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Thomas MW, Burkhart CN, Lugo-Somolinos A, Morrell DS. Patients' Perceptions of Physician Attire in Dermatology Clinics. Arch Dermatol. 2011;147(4):505–506. doi:10.1001/archdermatol.2011.70
Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011
Competence, trust, and approachability may be judged, at least initially, on a physician's appearance as well as factors such as attire and verbal or nonverbal communication styles. While previously published studies have concluded that patients prefer “traditional” physician attire consisting of white coat and professional dress,1 other studies indicate that patients are equally satisfied with their physicians regardless of casual or business attire.2 Since these studies were conducted in different specialties, we thought it would be helpful to explore patients' perceptions of physician attire in both adult and pediatric dermatology clinics.
An anonymous, confidential survey approved by the University of North Carolina institutional review board was given consecutively to all parents or guardians bringing their children to the university pediatric dermatology clinic and to all patients seen in the adult dermatology clinics. The questionnaire asked specifically about dermatologists' attire and whether the patient or parent thought a white coat “should be worn” and whether a “tie should be worn by male physicians.” In addition, we asked respondents the same questions with regard to their child's dermatologist. Finally, participants were asked to quantify (with a 1-5 score) the importance of a physician's attire and answer yes if physician attire affected trust in the physician. The surveys asked for optional demographic information including age, sex, race, and education level (high school, college, or graduate school).
Approximately 30% of parents of patients seen in the pediatric clinic felt that dermatologists treating adults should wear a white coat compared with approximately 55% of patients seen in the adult clinic who wanted to see white coats (Table 1). With regard to neckties, the numbers were uniformly low: generally fewer than 1 of 5 respondents stated that their physician should wear a tie. The differences between the 2 groups became more disparate with regard to white coats on physicians interacting with children: approximately 52% for adult patients and 25% for parents (Table 1). Parents of patients also gave higher importance to attire than adult patients did (Table 2).
Older adult patients tended to feel more strongly than younger adult patients that a white coat was necessary and whites were less inclined to want a white coat than African Americans, but neither of these 2 differences was statistically significant. In addition, patients' years of education did not have a statistical impact on trust or desire for the physician to wear a white coat.
In this study, women found the appearance of the physician to be more important than men did; thus, while a white coat may not be necessary, a well-groomed appearance does register with patients and parents. Similarly, while parents of patients indicated a relatively high level of importance of attire, the large majority of them did not feel that a white coat was necessary. This mirrors the findings by Pronchik et al,3 who found that tie wearing was correlated with a positive impression of physician appearance, but they also found that the presence or absence of a tie did not significantly affect patients' impressions of their care or their physician.
Children may feel intimidated by a white coat, and many pediatricians choose not to wear a white coat in their practices.4 However, it is also important to consider how attire may affect a parent's confidence in the physician's assessment and treatment recommendations. In clinics where providers may see both pediatric and adult patients with a wide variance in age, it is helpful to know what the expectations may be of your specific patient population.
A physician's choice of attire is best based on the patient population. Dermatologists working with a primarily older population may find their patients desire their physicians to wear white coats. Dermatologists caring for children can feel assured that a large majority of parents do not expect their child's doctor to wear a white coat and that the parent's trust is not compromised by less traditional physician attire. Many comments on the surveys highlighted that parents and patients felt that it was the interaction, the knowledge base, and the treatment that patients received during their visit that impacted trust most.
Correspondence: Dr Thomas, 101 Manning Dr, CB 7600, Chapel Hill, NC 27514 (firstname.lastname@example.org).
Author Contributions: Drs Thomas and Morrell had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Thomas and Morrell. Acquisition of data: Thomas and Morrell. Analysis and interpretation of data: Thomas, Burkhart, Lugo-Somolinos, and Morrell. Drafting of the manuscript: Thomas. Critical revision of the manuscript for important intellectual content: Thomas, Burkhart, Lugo-Somolinos, and Morrell. Administrative, technical, and material support: Morrell. Study supervision: Morrell.
Financial Disclosure: None reported.