Physicians' Attire Linked to Patient Satisfaction Rates

Evidence gleaned from 30 studies demonstrates that how a physician dresses has a bearing on patient compliance rates and patient satisfaction rates. But for some specialties, attire is less of a factor, researchers conclude.

What can incent a patient to trust a physician, follow her directions, and remember the interaction with satisfaction?

One recent study released this week in The BMJ suggests that a conservative and professional style of dress—complete with the quintessential white coat—is where trust, patient compliance, and patient satisfaction begin.

The study finds that the majority of patients prefer physicians in professional attire, as defined within the study as "a collared shirt, tie and slacks for male physicians and blouse (with or without a blazer), skirt, or suit pants for female physicians." This came as no surprise to the study's lead author, Christopher Petrilli, MD, an internal medicine resident at the University of Michigan Health System, who spent several years in the buttoned-down financial industry prior to beginning medical school.

"Every time a patient comes in to the clinic or sees physicians on the wards, there's a certain expectation of how their physician will dress," says Petrilli. The data overwhelmingly suggests that first impressions do matter, though Petrilli and his colleagues find that patients are less concerned with attire after the first visit.

Dirty Scrubs and Other Disease Spreading Attire

The Demographics of Dress
The researchers aggregated data from 30 studies originating in 14 countries and found that a majority of patients prefer physicians who dress professionally. The results were a bit more diverse when factoring a physician's specialty, geographic region, and care setting.

While 70% of studies analyzed found that patients prefer professional attire with or without white coats, Petrilli's team also found that four out of seven studies focusing on surgeons, gynecologists, and physicians working in emergency medicine, found that their attire was less important than that of a family or general physician.

"Those who are more acutely ill don't seem to prefer formal attire as much as in an outpatient setting. If you're sicker, you probably are more focused on getting appropriate care than on what your doctor is wearing," explains Petrilli.

So, while a skilled surgeon or emergency department doc might be able to bend the wardrobe rules, someone practicing in an outpatient setting should stick to the white coat and tie, he suggests.

There was also a regional component to the study. Patients in the United Kingdom and Ireland felt most strongly that physicians should dress in a conservative fashion (four out of five studies analyzed from this region found a strong preference for professional dress with a white coat).

Americans are more conflicted on the subject.

Petrilli's team analyzed 10 U.S. studies on dress expectations for physicians, six of which found patients had no preference for professional attire or scrubs—a trend likely to continue as younger, more casual physicians enter the workforce. But American patients over the age of 45 still "strongly prefer professional attire," cautions Petrilli.

More than anything, patient preferences have to do with physicians projecting confidence, trustworthiness, and respect, he says.

Examining The Evidence
The study came about when Petrilli's coauthors noticed that in contrast to many young clinicians, he was always dressed in a tie and a ironed shirt—a holdover from his banking career, he says.

"[My coauthor] said he liked that," Petrilli remembers. This conversation sparked the question of whether or not physicians had evidence-based practices they could follow regarding professional dress. "Everything we do in healthcare is supposed to be evidence-based. We found that lots of articles touched upon physician attire, but there was no actual, evidence-based study. We then asked ourselves if we wanted to do a systematic review of the topic," Petrilli remembers.

The study findings suggests that since the image a doctor presents has such bearing on whether or not patients perceive her as trustworthy, patients are more likely to be honest about subjects such as medication compliance, their sexual histories, and end-of-life wishes when physicians are dressed professionally.

"If physician attire has even a marginal impact on how some patients feel toward their provider, leads to any increase on compliance with medication or other instruction from a physician, prevents a hospitalization, or increases patient satisfaction, then dressing professionally becomes worthwhile in itself," says Petrilli.