What not to wear: Do doctors need a dress code?

What not to wear: Do doctors need a dress code?

Most patients want to see their doctor dressed in a white lab coat or a suit. But fancy threads take a back seat to scrubs when it comes to emergency or critical care.

For a new paper, researchers compiled the findings of  30 studies on physician attire involving 11,533 adult patients in 14 countries.

Age and culture

How patients feel about how their doctors dress depends a lot on age and culture, the research shows.

In general, Europeans and Asians of any age, and Americans over age 50, trust a formally dressed doctor more, while Americans in Generation X and Y tend to accept less-dressy physicians more willingly.

“As physicians, we want to make sure that we’re dressing in a way that reflects a level of professionalism and also mindful of patients’ preferences,” says lead author Christopher Petrilli, an internal medicine resident at the University of Michigan Health System.

“Many studies have looked at various aspects of physician attire, so we wanted to look across this body of literature to find common threads. But at the same time, we found a lack of detailed guidance from top hospitals to their physicians about how to dress.”

One size does not fit all

In all, 21 of the 30 studies found that patients expressed clear preferences about what they felt doctors should wear, or said that attire affected their perceptions of a physician. In 18 of those studies, formal attire or a white coat was preferred.

Four of the seven studies that involved surgery patients reported that attire choice didn’t matter or that scrubs were preferred. The same was true of four of five studies that involved patients receiving emergency care or intensive care.

Patient satisfaction now influences how doctors, and hospitals are paid—making the impact of patient perceptions of their doctors’ knowledge, caring, professionalism, and trustworthiness all the more important, says Vineet Chopra, assistant professor of internal medicine.

The findings, published in the journal BMJ Open, suggest that a “one size fits all” approach to policies and guidance for doctors won’t work.

“In order to better tailor physician attire to patient preferences and improve available evidence, we would recommend that healthcare systems capture the ‘voice of the customer’ in individual care locations, such as intensive care units and emergency departments,” Chopra says.

The subject of what to wear isn’t covered directly in medical school. Even for physicians in practice at hospitals on the US News & World Report Best Hospitals ranking, specific guidelines are few and far between.  Only five of those surveyed offer official guidance for physicians about attire at all, and most just recommended it be “professional.” The others offered no formal guidance.

The researchers are currently preparing to launch their own international study of the impact of physician clothing choices, under the name “Targeting Attire to Improve Likelihood of Rapport” or TAILOR.

The study will survey patients in outpatient general medicine and specialty clinic waiting rooms and inpatient medical units. Hospitals in three countries have signed on to participate, making it the largest such study of its kind. Pediatric patients and their parents will not be included, but the researchers say that is another area ripe for research.

“Everything is supposed to be evidence-based in medicine,” Petrilli says. “With this review and our new study, we can provide compelling evidence to influence the way physicians dress.”

Funding for the research came in part from the Agency for Healthcare Research and Quality. Source: University of Michigan / Original Study DOI: 10.1136/bmjopen-2014-006578

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