More than 4,000 patients have spoken up: they prefer doctors to dress professionally and wear a white coat, or to wear scrubs and a white coat. And the findings aren't limited to fashion.According to the largest-ever study of patient preferences for doctors' clothes, physicians may want to dig a little deeper into their closets or grab their white coats on their way out of the operating room if they want patients to regard them favorably.
Indeed, what medical doctors wear may be more important than most doctors — or perhaps patients — believe, according to the authors of a new report published in BMJ Open.
Based on their findings, the researchers recommend that more hospitals, health systems, and practice groups review existing physician dress rules and, if necessary, develop new ones.
Just over half of the 4,062 patients polled at the clinics and hospitals of ten major medical centers responded that what physicians wear is significant to them — and that it determines their satisfaction with their care. Patient preferences are important because hospitals are reimbursed in part by the Centers for Medicare and Medicaid based on patient satisfaction survey results.
"Professional dress on Wall Street, law, and nearly every other industry is relatively clear — and it typically mirrors what applicants would wear to a job interview," says Christopher Petrilli, M.D., lead author of the study and an assistant professor of hospital medicine at the University of Michigan Medical School.
"The dress code in medicine is fairly diverse, but as physicians, we should ensure that our apparel shows a certain level of professionalism while also being sensitive of patients' preferences."
Patients’ views on physician attire
The study also asked patients to visualize male and female physicians dressed in seven different outfits in both inpatient and outpatient clinical settings. They judged the physicians based on how competent, trustworthy, kind, and personable the physician appeared in each photo, as well as how comfortable the patient felt in the clothing.
- The alternatives were as follows:
Casual: Short-sleeved collared shirt and pants, with or without a white coat
Scrubs: Short-sleeved blue scrub top and slacks, with or without a white coat
Formal attire includes a light blue long-sleeved dress shirt and navy blue suit pants, with or without a white coat, 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 jacket and pants with the same dress shirt, tie, and shoes as in the "formal" option, but without the white coat.
Formal clothes with a white coat received the highest score on the five-measure composite and was especially popular with persons over the age of 65. Scrubs with a white coat were followed by formal dress without a white coat.
Variation by specialty, setting and region
When asked what their own doctors should wear, 44 percent chose formal clothing with a white coat, and 26 percent suggested scrubs with a white coat.
When asked what they would want surgeons and emergency physicians to wear, 34% said scrubs alone, while 23% said scrubs with a white coat.
Except for male surgeons, the outcomes were substantially the same for physicians of either gender. Patients preferred to wear formal attire rather than a white coat.
The setting of care was also important. Sixty-two percent agreed or strongly agreed that doctors should wear a white coat when meeting patients in the hospital, and 55 percent agreed or strongly agreed that doctors should wear the same when seeing patients in an office setting. For emergency physicians, the percentage who choose a white coat has dropped to 44 percent.
The surveys were performed throughout weekday business hours, and patients were also asked what doctors should dress when seeing patients on weekends. In this scenario, 44 percent thought the short-sleeved attire with jeans was appropriate, whereas 56 percent were neutral or disapproved, even on weekends.
Patients in the Northeast and Midwest were less adamant on white coats and formal clothes, with 38 percent and 40 percent preferring it, respectively, compared to 50 percent and 51 percent in the West and South. Scrubs alone were preferred by more than twice as many Northeasterners as Southerners.
Importance for patient satisfaction
The researchers reviewed the medical literature for past studies on this topic before beginning the study that led to the present report, and their findings were published three years ago. They also visited top hospitals around the country and discovered that only a few had specific physician clothing rules.
"Given the magnitude, methodological rigor, and representativeness of our data," adds Petrilli, who sees patients at Michigan Medicine and the VA Ann Arbor Healthcare System, "local, nuanced policy regarding physician attire should be addressed to improve the patient experience." He is a member of the University of Michigan Institute for Healthcare Policy and Innovation.
Despite studies showing that physicians' white coats, neckties, and sleeves harbor infectious organisms, prompting some countries to require physicians' arms to be "bare below the elbow," researchers note that no studies have shown actual transmission of infection to patients through contact with physician attire.
Another study found that wearing white jackets made physicians more attentive to tasks, perhaps boosting patient safety.
"Patients appear to be concerned with appearance and may anticipate to see their doctor in specific ways." "This may explain why white lab coats obtained a high grade for 'approachability' – patients may see a white coat comparable to a physician's 'uniform' and may similarly expect formal dress in most situations," says Petrilli, who is also a member of the U-M/VA Patient Safety Enhancement Program.
"Patients do not always have the option of selecting their doctor." Physician dress may be a significant, readily adjustable component of the patient care experience in this era of appropriately increased focus on patient centeredness and satisfaction."
To maintain consistency and prevent extraneous reasons from impacting assessments, all of the physicians depicted were young, thin, and Caucasian. Patients were addressed in general medicine and specialty clinic outpatient waiting rooms, as well as nonsurgical inpatient wards. Inpatients completed almost two-thirds of the surveys, and the sample was 71 percent white and 65 percent male, with 70 percent having attended some college or having a college degree.
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