Table 1

Characteristics of included studies

Authors, year, locationStudy designClinical setting (context)Patient characteristicsAttire comparedClinical encounter (Y/N)Perceptions/preferences measuredInfluence/preference expressed for attirePertinent results and comments
NMean age (years)Education level% MaleTypes of attireWhite coat specified
Al-Ghobain et al, 2012, Riyadh, Saudi Arabia15Picture-based survey and face-to-face interview of patients awaiting careGeneral medicine clinic (outpatient)39937.266% were at least high-school educated57.9Males: formal attire, scrubs, national attire
Females: formal attire, Scrubs
YesNoConfidence
Knowledge
respect
Yes; formal attire▸ Male and female patients preferred formal attire
▸ 85% indicated preference for white coats
▸ Confidence, competence, apparent medical knowledge and expertise was not significantly associated with the attire or gender of provider (p=0.238)
Au et al, 2013, Alberta, Canada16Cross-sectional, picture-based survey; family members reviewed pictures and rated factors such as age, sex, grooming, tattoos, etcThree intensive care units (acute care)337N/R60% College or university educated32Formal attire+white coat, suit, casual attire, scrubsYesNoCaring competence
Honesty
knowledge
Yes; formal attire and white coat▸ Formal attire+white coat was rated as being most important when first meeting a physician
▸ Neat grooming and visible name tags were also important
▸ When selecting preferred providers from a panel of pictures, formal attire and white coat were most preferred
▸ Physicians in formal attire: viewed as being most knowledgeable
▸ Physicians in scrubs or a white coat: viewed as being most competent to perform a procedure
Baevsky et al, 1998, Massachusetts, USA17Prospective encounter-based, non-randomised exit-survey of patients conducted after receiving care. Physicians alternated attire on daily basisUrban urgent care clinic (acute care)596N/RN/RN/RFormal attire+white coat, scrubs+white coatYesYesDegree of concern knowledge
Polite/courteous
Satisfaction
No preference▸ No differences seen between attires with regard to patient satisfaction
▸ Mean ranks were higher for scrubs+white coat regarding courtesy, seriousness and knowledge
▸ 18% of physicians broke from attire protocol during the study
Boon et al, 1994, Sheffield, England18Prospective questionnaire following clinical interactionAccident and emergency department (acute care)329N/RN/RN/RWhite coat, casual attire, scrubsYesYesProfessionalism
Neat
scruffy
No preference▸ Style of dress did not affect patient perceptions of medical staff
▸ Average visual analogue scale results did not differ between white coat, causal attire and scrubs (9.14 vs 8.98 vs 8.98)
▸ However, patients often failed to correctly recall physician attire when surveyed
Budny et al, 2006, Iowa and NY USA19Description-based survey of patients awaiting carePodiatric clinics in private practice and hospital-based settings (procedural)15518–25: 7%
26–40: 15%
41–55: 32%
56–70: 19%
>70: 26%
N/R36Formal attire, casual attire, scrubsYesNoConfidenceYes; formal attire▸ 68% of all patients reported more confidence if physicians donned formal attire
▸ Formal attire was preferred among older patients (Medicare) and patients who received care in private practice settings
▸ Females preferred formal attire more than male patients
Cha et al, 2004, Ohio, USA20Picture-based survey regarding patient preferences for attireObstetrics and gynaecology clinic at an academic medical centre (procedural)184Approximately 66% ≤25 years of ageApproximately 66% at least high-school educated0Formal attire+white coat, formal attire−white coat; scrubs+white coat; casual attire+white coat, casual attire−white coat, scrubs−white coatYesNoComfort
Confidence
Yes; scrubs+white coat▸ 63% of patients stated that physician clothing did not influence their comfort with the physician
▸ 62% reported that physician clothing did not affect their confidence in the physician
▸ However, following pictures, comfort level of patients and perceived competence of physicians were greatest for images of physicians dressed in white coats and scrubs.
▸ Comfort level was least for physicians wearing casual attire
Chang et al, 2011, Seoul, Republic of Korea21Picture-based survey regarding preferences for attire prior to clinical consultationAlternative medicine clinic at an academic medical centre (outpatient)15343.3N/R32White coat, formal attire, traditional attire
casual attire
YesNoComfort
Competence
trust
Yes; white coat▸ Patients most preferred white coats regardless of whether Western or oriental physician portrayed in photographs
▸ Competence and trustworthiness ranking: white coat, traditional, formal attire and, lastly casual attire
▸ Comfort ranking: traditional attire, white coat, formal attire and casual attire
Chung et al, 2012, Kyunggido, Republic of Korea5Prospective, non-randomised, clinical encounter-based survey of patients conducted after receiving careTraditional Korean medical clinic (outpatient)14337.7N/R34White coat, formal attire, traditional attire, casual attireYesYesComfort
Competence
Empathy
Satisfaction
trust
Yes; white coat▸ White coat was associated with competence, trustworthiness and patient satisfaction
▸ Traditional attire led to greater patient comfort and contentment with the physician
▸ No specifics regarding clothing under white coat provided
Edwards et al, 2012, Texas, USA22Prospective non-randomised, clinical encounter-based questionnaire. Physician attire rotated after 12-weeksOutpatient surgical clinic at a military teaching hospital (procedural)570N/RN/RN/Rscrubs+white coat, traditional attireYesYesAppropriatenessNo preference▸ Surgeon clothing did not affect patient's opinions
▸ Patients felt it was appropriate for surgeons to wear Scrubs in the clinic
▸ No preference regarding attire by 71% of those who replied
▸ 50% of patients in either group (scrubs vs no-scrubs) felt that white coats should be worn
▸ 30.7% response rate; demographic data not collected
Fischer et al, 2007, New Jersey, USA23Prospective non-randomised, clinical encounter-based questionnaire; physicians were randomly assigned to wear one of three attire types each weekOutpatient obstetrics and gynaecology clinics at a university hospital (procedural)111637.3N/R0Formal attire+white coat, casual attire±white coat, scrubsYesYesComfort
competence
Friendly and courteous
Hurried
Knowledge
listened to concerns
Professionalism
Satisfaction
No preference▸ Patient satisfaction with their physicians was high; attire did not influence satisfaction
▸ Physicians in all three groups were viewed as professional, competent and knowledgeable
▸ Among 20 physician providers, 8 preferred casual attire, 7 preferred formal attire, and 5 preferred scrubs
Friis and Tilles, 1988, California, USA24Picture-based survey; patients who had received care from a resident physician during a prior visit were surveyed regarding their preferences for physician attireInternal medicine clinic, emergency room, internal medicine ward, community-based internal medicine clinic (mixed)200N/R (Mode: 20–29)N/R40White coat
Formal attire
Casual attire
YesYesConfidence
Hurried
Neatness
Satisfaction
sympathy
No preference▸ Most patients voiced no attire preference; however, 64% said neatness of dress was moderately to very important
▸ 78% rated their physician as neat or very neat
▸ Variances between clinical settings: ward patients more frequently said female physicians should wear a white coat and skirt (27% vs 5%, p<.01)
▸ While participating physicians were all residents, level of resident training was not taken into account by the survey
Gallagher et al, 2008, Dublin, Ireland25Picture-based survey of patients awaiting careoutpatient endocrinology clinic in a tertiary referral hospital (outpatient)12452.3N/R50White coat, formal attire, suit, casual attire, scrubsYesNoAppropriateness of attire
Comfort
Yes; White coat▸ White coat was most often preferred by both male and female patients
▸ Scrubs and casual attire were least preferred
▸ Limited description of casual attire worn by both genders of physicians and formal attire worn by female physicians were provided
Gherardi et al, 2009, West Yorkshire, England26Picture-based survey in multiple care settingsoutpatient clinics, inpatient wards, emergency departments (mixed)511N/RN/R44White coat, formal attire, suit, casual attire, scrubsYesNoConfidenceYes; White coat▸ White coat was the most confidence-inspiring attire in all hospital settings
▸ Younger patients more tolerant of scrubs
▸ Patients had most confidence in physicians wearing Scrubs in the emergency department vs other settings
▸ White coat was worn with formal attire limiting ability to parse out impact of each element; survey conducted in a brief time frame
Gooden et al, 2001, Sydney, Australia27Cross-sectional, clinical encounter-based survey of hospitalised patientsMedical and surgical wards of two teaching hospitals (inpatient)154Median 54N/R58White coat, no white coatYesYesAloof
Approachable
Authoritativeness Competence
Easy to talk to Friendly
Knowledgeable
Preference
Professionalism
Scientific
Yes; White coat▸ Higher scores noted when white coat was worn
▸ 36% explicitly preferred physicians to wear White Coats
▸ Patient preference for physicians to wear a white coat correlated with preference to wear a uniform
▸ Older patients (53 or older) preferred white coats more than younger patients
▸ An imbalance between patients who saw providers with or without a white coat was reported (24% vs 76%)
Hartmans et al, 2014, Leuven, Belgium40Picture-based, cross-sectional survey administered online through social media as well as in-person in waiting roomsUniversity hospital-based outpatient clinic and related offsite clinics (outpatient)150638.470.1% completed at least high school32Formal attire+white coat, formal attire−white coat, semi-formal attire, casual attireYesNoConfidence, ease with physicianYes; Formal attire+white coat▸ Patients have the most confidence in a female doctor wearing formal attire+white coat, while they felt most at ease with a female physician in casual attire
▸ Most confidence inspiring outfit of the older male physician was formal attire+white coat,
▸ The response of ‘No preference’ was not included in this study
Ikusaka et al, 1999, Tokyo, Japan28Clinical encounter-based questionnaire; physician rotated wearing a white coat weeklyUniversity hospital outpatient clinic (outpatient)599White coat group: 50
No white coat group: 47.8
N/R45Formal attire+white coat, formal attire−white coatYesYesEase with physician
Satisfaction
No preference▸ Although patients stated they preferred white coats, satisfaction was not statistically different between the groups
▸ Older patients ≥ 70 years of age preferred a white coat over those ≤70 (69% vs 52%, p=0.002)
Kersnik et al, 2005, Krajnska Gora, Slovenia29Patient allocation-blinded, clinical encounter-based survey; physicians alternated wearing a white coat dailyOutpatient, urban family practice (outpatient)259N/RN/RN/RWhite coat, no white coatYesYesIntegrity
Professionalism
Satisfaction
No preference▸ There were no significant difference in patient satisfaction between the two groups
▸ 34% and 19% of all respondents fully agreed or agreed that white coats symbolise professional integrity
▸ Conversely, 25.9% and 8.5% either fully disagreed or disagreed that the white coat represented professional integrity
Kocks et al, 2010, Groningen, Netherlands30Picture-based survey of patient preferencesPatients were interviewed at home; professionals were given a written survey at a symposium (mixed)11678N/R56.9Formal attire, suit, business-casual attire, casual attireNoNoPreference
Trust
Yes; Formal attire▸ Patients preferred formal attire and suit over other attires
▸ Professionals preferred formal attire and business-casual attire over casual attire
▸ In general, patients were more tolerant of casual attire and less likely to have style preference than professionals
Kurihara et al, 2014, Ibaraki, Niigata and Tokyo, Japan41Picture-based, self-administered questionnairesoutpatients at 5 pharmacies across Japan49151.9N/R40.3Formal attire+white coat, formal attire−white coat, casual attire, scrubsYesNoAppropriatenessYes; Formal attire+white coat▸ Formal attire+white coat was considered the most appropriate style of clothing followed by scrubs
▸ Formal attire without a white coat for female physicians was felt to be inappropriate in 73% of patients vs 24% who felt that formal attire without a white coat was inappropriate for male physicians.
▸ 73% of respondents felt that casual dress was inappropriate for male physicians vs 79.8% for female physicians
▸ There was a statistically significant increase in the number of subjects over 50 years of age who thought scrubs were in appropriate compared to those aged 20–34 years.
▸ Study survey response rate was 35%
Li and Haber , 2005, New York, USA31Patient-allocation blinded, picture-based, quasi-experimental before-and-after study; physicians alternated attire weeklyUrban emergency department in a university medical centre (acute care)11142N/R53Formal attire+white coat, scrubsYesYesProfessionalism
Satisfaction
No preference▸ Physician attire was not associated with satisfaction or professionalism in the emergency department during the study
▸ No difference in attire preferences by patient age, gender, race, or physician gender and race were noted
▸ Hawthorne effect possible as physicians were aware of patient ratings and observations
Lill and Wilkinson, 2005, Christchurch, New Zealand32Picture-based survey of patient preferencesInpatients and outpatients from a wide range of wards, medical and surgical clinics (mixed)45155.9N/R47White coat, formal attire, semiformal
semiformal with smile
Casual
YesYes for inpatients (survey administered before clinical encounter in outpatients)Preference for physician based on attire displayed in picturesYes; Semiformal attire with smile▸ Semi-formal attire with a smile was preferred by patients
▸ Older patients preferred male and female physicians with white coats more than other age groups
▸ Most patients thought physicians should always wear a badge
▸ Smiling option in pictures may have introduced bias as this was not used equally for all categories
Maruani et al, 2013, Tours, France33Picture-based, prospective cross- sectional studyOutpatient dermatology patients of a tertiary care hospital, 2 dermatological private consulting rooms (procedural)32952.3N/R43.8White coat, formal attire, business-casual attire, casual attireYesNoConfidence
Importance of attire
Yes; White coat▸ White coats were preferred by hospital and private practice outpatients significantly more than other attires, for both male and female physicians
▸ 60% of adult patients in either setting considered physician attire important
McKinstry and Wang , 1991, West Lothian and Edinburgh, Scotland34Picture-based, interviewer-led surveys of patients using eight standardised photographs of physicians in different attires5 outpatient general medicine clinics (outpatient)475N/RN/R30.9Males: formal attire+white coat, formal attire−white coat, business-casual attire
Females: formal attire+white coat; business-casual, casual attire
YesNoAcceptability
Confidence
Yes; Formal attire+white coat▸ Male physicians: formal attire−white coat was preferred followed by formal attire+white coat
▸ Female physicians: casual attire scored significantly lower patients and higher socioeconomic levels preferred formal attire+white coat to a greater extent than others.
▸ Majority of patients felt that the way their doctor's dress is very important or quite important.
▸ Significant variations noted across sites suggest underlying patient- or site-level confounding
McLean et al, 2005, Surrey, England39Clinical encounter-based questionnaire with one of two providers dressed in military uniform or civilian formal attireFracture clinic in a ‘District Hospital’ (procedural)7739N/R62Military uniform, formal attireNoYesApproachable Confidence
Humorous
Hurried
Intimidation
Kindness
Polite/courteous
Professionalism
Yes; Formal attire▸ Civilian formal attire was felt more professional by patients
▸ No statistical differences were noted with respect to other dimensions including kindness, approachability, or confidence across attires
▸ This is small study with a small number of patients and only two providers; generalisability appears limited
McNaughton-Filion et al, 1991, Ontario, Canada35Picture and description based-survey administered by a research-assistant or resident to both patients and physiciansUrban, university hospital family practice and community-based family practice clinic (Outpatient)80N/R54% College or university educated41Formal attire+white coat, formal attire−white coat, casual attire+white coat, casual attire−white coat, scrubs+white coatYesNoProfessionalism
Trust and confidence
Yes; Formal attire+white coat▸ Majority of patients surveyed believed formal attire+white coats in male physicians would be more likely to inspire trust & confidence.
▸ Preferred attire for female physicians was less clear
▸ Most physicians opined that they should dress professionally, but white coats were not necessary
Niederhauser et al, 2009, Virginia, USA36Picture and description-based survey of patient preferencesHospital-based obstetrics and gynaecology clinics (procedural)32826.4N/R0Military uniform+white coat military uniform−white coat, scrubs+white coat, scrubs−white coatYesNoComfort
Confidence satisfaction
Yes; Scrubs±white coat▸ 61% of patients preferred Scrubs
▸ 83% of patients did not express a preference for white coats.
▸ 12% reported attire affects confidence in their physician's abilities
▸ 13% reported attire affects how comfortable they are talking to their physician about general topics
Pronchik et al, 1998, Pennsylvania, USA37Clinical encounter-based, prospective survey; All male students, residents and attendings assigned to wear or not wear a necktie according to a specified schedule; female providers were excludedEmergency department of a community teaching hospital
(Acute care)
316N/RN/RN/RNecktie, no necktieNoYesSatisfaction
Competence
No preference▸ Neckties did not influence patients’ impression of medical care, time spent, or overall provider competence
▸ Higher ‘general appearance’ ratings were noted among patients who believed their physician wore a necktie during their clinical encounter
▸ Of note, 28.6% of patients incorrectly identified their physician as having worn a necktie on a no necktie day
Rehman et al, 2005, South Carolina, USA1Picture-based, randomised, cross-sectional descriptive surveyOutpatient medicine clinic at a Veterans-Affairs Medical Center (outpatient)40052.442.8% at least high school educated54Formal attire+white coat; formal attire−white coat, casual attire, scrubsYesNoAuthoritative Compassionate
Competence
Confidence
Preference
responsible trustworthiness
Yes; Formal attire+white coat▸ Significant preference for formal attire+white coat
▸ Female respondents placed more importance on female physician attire than that of male physician attire
▸ Trend toward less preference for formal attire+white coat when physician pictured was African–American
Sotgiu et al, 2012, Sassari, Italy38Picture and description-based questionnaireMedical and surgical outpatient clinics (mixed)76543.245.8% finished high school or college-level7.5Formal attire+white coat, casual attire+white coat, scrubs+white coatYesNo‘Willingness to share heath issues’ with each of the physicians, but data not reportedYes; Scrubs+white coat▸ The greatest proportion of patients preferred scrubs+white Coat (47% for male physicians, 43.7% for female physicians respectively) followed by formal attire+white coat (30.7% for male physicians, 26.8% for female physicians)
▸ Male patients preferred Formal Attire+White Coat for both male and female physicians; female patients preferred scrubs+white coat for both male and female physicians.
▸ Younger patients chose scrubs+white coat more often than older patients; older patients preferred formal attire+white coat
Yonekura et al, 2013, Sao Paulo, Brazil42Picture-based survey of patient preferencesInpatients and outpatients at a university hospital25947.8N/R42.9White coat, formal attire+white coat, traditional attire, casual attire, scrubsYesNoCleanliness Competence
‘Concern for patients’
Confidence
Knowledge
Yes; White coat▸ The combined white coat options in the survey were the most preferred by patients across all measured perceptions
▸ White coat was preferred by patients in both routine outpatient appointments as well as emergency room visits
▸ Traditional attire was defined as ‘All White’ without a white coat for both male and female physician models
▸ Physicians surveyed in this study expressed a preference for formal attire+white coat for the male physician model and white coat for the female physician model