Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department

doi:10.1016/S0196-0644(89)80104-0

Annals of Emergency Medicine

Volume 18, Issue 2, February 1989, Pages 145-151

https://doi.org/10.1016/S0196-0644(89)80104-0 Get rights and content

To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

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Cited by (39)

Perceptions of patients, physicians, and Medical students on physicians' appearance
2013, Revista da Associacao Medica Brasileira
Investigar as impressões causadas em pacientes, estudantes de Medicina e médicos brasileiros por diferentes estilos de vestimenta e aparência adotados pelos médicos.
Participaram da pesquisa 259 pacientes, 119 estudantes e 99 médicos, respondendo questões relativas a um painel de fotos de médico e médica vestidos nos seguintes estilos: roupa branca, avental branco, avental social, formal, informal, casual e centro cirúrgico. Eles ainda registraram seu grau de desconforto frente uma lista de 20 itens de aparência para profissionais de ambos os sexos.
A maioria das respostas dos voluntários envolveu o uso de roupa branca ou avental branco, e em muitas questões os percentuais de preferência referidos para esses estilos foram muito próximos. Médicos e estudantes preferiram profissionais em traje de centro cirúrgico para consultas de urgência, e o estilo informal para discutir problemas psicológicos com profissional masculino. Os pacientes escolheram mais frequentemente a roupa branca em resposta às questões. No tocante aos profissionais masculinos, os três grupos referiram elevado grau de incômodo para o uso de shorts e bermudas, muitos anéis, piercing facial, sandálias, cabelos de cor extravagante, cabelos compridos e brincos. Para o sexo feminino, níveis elevados de desconforto foram assinalados para shorts, blusas mostrando a barriga, piercing facial, bermudas, muitos anéis, cabelos de cor extravagante e maquiagem carregada.
Pacientes, médicos e estudantes de Medicina brasileiros desenvolvem melhor impressão inicial de médicos que utilizam trajes tradicionalmente associados com a profissão e de aparência mais convencional. O uso da vestimenta inteiramente branca parece ser opção satisfatória no Brasil.
To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students and other physicians in Brazil.
Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians’ pictures covering the following styles: white clothing; white coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders.
Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercing, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported to shorts, blouses exposing the belly, facial piercing, multiple rings, extravagant hair color, and heavy makeup.
Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country.
Do patients understand the changes in the way doctors dress?
2010, Journal of Hospital Infection
Effects of 'bare below the elbows' policy on hand contamination of 92 hospital doctors in a district general hospital
2010, Journal of Hospital Infection
Citation Excerpt :
What doctors wear has an influence on patients' perceptions, which may have potential consequences on the likelihood of patients following advice. Formal attire has been shown to be associated with greater trust and confidence.22–24 It has been shown that patients perceive BBE-compliant uniforms as unhygienic (Subramanian et al., unpublished study); however, if the rationale for such attire is explained, opinions may be changed.3
Despite a lack of evidence the UK's Department of Health introduced a policy of ‘bare below the elbows’ attire in order to try to reduce the incidence of nosocomial infection. This study investigates the link between this state of dress and hand contamination. A prospective observational study of doctors working in a district general hospital was carried out. The fingertips of each hand were imprinted onto culture medium, and resultant growth assessed for number of colony-forming units and presence of clinically significant pathogens or multiply resistant organisms. These findings were correlated with attire, grade, sex and specialty. Ninety-two doctors were recruited of whom 49 were ‘bare below the elbows’ compliant and 43 were not. There was no statistically significant difference between those doctors who were ‘bare below the elbows’ and those that were not, either for the number of colony-forming units or for the presence of clinically significant organisms. No multiply resistant organisms were cultured from doctors' hands. ‘Bare below the elbows’ attire is not related to the degree of contamination on doctors' fingertips or the presence of clinically significant pathogens. Further studies are required to establish whether investment in doctors' uniforms and patient education campaigns are worthwhile.
Pants, policies and paranoia...
2010, Journal of Hospital Infection
Citation Excerpt :
There are sequelae to introducing changes to dress within an established profession. Patients judge the professionalism and trustworthiness of practitioners based on the clothes they wear, so the loss of white coats and ties could potentially damage the patient–doctor relationship.26–28 Formal attire has been shown to be associated with greater trust and confidence.
In response to the rising tide of hospital-acquired infections (HAIs) in UK hospitals, governmental health departments have introduced dress codes for healthcare staff. These include measures such as the use of short sleeves, no wristwatches or jewellery, and avoidance of ties and white coats. Although hospital pathogens have been found on such items, there is no evidence that they play a major role in transmitting HAIs and these policies have received much criticism. This Leader examines the evidence underpinning the new dress codes and concludes that there is insufficient evidence to justify recent policies. Dress codes appear to have been imposed more for political purposes than in deference to effective infection control. In addition, the UK ‘zero tolerance’ mandate towards HAI does not balance personal accountability against a failing healthcare system. These policies may try to impose good practice but over-reliance on cheap, short-term solutions will not adequately address longer-term problems with HAI.
Attitudes regarding surgeons' attire
2005, American Journal of Surgery
No studies to date exist regarding the attire of physicians on a surgical service. The objective of this study was to determine patient, surgeon, and nonhospitalized public (NHP) attitudes and preferences regarding surgeons’ attire and mannerisms.
A questionnaire was developed to survey each group. The Internet was used as a novel avenue to survey the NHP. Eight questions were presented to each group, and each question had three possible responses: agree, disagree, or no opinion. Total responses and percentages were determined for each group’s answers, and statistical analysis was performed using chi-square test.
Thirty-eight surgical inpatients, 38 surgeons, and 334 NHP participated in the study. All groups agreed that surgeons should wear nametags while they are seeing patients. Inpatients agreed with surgeons that surgeons should wear white coats while seeing patients (P > .05). Surgeons considered scrubs and clogs to be acceptable attire, which differed from all other groups (P < .05). Although 31% of the NHP considered blue jeans acceptable, only 10% of surgeons (P < .05) and 22% of patients (P > .05) considered them acceptable. All groups believed that a surgeon’s appearance influences their perceptions and impressions regarding the quality of medical care they received (P < .05).
Based on the agreement of all groups that a surgeon’s appearance and mannerisms affects perceptions of the quality of medical care received, surgeons should respond to these perceptions and dress accordingly while seeing surgical patients.
Patient attitudes toward emergency physician attire
2005, Journal of Emergency Medicine
Previous studies have suggested that Emergency Department (ED) patient satisfaction is unaffected by physician attire. We conducted a before-and-after trial to test this hypothesis. A convenience sample of ED patients was surveyed during a 2-week period. In the first week, emergency physicians wore white coats and formal attire. In the second week, the same physicians wore scrubs. Patients were asked to indicate on a 100-mm visual analog scale (VAS) their ratings of physician appearance, satisfaction, and professionalism. The primary outcome was the difference in VAS scores between the two dress styles. There were 111 patients surveyed. There were no significant differences between patients’ evaluation of appearance (Δ = −.68 mm VAS, 95% confidence interval [CI] −5.5 to 4.1), satisfaction (Δ = .83 mm VAS, 95% CI −3.0 to 4.6), or professionalism (Δ = −.46 mm VAS, 95% CI −3.6 to 2.6) between the two dress styles. Emergency physician attire does not affect patient satisfaction.

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Original contributionAttitudes of patients and physicians regarding physician dress and demeanor in the emergency department

J Adolesc Health Care

The doctor's white coat

Ann Intern Med

Coats, white or soiled

N Engl J Med

Coats, white or soiled

N Engl J Med

On white coats and other matters

N Engl J Med

Original contribution
Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department