What is the background of this particular study?

This study began with one of my colleagues, Christopher Petrilli, MD, here at the University of Michigan. In 2015, Dr Petrilli and colleagues conducted the Targeting Attire to Improve Likelihood of Rapport (TAILOR) study8; a systematic review regarding the role of physician attire in patient perceptions. The researchers analyzed 30 studies involving over 11,500 patients in 14 countries. The reviewed studies encompassed an array of different specialties, including general medicine, surgery, obstetrics, emergency departments, and hospital settings. They found a wide variety of perceptions among patients regarding physician attire, based on culture, tradition, patient expectations, geographic location, patient age, and context of care. For example, preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Level of education also made a difference. US respondents with a college degree were more likely to prefer formal attire with a white coat for a primary care physician, compared to those without a college degree.

What was the focus of your study4 and what were the findings?

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We used a rigorous methodology from a previous study9 and surveyed 834 patients in 3 different specialties – dermatology, infectious disease, and neurology – using photographs of male or female physicians wearing various forms of attire. We then asked participants to rate how the physician’s attire affected perceptions in 5 domains: knowledge, trustworthiness, caring, being approachable, and feeling comfortable with the physician. Using these domains, we created a composite preference score, which was calculated as part of the primary outcome. Secondary outcomes included variation in preferences based on characteristics of the respondents and the context in which the care was delivered. The study was performed at 3 ambulatory clinics in a Swiss hospital.

We found that patients generally preferred physicians to be dressed in white scrubs with a white coat, while a business suit ranked lowest. But there was substantial variation among the respondents based on demographics and clinical setting. For example, respondents 65 years of age or older tended to report that physician dress was important to them and influenced their satisfaction with care. More respondents under age 65 preferred casual dress with a white coat, compared to those 65 years and older. On the other hand, in the emergency department setting, more respondents under age 65 preferred scrubs.

In the domains rated, formal attire with a white coat was rated highest for how knowledgeable a physician appeared, while white coats with white scrubs was rated highest for how trustworthy, caring, and approachable the physician appeared, and how comfortable the participant felt. The respondents in Switzerland seemed to reflect what is expected in their country, where the dress code of physicians is already relatively established and includes even the color of the scrubs under the white coat.

Similar research has been conducted in Japan. What we have seen from the results is that older patients generally prefer more formal attire with a white coat, especially in primary care and hospital settings, and that physician attire had a greater impact on older respondents. But even there, geographic differences are apparent, with formal attire and a white coat preferred in Western Japan, while in Eastern Japan, people prefer more casual attire with a white coat.

This article originally appeared on MPR