Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA

Abstract

Objective: Several large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience-and how this influences satisfaction-is unknown. Therefore, we performed a national, cross-sectional study to examine patient perceptions, expectations and preferences regarding physicians dress.

Setting: 10 academic hospitals in the USA.

Participants: Convenience sample of 4062 patients recruited from 1 June 2015 to 31 October 2016.

Primary and secondary outcomes measures: We conducted a questionnaire-based study of patients across 10 academic hospitals in the USA. The questionnaire included photographs of a male and female physician dressed in seven different forms of attire. Patients were asked to rate the provider pictured in various clinical settings. Preference for attire was calculated as the composite of responses across five domains (knowledgeable, trustworthy, caring, approachable and comfortable) via a standardised instrument. Secondary outcome measures included variation in preferences by respondent characteristics (eg, gender), context of care (eg, inpatient vs outpatient) and geographical region.

Results: Of 4062 patient responses, 53% indicated that physician attire was important to them during care. Over one-third agreed that it influenced their satisfaction with care. Compared with all other forms of attire, formal attire with a white coat was most highly rated (p=0.001 vs scrubs with white coat; p<0.001 all other comparisons). Important differences in preferences for attire by clinical context and respondent characteristics were noted. For example, respondents≥65 years preferred formal attire with white coats (p<0.001) while scrubs were most preferred for surgeons.

Conclusions: Patients have important expectations and perceptions for physician dress that vary by context and region. Nuanced policies addressing physician dress code to improve patient satisfaction appear important.

Keywords: health policy; infection control; public health; qualitative research; quality in health care.

Figure 1

Photographs of model male and female physician in various attire used in survey instrument.

Figure 2

Rating of physician attire across preference domains.

Figure 3

Preference for white coat by clinical care setting and physician gender. ED, emergency department.