Patients Prefer Physicians to Wear White Coats

Most patients prefer their dermatologists to wear professional attire, in particular a white coat, a new study suggests.

Joshua D. Fox, MD, from the University of Miami Miller School of Medicine, Florida, and colleagues published the results of their study online June 1 in JAMA Dermatology.

"[W]e found that patient and physician characteristics, as well as clinic setting, all affect patient preference in dermatologist attire," the authors write. "Nonetheless, professional attire is the predominantly preferred option for dermatologists in the medical, surgical, and wound care setting."

According to the authors, physicians and patients quickly form opinions about each other during their initial encounter, which plays an important role in the development of the patient–physician relationship. A patient's perceptions of physician knowledge and skill may also be influenced by the physicians' appearance. Indeed, in other medical specialty areas, these perceptions have been shown to affect affect patient outcomes, such as quality of life, depression, blood pressure, cholesterol levels, and hemoglobin A1c levels.

"Part of this perception is based on physician attire, and consequently, it is possible that physician attire may affect patient outcomes," the authors note.

Three previous studies have evaluated patient preference in dermatologist attire: One found that patients slightly preferred their dermatologists to wear a white coat, another reported the white coat as "desirable," and the third also found that patients in inpatient and private practice settings preferred their dermatologists to wear professional attire.

In this study, Dr Kirsner and colleagues aimed to examine patient preference in dermatologists' attire in outpatient medical, surgical, and wound care settings and to identify other factors that may affect these preferences, as well as how dermatologists' attire influences patients' perception of their physician.

They surveyed 255 dermatology patients, showing each patient one picture series that featured one physician (white man, white woman, black man, or black woman) dressed in four different outfits: in business attire (suit and tie), professional attire (white coat and tie), surgical attire (scrubs), and casual attire (t-shirt and jeans). Each picture series was on a single page, so the patient was able to see the four types of attire simultaneously. Patients were asked to indicate which physician they preferred in response to a series of questions.

Among the respondents, 62.6% were medical dermatology patients, 24.0% were surgical dermatology patients, and 13.4% were dermatology wound care patients.

"Respondents overwhelmingly preferred professional attire across all clinic settings," the authors write. Specifically, 73% preferred professional attire, 19% preferred surgical attire, 6% preferred business attire, and 2% preferred casual attire.

Respondents only indicated a preference for surgical attire over professional attire (49% vs 47%; P < .001) in cases of a dermatologic emergency.

Respondents who viewed a picture of a black male or black female physician were also significantly more likely to exclusively prefer professional attire (unadjusted odds ratio [OR], 3.21; 95% confidence interval [CI], 1.39 - 7.42 for a black male physician; unadjusted OR, 2.78; 95% CI, 1.18 - 6.51 for a black female physician) than respondents who viewed a picture of a white male physician were. Nonwhite (OR, 0.28; 95% CI, 0.10 - 0.83) and unemployed (OR, 0.28; 95% CI, 0.08 - 0.99) respondents were less likely to prefer professional attire exclusively.

Respondents also preferred professional attire in all clinic settings (P < .001), although those in the surgical setting were less likely than those in the medical setting to prefer professional attire (race-adjusted OR, 0.74; 95% CI, 0.56 - 0.98). Respondents in the wound care and medical settings indicated similar preferences for professional attire.

The results of this study show that most patients prefer their dermatologist to wear professional attire in all clinic settings and that patient and physician characteristics affect this preference.

In an author interview posted by the JAMA Network, the study's corresponding author, Robert S. Kirsner, MD, PhD, from the University of Miami Miller School of Medicine, emphasized that physicians should consider how they represent themselves. "Patients make up their mind about a physician very, very early in the interaction," so their initial gut reaction may dictate how they perceive us — how they are going to interpret our recommendations."



However, he notes that current physician behavior is not always in line with patient preference. "Nearly three quarters of dermatologists on their own websites are not dressed with white coats, so even before a patient goes to see a physician, they may already be biased in not the best way they could be, towards that physician," Dr Kirsner concludes.

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