Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA

Abstract

ObjectiveSeveral large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience—and how this influences satisfaction—is unknown. Therefore, we performed a national, cross-sectional study to examine patient perceptions, expectations and preferences regarding physicians dress.Setting10 academic hospitals in the USA.ParticipantsConvenience sample of 4062 patients recruited from 1 June 2015 to 31 October 2016.Primary and secondary outcomes measuresWe conducted a questionnaire-based study of patients across 10 academic hospitals in the USA. The questionnaire included photographs of a male and female physician dressed in seven different forms of attire. Patients were asked to rate the provider pictured in various clinical settings. Preference for attire was calculated as the composite of responses across five domains (knowledgeable, trustworthy, caring, approachable and comfortable) via a standardised instrument. Secondary outcome measures included variation in preferences by respondent characteristics (eg, gender), context of care (eg, inpatient vs outpatient) and geographical region.ResultsOf 4062 patient responses, 53% indicated that physician attire was important to them during care. Over one-third agreed that it influenced their satisfaction with care. Compared with all other forms of attire, formal attire with a white coat was most highly rated (p=0.001 vs scrubs with white coat; p<0.001 all other comparisons). Important differences in preferences for attire by clinical context and respondent characteristics were noted. For example, respondents≥65 years preferred formal attire with white coats (p<0.001) while scrubs were most preferred for surgeons.ConclusionsPatients have important expectations and perceptions for physician dress that vary by context and region. Nuanced policies addressing physician dress code to improve patient satisfaction appear important.

Patient Preferences for Physician Attire: A Multicenter Study in Japan

“…In contrast, US respondents rated "formal attire with white coat" highest and "scrubs with white coat" second. 10 Our result runs counter to our expectation in that we expected Japanese respondents to prefer formal attire, since Japan is one of the most formal cultures in the world. One potential explanation for this difference is that the casual style chosen for this study was close to the smart casual style (slightly casual).…”

“…Among Japanese participants, 61% agreed that physician dress is important (US, 53%; Switzerland, 36%), and 47% agreed that physician dress influenced how satisfied they were with their care (US, 36%; Switzerland, 23%). 10 This result supports the notion that nonverbal and implicit communications (such as physician dress) may carry more importance among Japanese people. [11][12][13] Regarding preference ratings for type of dress among respondents in Japan, "casual attire with white coat" received the highest mean composite score rating, with "formal attire with white coat" rated second overall.…”

“…We used a modified version of the survey instrument from a prior study. 10 The first section of the survey showed photographs of either a male or female physician with 7 unique forms of attire, including casual, casual with white coat, scrubs, scrubs with white coat, formal, formal with white coat, and business suit ( Figure 1). Given the Japanese context of this study, the language was translated to Japanese and photographs of physicians of Japanese descent were used.…”

“…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.…”

Neckties on Physicians: Going the Way of Powdered Wigs

“…35 In contrast, a large recent survey reported that physicians who wore a white coat were deemed to be more knowledgeable and trustworthy by their patients, especially among patients 65 and older. 36…”