Inpatient Attire: An Opportunity to Improve the Patient Experience

A recent commentary in JAMA^1(p2169) suggested that patients should be encouraged to wear their own clothing so they might “maintain their self-esteem and orientation and also remind their care professionals to recognize them as people.” Other articles suggest that traditional patient gowns are associated with a loss of dignity, the reinforcement of the “patient role,” and the assumption of a low-status position in the hospital.^2,3 Far more has been written on the attire of health care practitioners than that of patients.

Although patient attire can be graduated from an open-backed gown, at one end of the spectrum, to full home dress at the other, we suggest that the absence of lower-body attire that leaves the backside and genital areas unnecessarily exposed has an important effect on dignity. We sought to determine the proportions of our patients who were wearing clothing in this bodily region and for whom wearing it would be appropriate and to elicit patient preference on the issue.

The Research Ethics Board of McGill University Health Centre granted ethics approval of this study and waived informed consent. The presence of lower-body garments, defined as any clothing more substantial than underwear or diapers, was recorded during rounds for all patients admitted on the same calendar day to 6 clinical teaching units at 5 hospitals in Toronto, Ontario, Canada, and Montreal, Quebec, Canada. The eligibility of individual patients to wear lower-body attire was determined by the attending physicians of those services by asking themselves: “If this patient requested to wear pants or other similar garments, would you agree?” Reasons not to agree were left to the individual physician but may have included (1) that the patient had a medical problem, wound, line, or catheter precluding their wearing lower-body garments or (2) that the patient was too immobile, too incontinent, too confused, or too ill to wear such attire, given the available nursing resources.

At one center, eligible patients were asked whether they would want to wear such attire, and if not, why. We performed statistical comparisons using the χ² test.

Of 127 patients included in the evaluation, only 14 (11.0%) were wearing lower-body garments (Table). Physicians deemed 57 patients (56.4% of patients with available data) to be eligible to wear lower-body garments; however, among them only 14 (24.6%) were actually doing so. We found no significant differences between the 2 cities with respect to the proportion wearing lower-body attire; however, physicians in Montreal were more likely than those in Toronto to deem patients eligible (46 of 70 [65.7%] vs 11 of 31 [35.5%]; P = .005).

In the survey, 13 of 17 patients (76.5%) in a single center who were eligible but who were not wearing lower-body attire wanted to do so. The other 4 patients were indifferent and equated the hospital gown with “what patients wear.”

We demonstrate that most of the patients admitted to our acute medical units do not wear lower-body attire. This situation occurs despite more than half of them being deemed eligible to do so, despite most of those patients surveyed being interested in doing so, and despite encouragement to wear home clothing as a means of preventing hospital-induced disability.⁴

Despite our study being relatively small, we suspect that the results would be similar in other centers without an existing culture to encourage home attire. We suggest that to improve the patient experience, eligible patients should be encouraged to wear lower-body garments when full home attire is not feasible. Furthermore, we suggest that functional fashions⁵ for those with disabilities and special needs, such as the hospitalized patient population, should be developed to allow those who cannot wear or do not have access to their home attire something more dignified than a one-size-fits-all open-backed patient gown.

Corresponding Author: Todd C. Lee, MD, MPH, Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, 687 Pine Ave W, Room M603B, Montreal, QC H3A1A1, Canada (todd.lee@mcgill.ca).

Published Online: September 22, 2014. doi:10.1001/jamainternmed.2014.4513.

Author Contributions: Dr Lee had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis.

Study concept and design: McDonald, Lee.

Acquisition, analysis, or interpretation of data: Dounaevskaia, Lee.

Drafting of the manuscript: Dounaevskaia, Lee.

Critical revision of the manuscript for important intellectual content: McDonald, Lee.

Statistical analysis: Lee.

Administrative, technical, or material support: McDonald.

Study supervision: Lee.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Yash Patel, MD, MSc, FRCPC, and Isaac I. Bogoch, MD, MPH, FRCPC, Department of Medicine, University of Toronto, participated in data collection and did not receive compensation for their roles.