Physicians may want to dig a little deeper into their
closets, or grab their white coats on the way out of the operating room, if
they want patients to view them favourably, according to the largest-ever study
of patient preferences for doctors’ attire.

 In fact, what medical doctors wear may matter more
than most doctors – or even patients – might think, say the researchers behind
the new paper published in BMJ Open.

Based on their findings, they call for more hospitals,
health systems and practice groups to look at their dress standards for
physicians, or create them if they don’t already have one.

Just over half of the 4062 patients surveyed in the clinics
and hospitals of ten major medical centres said that what physicians wear is
important to them – and more than one-third said that what a doctor wears
influences their satisfaction with their care.

“In medicine, the dress code is quite heterogeneous,
but as physicians we should make sure that our attire reflects a certain level
of professionalism that is also mindful of patients’ preferences,” says
Christopher Petrilli, MD, lead author of the study and an assistant professor
of hospital medicine at the University of Michigan Medical School

Patients’ views on
physician attire

The study also asked patients to look at pictures of male
and female physicians in seven different forms of attire, and to think of them
in both inpatient and outpatient clinical settings. For each photo, they rated the
providers on how knowledgeable, trustworthy, caring and approachable the
physician appeared, and how comfortable the attire made the patient feel.

The options were:

Short-sleeved collared shirt and jeans with tennis shoes, with or without white

Scrubs: Blue
short-sleeved scrub top and pants, with or without white coat

Formal: Light
blue long-sleeved dress shirt and navy blue suit pants, with or without white
coat, with black leather shoes with one-inch heels for women and black leather
shoes for men, and a dark blue tie for men

Business suit:
Navy blue jacket and pants with the same dress shirt, tie and shoes as in the
“formal” option, no white coat

Formal attire with a white coat got the highest score on the
composite of five measures, and was especially popular with people over age 65.
It was followed by scrubs with a white coat, and formal attire without a white

When asked directly what they thought their own doctors
should wear, 44% said the formal attire with white coat, and 26 % said scrubs
with a white coat. When asked what they would prefer surgeons and emergency
physicians wear, scrubs alone got 34% of the vote, followed by scrubs with a
white coat with 23%.

The results were largely the same for physicians of either
gender except for male surgeons. Patients tended to prefer that they go with
formal wear, without a white coat.

The setting of care mattered, too. Sixty-two percent agreed
or strongly agreed that when seeing patients in the hospital, doctors should
wear a white coat, and 55% said the same for doctors seeing patients in an
office setting. The percentage preferring a white coat fell to 44% for
emergency physicians.

Though the surveys were conducted during business hours on
weekdays, the researchers asked patients what they thought doctors should wear
when seeing patients on weekends. In this case, 44% said the short-sleeved
outfit with jeans was appropriate, though 56% were neutral or disapproved of
such a look even on weekends.

Before launching the study that led to the new paper, the
researchers reviewed the medical literature for other studies on this topic,
and published their findings three years ago. They also contacted top
hospitals across the country and found that only a few at the time had formal
guidance for physicians on their attire.

“This is by far the largest study to date in this area.
We used the expertise gained from our previous systematic review along with a
panel of psychometricians, research scientists, choice architects, survey
experts, and bioethicists to develop our study instrument. Given the size,
methodological rigor and representativeness of these data, local, nuanced
policies addressing physician attire should be considered to improve the
patient experience,” says Petrilli.

The researchers note that while studies have shown that
while physicians’ white coats, neckties and sleeves have been shown to harbour
infectious organisms, leading some countries to require physicians’ arms to be
“bare below the elbow,” no studies have shown actual transmission of
infection to patients through contact with physician attire.

However, other research has suggested that physicians may be
more attentive to tasks when wearing their white coats, perhaps increasing
patient safety.

“Patients appear to care about attire and may expect to
see their doctor in certain ways. Which may explain why even white lab coats
received a high rating for ‘approachability’ – patients may see a white coat
similar to a physician’s ‘uniform’ and may similarly also expect formal attire
in most settings,” notes Petrilli.

“Patients don’t always have the opportunity to choose
their doctor. In this era of appropriately increased focus on patient
centeredness and satisfaction, physician attire may be an important, easily
modifiable component of the patient care experience.”


Reference: Petrilli C, et al. Understanding patient
preference for physician attire: a cross-sectional observational study of 10
academic medical centres in the USA.