐up patients with advanced cancer were randomized to watch two standardized, 3‐minute video vignettes with the same script, depicting a routine physician‐patient clinic encounter. Videos included a physician in formal attire with tie and buttoned‐up white coat and casual attire without a tie or white coat. Actors, patients, and investigators were all blinded to the purpose and videos watched, respectively. After each video, patients completed validated questionnaires rating their perception of physician compassion, professionalism, and their overall preference for the physician. Results There were no significant differences between formal and casual attire for compassion (median [interquartile range], 25 [10–31] vs. 20 [8–27]; p = .31) and professionalism (17 [13–21] vs. 18 [14–22]; p = .42). Thirty percent of patients preferred formal attire, 31% preferred casual attire, and 38% had no preference. Subgroup analysis did not show statistically significant differences among different cohorts of age, sex, marital status, and education level. Conclusion Doctors’ attire did not affect the perceptions of patients with cancer of physician's level of compassion and professionalism, nor did it influence the patients’ preference for their doctor or their trust and confidence in the doctor's ability to provide care. There is a need for more studies in this area of communications skills. Clinical trial identification number. NCT03168763 Implications for Practice The significance of physician attire as a means of nonverbal communication has not been well characterized. It is an important element to consider, as patient preferences vary geographically, are influenced by cultural beliefs, and may vary based on particular care settings. Previous studies consisted of nonblinded surveys and found increasing confidence in physicians wearing a professional white coat. Unfortunately, there are no randomized controlled trials, to the authors’ knowledge, to confirm the survey findings. In this randomized, blinded clinical trial the researchers found that physician's attire did not affect patients’ perception of the physician's level of compassion and professionalism. Attire also did not influence the patients’ preferences for their doctor or their trust and confidence in the doctor's ability to provide care.

Physician Attire Influences Patient and Family Perceptions of Care in the Palliative Care Unit in Japan

“…19 Recent report by Azhar et al demonstrated patients aged less than 60 years were more likely to prefer formal attire than patients at least 60 years. 29 In the current study, there was no difference in physician attire preference among each respondent age group.…”

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

“…Some studies have shown preference for different forms of attire such as scrubs (eg, specific circumstances such as gastroenterology suites18 53 and emergencies5) and informal attire,54 and some have revealed no specific patient preferences 52 55 56. Five studies noted that patient perceptions of compassion, professionalism and credibility were not associated with a physician’s dress 25 32 57–59. Finally, some studies have demonstrated that attire is more important to patients who are older,34 51 60 a finding we noted in Japan and the USA.…”

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

“…A survey of advanced-stage tumor patients was able to rule out a relationship between physician professionalism and compassion and professional attire [ 34 ]. Likewise, physician attire did not play a role in the perceptions of patients in a military eye clinic [ 10 ].…”