Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study.
TL;DR: Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat, and healthcare systems should consider context of care when defining policies related to dress code.
Abstract: 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.
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TL;DR: Geography, settings of care, and patient age appear to play a role in patient preferences, and the majority of Japanese patients indicated that physician attire is important and influenced their satisfaction with care.
Abstract: 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.
10 citations
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...Number of Physicians Seen in the Past Year 0 1 2 3 4 5 6+ N = 2,009 38 (2) 140 (7) 373 (19) 512 (25) 359 (18) 225 (11) 362 (18) TABLE 2....
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TL;DR: It is 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.
Abstract: 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.
7 citations
TL;DR: In this paper, a cross-sectional study was conducted 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.
Abstract: 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.
4 citations
DOI•
01 Dec 2020TL;DR: 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, shows that training interns for dressing professionally and complying with the necessary standards should be considered.
Abstract: 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.
3 citations
Cites background from "Understanding patient preference fo..."
...Therefore, the patients’ satisfaction with medical services is affected by the physicians’ professional appearance (6, 7)....
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...In the survey in the University Hospital Zurich, the researchers used photographs of male and female physicians dressing and investigated the patients’ perception of physicians outfits in five domains similar to our study and showed that they preferred white coat dressing for physicians (6)....
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TL;DR: Students in scrubs were perceived to be less knowledgeable, competent, and professional by older patients, and younger patients seemed unaffected by the dress of medical students in clinic, suggesting that Surgical educators should require a standard of professional attire for patients in clinic.
2 citations
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TL;DR: A simple and definite procedure is proposed for dividing treatments into distinguishable groups, and for determining that the treatments within some of these groups are different, although there is not enough evidence to say "which is which."
Abstract: The practitioner of the analysis of variance often wants to draw as many conclusions as are reasonable about the relation of the true means for individual "treatments," and a statement by the F-test (or the z-test) that they are not all alike leaves him thoroughly unsatisfied. The problem of breaking up the treatment means into distinguishable groups has not been discussed at much length, the solutions given in the various textbooks differ and, what is more important, seem solely based on intuition. After discussing the problem on a basis combining intuition with some hard, cold facts about the distributions of certain test quantities (or "statistics") a simple and definite procedure is proposed for dividing treatments into distinguishable groups, and for determining that the treatments within some of these groups are different, although there is not enough evidence to say "which is which." The procedure is illustrated on examples.
2,923 citations
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...Strongly disagree/disagree 63 (13) 30 (10) 81 (12) 12 (9)...
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TL;DR: In this article, the authors link patient treatment adherence to physician-patient communication and meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians.
Abstract: Background:Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians
1,975 citations
TL;DR: From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved and the factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ.
Abstract: Objective
To explore and evaluate the most common factors causing therapeutic non-compliance.
1,151 citations
TL;DR: This portrait of patients' experiences in U.S. hospitals offers insights into areas that need improvement, suggests that the same characteristics of hospitals that lead to high nurse-staffing levels may be associated with better experiences for patients, and offers evidence that hospitals can provide both a high quality of clinical care and a good experience for the patient.
Abstract: BACKGROUND Patients' perceptions of their care, especially in the hospital setting, are not well known. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients' experiences in U.S. hospitals. METHODS We assessed the performance of hospitals across multiple domains of patients' experiences. We examined whether key characteristics of hospitals that are thought to enhance patients' experiences (i.e., a high ratio of nurses to patient-days, for-profit status, and nonacademic status) were associated with a better experience for patients. We also examined whether a hospital's performance on the HCAHPS survey was related to its performance on indicators of the quality of clinical care. RESULTS We found moderately high levels of satisfaction with care (e.g., on average, 67.4% of a hospital's patients said that they would definitely recommend the hospital), with a high degree of correlation among the measures of patients' experiences (Cronbach's alpha, 0.94). As compared with hospitals in the bottom quartile of the ratio of nurses to patient-days, those in the top quartile had a somewhat better performance on the HCAHPS survey (e.g., 63.5% vs. 70.2% of patients responded that they "would definitely recommend" the hospital; P<0.001). Hospitals with a high level of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined. For example, those in the top quartile of HCAHPS ratings performed better than those in the bottom quartile with respect to the care that patients received for acute myocardial infarction (actions taken to provide appropriate care as a proportion of all opportunities for providing such actions, 95.8% vs. 93.1% in unadjusted analyses; P<0.001) and for pneumonia (90.5% vs. 88.6% in unadjusted analyses, P<0.001). CONCLUSIONS This portrait of patients' experiences in U.S. hospitals offers insights into areas that need improvement, suggests that the same characteristics of hospitals that lead to high nurse-staffing levels may be associated with better experiences for patients, and offers evidence that hospitals can provide both a high quality of clinical care and a good experience for the patient.
842 citations
TL;DR: Despite criticism of patient-satisfaction measures, patient-experience surveys that are designed and administered appropriately provide robust measures of the quality of health care and offer insight into a dimension that is otherwise difficult to measure objectively.
Abstract: Despite criticism of patient-satisfaction measures, patient-experience surveys that are designed and administered appropriately provide robust measures of the quality of health care and offer insight into a dimension that's otherwise difficult to measure objectively.
701 citations