Patient Preferences for Physician Attire: A Multicenter Study in Japan

Abstract

T he patient-physician relationship is critical for ensuring the delivery of high-quality healthcare. Successful patient-physician relationships arise from shared trust, knowledge, mutual respect, and effective verbal and nonverbal communication. The ways in which patients experience healthcare and their satisfaction with physicians affect a myriad of important health outcomes, such as adherence to treatment and outcomes for conditions such as hypertension and diabetes mellitus. 1-5 One method for potentially enhancing patient satisfaction is through understanding how patients wish their physicians to dress 6-8 and tailoring attire to match these expectations. In addition to our systematic review, 9 a recent largescale, multicenter study in the United States revealed that most patients perceive physician attire as important, but that prefer-ences for specific types of attire are contextual. 9,10 For example, elderly patients preferred physicians in formal attire and white coat, while scrubs with white coat or scrubs alone were preferred for emergency department (ED) physicians and surgeons, respectively. Moreover, regional variation regarding attire preference was also observed in the US, with preferences for more formal attire in the South and less formal in the Midwest.Geographic variation, regarding patient preferences for physician dress, is perhaps even more relevant internationally. In particular, Japan is considered to have a highly contextualized culture that relies on nonverbal and implicit communication. However, medical professionals have no specific dress code and, thus, don many different kinds of attire. In part, this may be because it is not clear whether or how physician attire impacts patient satisfaction and perceived healthcare quality in Japan. [11][12][13] Although previous studies in Japan have suggested that physician attire has a considerable influence on patient satisfaction, these studies either involved a single department in one hospital or a small number of respondents. [14][15][16][17] Therefore, we performed a multicenter, cross-sectional study to understand patients' preferences for physician attire in different clinical settings and in different geographic regions in Japan.

Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care

“…Previous studies in Japan [ 1 , 24 ] have shown that most patients prefer Japanese FPs to wear white coats. It is likely that patients whose expectations are met in terms of their physician’s attire will experience more empathy in the therapeutic relationship.…”

“…Five FPs were JPCA certified. The FPs' usual attire was white coats (3), casuals (3), or scrubs (1).…”

“…Most patients report that physician attire is important and associated with their satisfaction with care [1][2][3]. Patient preference for physician attire is influenced by age, locale, setting, and context of care [1,[3][4][5][6][7][8]. Reports from several countries suggest that patients prefer primary care physicians to wear white coats [4][5][6].…”

“…However, in some countries, most patients who visit a family physician (FP) no longer consider white coats a powerful symbol [ 8 ]. Previous research in Japan shows that most patients prefer physicians to wear white coats in a primary care setting [ 1 ]. However, one study found that some family medicine specialists certified by the Japan Primary Care Association (JPCA), which was established in 2010 following the merger of three primary care academic societies, preferred non-white coat attire, because they felt that casual attire allowed more empathetic interactions with patients [ 9 ].…”

“…Empathy is also context-sensitive in patient–physician relationships [ 21 ]. Japan has a very unique culture that relies heavily on nonverbal and implicit communication [ 1 , 22 , 23 ]; thus, physician attire may play a more important role in patient–physician relationships in Japan than in other countries. In Japan, most patients prefer physicians to wear a white coat because it is considered professional or hygienic [ 24 ].…”