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Do clothes make the doctor? U-M researchers report on patient perceptions of physicians based on attire

Age, culture & type of care matter – and new survey will look at impact further

ANN ARBOR, Mich. — What should doctors wear? And how does something as simple as their choice of a suit, scrubs or slacks influence how patients view them?

A new analysis takes a comprehensive look – and finds that the answer isn’t as simple as you might think.

It also finds that doctors don’t seem to be getting a lot of guidance on how to dress – despite the influence their attire can have on patients’ perceptions.

In general, the study finds, people prefer their physicians dress on the formal side – and definitely not in casual wear. Doctors of either gender in suits, or a white coat, are more likely to inspire trust and confidence.

But fashion takes a back seat when it comes to emergency, surgical or critical care, where data show clothes don’t matter as much—and patients may even prefer to see doctors in scrubs.

How you feel about your doctor’s attire can depend greatly on your age and culture, the researchers find. In general, Europeans and Asians of any age, and Americans over age 50, trusted a formally dressed doctor more, while Americans in Generation X and Y tended to accept less-dressy physicians more willingly.

The findings were compiled by a University of Michigan Health System team, from a comprehensive international review of studies on physician attire, and other sources. In all, the data they reviewed came from 30 studies involving 11,533 adult patients in 14 countries. Their review has been published in British Medical Journal Open.

Currently, the team is preparing to launch their own international study of the impact of physician clothing choices, under the name “Targeting Attire to Improve Likelihood of Rapport” or TAILOR. They’ll work to quantify how patients’ views of physicians change based on what they’re wearing, and where they’re providing care. The team will also evaluate how attire might affect patients’ trust in what that doctor says or recommends.

Lead author Christopher Petrilli, M.D., an internal medicine resident at the U-M Health System who worked in the sharp-dressed world of investment banking before switching to medicine, says the study grew out of his conversations with senior physicians, including senior author Vineet Chopra, M.D., MSc, and co-author Sanjay Saint, M.D., MPH.

“As physicians, we want to make sure that we’re dressing in a way that reflects a level of professionalism and also mindful of patients’ preferences.”

Petrilli explains. “Many studies have looked at various aspects of physician attire, so we wanted to look across this body of literature to find common threads. But at the same time, we found a lack of detailed guidance from top hospitals to their physicians about how to dress.”

One size does not fit all

In all, 21 of the 30 studies found that patients expressed clear preferences about what they felt doctors should wear, or said that physician attire affected their perceptions of a physician. In 18 of those studies, formal attire or a white coat was the preferred attire.

When the researchers drilled down further, they found that four of the seven studies that involved surgery patients reported that attire choice didn’t matter or that scrubs were preferred. The same was true of four of five studies that involved patients receiving emergency care or intensive care.

Chopra, a hospitalist and U-M Medical School assistant professor of general medicine, adds that patient satisfaction now influences how doctors, and hospitals are paid – making the impact of patient perceptions of their doctors’ knowledge, caring, professionalism and trustworthiness all the more important.

And, he says, the findings of the new study suggest that a “one size fits all” approach to policies and guidance for doctors won’t work.

“In order to better tailor physician attire to patient preferences and improve available evidence, we would recommend that healthcare systems capture the ‘voice of the customer’ in individual care locations, such as intensive care units and emergency departments,” he says.

The subject of what to wear isn’t covered directly in medical school. Even for physicians in practice at hospitals on the U.S. News & World Report Best Hospitals ranking, specific guidelines are few and far between. Only 5 of those surveyed by the U-M team had official guidance for physicians about attire at all, and most just recommended it be “professional.” The others offered no formal guidance.

Gathering more data

The new TAILOR study will survey patients in outpatient general medicine and specialty clinic waiting rooms and inpatient medical units. Hospitals in three countries have signed on to participate, making it the largest such study of its kind. While pediatric patients and their parents will not be included, the researchers note that this is another area ripe for research. 

“Everything is supposed to be evidence-based in medicine,” says Petrilli. “With this review and our new study, we can provide compelling evidence to influence the way physicians dress.”

In addition to Petrilli, Chopra and Saint, the research team included Megan Mack, M.D., Jennifer Janowitz Petrilli, and Andy Hickner. Saint, Chopra and Mack all hold positions at the VA Ann Arbor Healthcare Center. Saint and Chopra are members of the U-M Institute for Healthcare Policy and Innovation, and the VA Center for Clinical Management Research.

Funding for the research came in part from the Agency for Healthcare Research and Quality.

Reference: BMJ Open 2015;5:e006578. doi:10.1136/bmjopen-2014-006578

NOTICE: Except where otherwise noted, all articles are published under a Creative Commons Attribution 3.0 license. You are free to copy, distribute, adapt, transmit, or make commercial use of this work as long as you attribute the University of Michigan Health System as the original creator and include a link to this article.

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