You are here

  • Home
  • Archive
  • Volume 12, Issue 10
  • International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents

Article Text

Article menu
Patient-centred medicine
Original research
International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents
  1. Nathan Houchens1,2,
  2. Sanjay Saint1,2,
  3. Christopher Petrilli3,
  4. Latoya Kuhn1,2,
  5. David Ratz1,
  6. Lindsey De Lott4,
  7. Marc Zollinger5,
  8. Hugo Sax6,
  9. Kazuhiro Kamata7,8,
  10. Akira Kuriyama9,
  11. Yasuharu Tokuda10,
  12. Carlo Fumagalli11,
  13. Gianni Virgili12,13,
  14. Stefano Fumagalli11,
  15. Vineet Chopra14
  1. 1Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Medicine, NYU Langone Health, New York, New York, USA
  4. 4W K Kellogg Eye Center, Ann Arbor, Michigan, USA
  5. 5Psychiatric University Hospital Zurich Department of Social and General Psychiatry Zurich West, Zurich, Switzerland
  6. 6Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
  7. 7Department of Pediatrics, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
  8. 8Department of General Internal Medicine, Fukushima Medical University Aizu Medical Center, Fukushima, Japan
  9. 9Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
  10. 10Department of Medicine, Muribushi Project for Okinawa Residency Programs, Okinawa, Japan
  11. 11Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  12. 12Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
  13. 13Centre for Public Health, Queen's University Belfast, Belfast, UK
  14. 14Department of Medicine, University of Colorado, Denver, Colorado, USA
  1. Correspondence to Dr Nathan Houchens; nathanho{at}med.umich.edu

Abstract

Objective The patient–physician relationship impacts patients’ experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings.

Setting 20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA.

Participants Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices.

Primary and secondary outcome measures The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics.

Results The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only.

Conclusions Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.

  • GENERAL MEDICINE (see Internal Medicine)
  • Health policy
  • Protocols & guidelines
  • Physician attire
  • dress
  • clothing
  • uniform
  • patient preferences
  • patient-physician relationship
  • nonverbal communication

Data availability statement

No data are available.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2022-061092

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    No data are available.

    View Full Text

    Supplementary materials

    Footnotes

    • Twitter @nate_houchens, @PetrilliMD, @yasuharutokuda

    • Contributors Conception and design of the work: SS, CP and VC. Acquisition of the data: SS, CP, LK, VC, MZ, HS, AK, and KK. Analysis and interpretation of the data: NH, SS, CP, LK, DR, LDL, MZ, HS, KK, AK, YT, CF, GV, SF and VC. Drafting of the manuscript: NH, CP, LK, DR, and VC. Critical revision of the manuscript for important intellectual content: NH, SS, CP, LK, DR, LDl, MZ, HS, KK, AK, YT, CF, GV, SF and VC. Accountable for all aspects of the work: NH, SS, CP, LK, DR, LDL, MZ, HS, KK, AK, YT, CF, GV, SF and VC. Approval of the final manuscript: NH, SS, CP, LK, DR, LDL, MZ, HS, KK, AK, YT, CF, GV, SF and VC. Guarantor: NH.

    • Funding This work was partially supported by a Swiss National Science Foundation grant (32 003B_149474; PI, HS). Several investigators (SS, HS, MZ, VC and LDL) received extramural funding for salary support. All authors had full access to all the data in the study and accept responsibility for the decision to submit for publication.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.