June 26, 2018
A survey of 4,062 patients at ten major medical centers nationwide by Michigan Medicine at the University of Michigan has found that doctors should consider their white coats as much more than a fashion statement. In fact, one-third of respondents to the study, published on June 6 in Science Daily, said that what a doctor wears influences their satisfaction with their care.
Based on the findings, the researched have called for more hospitals, health systems, and practice groups to look at their dress standards for physicians, or create them, if they don’t already have one.
“Professional dress on Wall Street, law and nearly every other industry is relatively clear—and it typically mirrors what applicants would wear to their job interview,” says Christopher Petrilli, M.D., lead author of the study and an assistant professor of hospital medicine at the University of Michigan Medical School, who worked in the finance industry before entering medicine. “In medicine, the dress code is quite heterogeneous, but, as physicians, we should make sure that our attire reflects a certain level of professionalism that is also mindful of patients’ preferences.”
The study asked patients to look at pictures of male and female physicians in seven different forms of attire, and to think of them in both inpatient and outpatient clinical settings. For each photo, they rated the providers on how knowledgeable, trustworthy, caring, and approachable the physician appeared, and how comfortable the attire made the patient feel.
The options were:
- Casual: Short-sleeved collared shirt and jeans with tennis shoes, with or without white coat;
- Scrubs: Blue short-sleeved scrub top and pants, with or without white coat;
- Formal: Light blue long-sleeved dress shirt and navy blue suit pants, with or without white coat; with black leather shoes with one-inch heels for women, and with black leather shoes for men, and a dark blue tie for men; or
- Business suit: Navy blue jacket and pants with the same dress shirt, tie and shoes as in the “formal” option, no white coat.
Formal attire with a white coat got the highest score on the composite of five measures, and was especially popular with people over age 65. It was followed by scrubs with a white coat, and formal attire without a white coat. Indeed, when asked directly what they thought their own doctors should wear, 44% of patients said they preferred the formal attire with white coat, and 26% said scrubs with a white coat. When asked what they would prefer surgeons and emergency physicians wear, scrubs alone got 34% of the vote; followed by scrubs with a white coat with 23%.
The results were largely the same for physicians of either gender except for male surgeons. Patients tended to prefer that they go with formal wear, without a white coat.
The setting of care mattered, too. Sixty-two percent agreed or strongly agreed that when seeing patients in the hospital, doctors should wear a white coat, and 55% said the same for doctors seeing patients in an office setting. The percentage preferring a white coat fell to 44% for emergency physicians.
Though the surveys were conducted during business hours on weekdays, the researchers asked patients what they thought doctors should wear when seeing patients on weekends. In this case, 44% said the short-sleeved outfit with jeans was appropriate, although 56% were neutral or disapproved of such a look even on weekends.
Interestingly, patients in the Northeast (38%) and Midwest (40%) were less insistent on white coats and formal attire;, compared with those in the West (50%) and in the South (51%). Northeasterners were more than twice as likely as southerners to prefer scrubs alone for surgeons.
“This is by far the largest study to date in this area. We used the expertise gained from our previous systematic review along with a panel of psychometricians, research scientists, choice architects, survey experts, and bioethicists to develop our study instrument. Given the size, methodological rigor and representativeness of these data, local, nuanced policies addressing physician attire should be considered to improve the patient experience,” says Petrilli, who treats patients in the hospitals of Michigan Medicine, U-M’s academic medical center, and holds a position at the VA Ann Arbor Healthcare System. He is a member of the U-M Institute for Healthcare Policy and Innovation.
The researchers note that while studies have shown that while physicians’ white coats, neckties and sleeves have been shown to harbor infectious organisms—leading some countries to require physicians’ arms to be “bare below the elbow”—no studies have shown actual transmission of infection to patients through contact with physician attire.
However, other research has suggested that physicians may be more attentive to tasks when wearing their white coats, perhaps increasing patient safety.
“Patients appear to care about attire and may expect to see their doctor in certain ways. Which may explain why even white lab coats received a high rating for ‘approachability’ — patients may see a white coat similar to a physician’s ‘uniform’ and may similarly also expect formal attire in most settings,” notes Petrilli. “Patients don’t always have the opportunity to choose their doctor. In this era of appropriately increased focus on patient centeredness and satisfaction, physician attire may be an important, easily modifiable component of the patient care experience.”
Research contact: MichMedmedia@med.umich.edu