HEALTH SYSTEM NEWS

Do clothes make the MD?

What you wear affects patient perceptions

issue 24 | Summer 2015

What should doctors wear? And how does something as simple as their choice of a suit, white coat, 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.

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.

In total, 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.

One size does not fit all

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

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. 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.

What to wear?

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 five 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.

Currently, the U-M 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.

Hospitals in three countries have signed on to participate, making it the largest 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."