Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators

Abstract

ObjectivesDespite a growing body of literature, uncertainty regarding the influence of physician dress on patients’ perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence.Setting, participants, interventions and outcomesWe searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted.ResultsOf 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions.ConclusionsAlthough patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary.

Physicians’ Attire Influences Patients’ Perceptions in the Urban Outpatient Orthopaedic Surgery Setting

“…This study has several limitations. The study was conducted at one institution in an urban setting with relatively young patients, which is a potentially important limitation as previous studies have established the influence of location, culture, and age on patients' preferences [16,22]. For several reasons, location may have an effect on respondents' preferences.…”

“…For professional and hygienic reasons, the debate has persisted regarding the most appropriate clothing and how this may affect the patient-physician relationship. Numerous studies have confirmed the strong influence of physician attire on communication, patient education, confidence, trust, respect, adherence to medical treatments, and ultimately the quality of care patients receive [6,7,15,22,23]. Although concepts such as trust and confidence are complex and likely involve many other factors such as respect and good communication, previous studies in settings outside orthopaedics have confirmed attire influences these variables [2,12,16,23].…”

“…Thus, their perception of physician professionalism now is balanced against the threat of attire as a potential fomite such as neckties, watches, and long sleeves. Patients' preferences for physician attire is further influenced by patient age and cultural and societal standards in that particular region [4,12,15,22]. In the pediatric and psychiatric settings, for example, patients view the white coat as a symbol of authority, which in turn acts as a barrier in developing a strong patient-physician relationship [5,8].…”

“…In the pediatric and psychiatric settings, for example, patients view the white coat as a symbol of authority, which in turn acts as a barrier in developing a strong patient-physician relationship [5,8]. Age also may influence preference, with older patients tending to prefer a more formally dressed doctor [4,12,22].…”

Editor's Spotlight/Take 5: Physicians’ Attire Influences Patients’ Perceptions in the Urban Outpatient Orthopaedic Surgery Setting

“…The idea that some patient populations prefer doctors in white coats certainly is not new. Others have found that white coats inspire trust [9], that they make doctors easier to identify from among other hospital personnel (although this probably is not a reliable form of identification [3,11]), and that older patients in particular seem to like them [3]. Patient satisfaction is what matters, and this study by Dr. Haydel's team in this month's CORR 1 represents the best orthopaedic-specific information we have on the topic.…”