Background Previous studies have shown that patients have specific expectations regarding physician dress. Japan has a cultural background that is in many ways distinct from western countries. Thus, physician attire may have a different impact in Japan. Methods We conducted a multicenter, cross-sectional study to examine patients' preferences for and perceptions of physician attire in Japan. The questionnaire was developed using photographs of either a male or female physician dressed in seven different forms of attire, and it was randomly distributed to inpatients and outpatients. Respondents were asked to rate the provider pictured; they were also asked to provide preferences for different forms of attire in varied clinical settings. Preference was evaluated for five domains (knowledgeable, trustworthy, caring, approachable, and comfortable). We also assessed variation in preferences for attire by respondent characteristics. Results A total of 1,233 (61%) patients indicated that physician dress was important, and 950 (47%) patients agreed that it influenced their satisfaction with care. Compared with all forms, casual attire with a white coat was the most preferred dress. Older patients more often preferred formal attire with a white coat in primary care and hospital settings. In addition, physician attire had a greater impact on older respondents' satisfaction and experience. Conclusion The majority of Japanese patients indicated that physician attire is important and influenced their satisfaction with care. Geography, settings of care, and patient age appear to play a role in patient preferences.

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Patient Preferences for Physician Attire: A Multicenter Study in Japan

There is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy. This was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy. A total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000). This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully. Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749
 ). The study was prospectively registered.

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Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care.

Objectives To determine which modifiable and non-modifiable attributes patients prefer in a family physician, as well as to analyse participants’ characteristics associated with their choices. Design Cross-sectional study. Setting Family healthcare units (FHU) in the city of Braga and Barcelos (Northern Portugal). Participants Adults aged 18 years or more, enrolled in the selected FHU. Main outcome measures The preferred attributes were assessed with a questionnaire delivered in the FHU. These attributes included gender, age and nationality and the importance of being Portuguese, of greeting with a handshake, of welcoming in the waiting area, of using an identification badge and of wearing a white coat. Results A total of 556 questionnaires were included in the analysis; 66% and 58% of the participants had no preference for the gender or age of the family physician, respectively. Using a multinomial logistic regression, male participants were 3.8 times more likely to have a preference for a male physician than having no preference, in comparison to female participants (OR 3.864, 95% CI 1.96 to 7.61). More than 69% of the participants considered greeting with a handshake, using an identification badge and wearing a white coat important or very important. There was a statistically significant association between being Portuguese and the major importance given to the use of an identification badge (β=0.68, 95% CI 0.23 to 1.12). Conclusions Our data show that modifiable attributes of the family physician (greeting, presence of an identification badge and wearing a white coat) are important for patients. Potential changes in family physician attitude in consultation could ultimately affect patient–physician relationship.

https://bmjopen.bmj.com/content/bmjopen/11/1/e035130.full.pdf

What attributes do patients prefer in a family physician? A cross-sectional study in a northern region of Portugal.

Background: A person’s appearance and his/her adherence to the dress code standards are essential in the medical profession. Objectives: This study aimed to investigate patients’ and physicians’ viewpoints on interns’ professional outfits. Methods: This is a cross-sectional study, with the participation of patients and physicians of general departments in a teaching hospital of Kerman University of Medical Sciences in 2018. The patients and physicians were selected through convenience and census method, respectively. To examine the participants’ perspectives on the professional dressing, six schematic images, three for males (1, 2, 3) and three for females (A, B, C) were designed. Data were collected through a structured interview in this way, the schematic images were displayed to the participants and they were asked to express their perspective using a series of questions. Data analyzed using SPSS version20. Results: Totally, 381 patients and 34 physicians participated. The majority of the participants preferred the professional outfit A for female interns and the professional outfit 1 for male interns in response to questions regarding the knowledge, responsibility, patient-care, hygiene, reliability of diagnosis and treatment of diseases, giving emergency consultations, the possibility for discussing sexual and psychiatric problems, as well as life problems. The physicians and patients had the same perspective except for the item about knowledge. (p <0.05). Conclusion: Our study shows that the outfits of physicians were considered by the participants in forming an effective relationship between the doctor and the patient, and the amount of patients' trust. Therefore, training interns for dressing professionally and complying with the necessary standards should be considered.

http://sdme.kmu.ac.ir/article_91544_c2a8917e8e8cca43d2d2e331386410d4.pdf

Patients' and Physicians' Viewpoints on Interns' Professional Outfit: A Survey in an Iranian Teaching Hospital

Patient Perception of Medical Student Professionalism: Does Attire Matter?

Objectives We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician–patient relationship. Setting The 900-bed University Hospital Zurich, Switzerland. Participants A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey. Primary and secondary outcome measures The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents’ ratings of how the physician’s attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided. Results Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively). Conclusions Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.

https://bmjopen.bmj.com/content/bmjopen/9/5/e026009.full.pdf

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study.

Objective The patient–physician relationship impacts patients’ experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings. Setting 20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA. Participants Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices. Primary and secondary outcome measures The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics. Results The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only. Conclusions Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.

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Marc Zollinger

Papers

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study.

International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents