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26
JIDA - Journal of Indian Dental Association - Vol 7 - Issue 7 - July 2013
MDS, Assistant Professor
Department of Public Health Dentistry
Mamata Dental College and Hospital
Giriprasad Nagar, Khammam
Andhra Pradesh
MDS, Professor
MDS, Professor and Head
MDS, Reader
Department of Public Health Dentistry
Narayana Dental College and Hospital
Chintareddypalem, Nellore
Andhra Pradesh
1
2
3
4
Abstract
Brief Background
A substantial amount of research dealing with the
professional image of healthcare provider has mainly
focused on nurses and physicians. There is limited
scientific literature giving importance to clinical attire
among the dental practitioners. This article aims to assess
the patients’ attitude towards dental clinical attire in
Nellore district of Andhra Pradesh.
Materials and Methods
A cross-sectional descriptive study was conducted among
575 subjects selected from the dental healthcare centres
across the district. Data was collected by means of an
interview using a close-ended questionnaire. Statistical
analysis was performed using SPSS version 14 and chi-
square test was used to test the level of significance
for the qualitative data and Z-proportionality test was
used to compare the patient’s preference regarding the
particular attire that portrays Cleanliness, Trustworthiness,
Approachability and Professionalism. Statistical
significance was set at p<0.05.
Results
80.5% of the subjects felt that dental clinical attire was
important. Doctor’s dress was preferred as an appropriate
attire for the dentist by 47.2%. Majority of them selected
the doctor’s dress for the quality of trustworthiness
(44.4%) and professionalism (63%). The formal dress
was the dress of choice for the qualities of cleanliness
(55.2%) and approachability (21.3%).
Summary and Conclusions
The doctors have a responsibility to put their patients at
ease, and professional appearance may be a part of that
responsibility. The clinical significance is that if the patients
are made uncomfortable by a doctor’s appearance, then it
is the doctor’s duty to consider changing their appearance.
Key Words
Dentist, attire, patients’ attitude.
Patients’ attitude towards dental clinical
attire - A cross sectional community based
study
V. Siva Kalyan
1
Shanti M
2
Nusrath Fareed
3
K. M. Sudhir
4
COMMUNITY DENTISTRY
J
I
D
A
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JIDA - Journal of Indian Dental Association - Vol 7 - Issue 7 - July 2013
Introduction
The reason people choose to wear clothes range from
it being a necessity of life to an escape for personal
individuality.
[1]
Clothing is considered as a form of non-
verbal communication that reflects confidence in ability,
judgment, personal behaviour and a sense of professional
image.
[2]
Expectations about how the individuals dress also
depends on their role in the society and as members in
various organizations.
[3]
In the first encounter, almost all
people today are apt to make snap judgments of others
by their physical appearance, and then base all their later
decisions on them.
[4]
Sociologists and psychologists have
recognized the effects of one’s appearance on important
life experiences such as interpersonal relationships and
job related success.
[5]
In the primitive societies the way the healers dressed
was a part of their paraphernalia and the ritual of
healing.
[5]
Since the early days of medicine, the symbolic
implications of the physician’s professional clothing
have been stressed.
[6]
Hippocrates has stated that the
physician should “be clean in person, well dressed and
anointed with sweet smelling unguents”
[7]
The general
appearance and standards of dress are important issues
in our profession. Society has accorded physicians special
privileges and status and expects us, as part of a larger
“social contract”, to conduct ourselves in accordance
with standards that we ourselves regulate but that are
driven by the interests of those we serve.
[8]
Medical care provider’s appearance has been found to
be a key symbol that not only identifies the individual as
a professional but also defines certain characteristics of
the provider. A carefully dressed provider might convey
the image that he or she is meticulous and careful.
Alternatively, an unkempt appearance might convey
the impression of an uncaring or disorganized behaviour.
[9]
It has also been pointed out that proper appearance
is integral to the successful relationship in healthcare;
patients also are more apt to discuss medical issues with a
provider who is well groomed.
A substantial amount of research dealing with the
professional image of healthcare providers has mainly
focused on nurses and physicians; there is very little
scientific literature giving importance to the clinical
attire among dental practitioners.
[10]
This study was thus
undertaken with an aim of assessing patients’ attitude
towards dental clinical attire in Nellore District of Andhra
Pradesh.
Materials and Methods
A cross–sectional community based study was designed
to assess patients’ preference regarding dentist’s attire
in Nellore district of Andhra Pradesh. The study was
conducted over a period of 3 months (1
st
July to 30
th
September 2010). Patients attending various dental
Fig 2: Flow Chart showing the sampling procedure
DENTAL HEALTH CARE FACILITIES
Stratum 1
Urban Centre
Through Cluster Sampling
4 areas were selected
Through random sampling
3 Private 1 Private1 Government 2 Government
Through random sampling
Through Cluster Sampling
3 areas were selected
Rural Centre
Stratum 2
Fig 1a: Male and female model portrayed in Formal dress
Fig 1b: Male and female model portrayed in Surgeon’s scrub
Fig 1c: Male and female model portrayed in Doctor’s dress
Fig 1d: Male and female model portrayed in Casual dress
JIDA_NEW LAYOUT_JULY 2013.indd 27 9/3/2013 11:50:33 AM
JIDA - Journal of Indian Dental Association - Vol 7 - Issue 7 - July 2013
28
healthcare centres in the Nellore district aged 18 years
and above, and who were willing to participate, were
included in the study. A stratified cluster random sampling
technique was used to select the dental healthcare centres
from the entire district (Fig. 2). Before the commencement
of the study ethical clearance was obtained from the
ethical committee, Narayana Dental College and Hospital
2069/NDC/25/06/2010 Permission and co-operation were
also solicited from the dental surgeons of the sampled
dental healthcare centres. Data was collected by interview
method using a close-ended questionnaire consisting of
eleven items pertaining to the variables measured in the
study. Four pairs of photographs (Fig 1a, 1b, 1c, and 1d)
with a uniform background portraying models in different
attires were included as a part of the questionnaire to
elicit subjects’ response on the attire.
The attires included in the study were:
Fig 1a: Formal dress: Shirts and pants (male); sari (female)
Fig 1b: Surgeon’s scrub: Surgical dress, head cap &
surgical mouth mask (male &female)
Fig 1c: Doctor’s dress: White coat, head cap & surgical
mouth mask (male& female)
Fig 1d: Casual dress: Jeans & T. shirt (male), Salwar kameez
(female)The patients in need of emergency treatment
were excluded from the study.
Statistical analysis was performed using SPSS version
14 and chi-square test was used to test the level of
significance for the qualitative data and Z-proportionality
test was used to compare the patient’s preference
regarding the particular attire that portrays cleanliness,
trustworthiness, approachability and Professionalism.
Statistical significance was set at p<0.05.
Results
A total of 575 subjects participated and completed the
questionnaires at the end of the study period. Twenty one
forms were rejected as they were either incomplete or
illegible thus giving a response rate of 96.3% 55.9%
of the subjects were in the age range of 36-50 years
with a mean age of 40.5. 55.2% of them were male and
64.6% were from urban background. A total of 80.5%
subjects felt that the dental clinical attire was important.
A detailed analysis of the importance of clinical attire
in relation to age (Table 1) revealed that 79.9% of the
subjects in the age ranging from 18 - 35 years and 84.9%
among 36 - 50 years considered that the dental clinical
attire was important. On the contrary 53.7% of the
elderly patients (>51yrs) felt that the dental clinical attire
was not so important. There was no significant difference
between males and females on their perceptions of the
importance of the clinical attire. 69.2% of the patients
from urban background considered that clinical attire was
important compared to 59% of their counterparts (Table
2). This is a report of descriptive data. An analysis of the
opinions regarding the preference of the appropriate
AGE GROUP
(IN YEARS)
IMPORTANT NOT IMPORTANT P. VALUE
20 – 35 79.9% 20.1% 0.01
36 – 50 84.9% 15.1% 0.01
51 – 65 46.3% 53.7% NS
NS = not significant
Table 1: Importance of Dental Clinical attire according to Patient’s age
AREA IMPORTANT P-VALUE NOT IMPORTANT
Urban 69.2%
0.01
30.8%
Rural 59% 41%
Table 2: Importance of Dental Clinical attire according to Geographic distribution of Patients
Fig 3: Patient's preference regarding appropriate attire for dentist
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JIDA - Journal of Indian Dental Association - Vol 7 - Issue 7 - July 2013
clinical attire for dentists revealed that 47.2% of the
patients preferred the doctor's dress (most preferred) and
0.3% of them preferred the casual dress (least preferred)
(P = 0.01) which was statistically significant ( Fig.3)
Since it was a qualitative data, non-parametric analysis
was performed using chi-square test and z-proportionality
test was used to compare the patients’ preference
regarding the particular attire that portrays cleanliness,
trustworthiness, approachability and professionalism.
Analysis of the opinions regarding the attire that
portrayed the qualities of cleanliness, trustworthiness,
approachability and professionalism (Table 3) revealed that
a total of 55.3% of the patients preferred formal dress
(most preferred) over doctors dress 32.5% which was
statistically significant and 0.7% of them preferred the
casual dress (least preferred) for the quality of cleanliness.
Doctor’s dress was preferred most for trustworthiness
by about 44.4% of the respondents followed by formal
dress 42.3% difference was marginal and was not
statistically significant, whereas the casual dress ranked
the least 0.7%. Interestingly formal dress (most preferred)
was the choice for the quality of approachability by 61%
of the patients followed by doctors dress 25.3% which
was statistically significant and 0.7% preferred the casual
dress (least preferred). The most preferred dress for
professionalism was the doctors’ dress 62.2% followed
by formal dress by 21.3% of the participants’ which was
statistically significant and the least preferred was the
casual dress 0.3%.
Discussion
As described by Taylor
[12]
, the patient’s first impression
of a physician can have a strong influence on the
Attire Cleanliness Trustworthiness Approachability Professionalism
Formal Dress
55.3%
(306)
42.3%
(234)
61%
(338)
21.3%
(118)
Surgeon’s Scrub
11.5%
(64)
12.6%
(70)
13%
(72)
16.2%
(90)
Doctor’s Dress
32.5%
(180)
44.4%
(246)
25.3%
(140)
62.2%
(344)
Casual Dress
0.7%
(04)
0.7%
(04)
0.7%
(04)
0.3
(02)
Formal Dress Vs Surgeon’s
Scrub
Z = 6.3798,
p = 0.00001*
Z = 4.5571,
p = 0.00001*
Z = 7.4059,
p = 0.00001*
Z = 0.9272,
p = 0.3538
Formal Dress Vs Doctor’s
Dress
Z = 4.8641,
p = 0.00001*
Z = -0.4640,
p = 0.6426
Z = 7.1045,
p = 0.00001*
Z = -7.6722,
p = 0.00001*
Formal Dress Vs Casual
Dress
Z = 2.1791,
P = 0.0293*
Z = 1.6737,
p = 0.0942
Z = 2.4504,
P = 0.0143*
Z = 0.7271,
p = 0.4671
Surgeon’s Scrub Vs
Doctor’s Dress
Z = -3.2505,
p=0.0018*
Z = -4.8527,
p=0.00001*
Z = -2.0779,
p=0.0377*
Z = -7.7814,
p = 0.00001*
Surgeon’s Scrub Vs Casual
Dress
Z = 0.6734,
p = 0.5007
Z = 0.7134,
P = 0.4756
Z = 0.7279,
P = 0.4668
Z = 0.6128,
p = 0.5400
Doctor’s dress Vs Casual
Dress
Z = -1.3571,
p = 0.1747
Z = 1.7479,
p = 0.0805
Z = 1.1261,
P = 0.2601
Z = 1.7998,
p = 0.0719
Table 3: Patients preference regarding the attire that portrays cleanliness, trustworthiness, approachability
and Professionalism
*p<0.05 Note: Z - Z-proportionality test used
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JIDA - Journal of Indian Dental Association - Vol 7 - Issue 7 - July 2013
30
perceptions of the care provider’s competence level and
expectations of care delivered in the future. The carefully
dressed physician might convey the message that patient
contact is an important event and that it takes time to
prepare for it, whereas the unkempt physician might
be perceived as uncaring and aloof.
[13]
The nonverbal
communication attributed to a dental care provider’s
attire/appearance can also play a major role in the patient
- doctor relationship. Positive first impressions, traditional
dress and an overall level of professionalism portrayed
by the dental healthcare provider can increase patient
feelings of comfort and confidence, thus leading to an
improved experience within the dental setting. These
positive patient attitudes can lead to an increase in the
exchange of information between the patient and the
dental healthcare provider, thus resulting in efficiency and
improved delivery of dental care.
Importance of dental clinical attire
The results of the study indicate that the patients have strong
opinions on how a dental professional should dress. The
majority of patients (80.5%) in the present study felt that dental
clinical attire was important; these findings are in accordance
with the findings of other studies
[10-16]
. When the responses
corresponding to the age group were compared, a
majority of the respondents in the age range 20-50
years felt that the dental clinical attire was important,
but the older age group did not place any importance
when compared to the other two age groups which
was contrary to the findings of some of the studies
[10-17]
conducted on medical care providers in which age and
sex of the respondents did not affect the preference.
Both male and female patients equally felt that the
dental clinical attire was important which was similar
to the findings of Kanzler M.H et al
[17]
and contrary
to the findings of McKenna G. et al
[10]
where females
placed more importance on the dental clinical attire. The
depiction of a physician in a white coat is indeed the
symbol of medicine.
[18]
The white coat has served as the
pre-eminent symbol of physicians for over 100 years
[19]
.
The patients like doctors to wear a white coat; they have
more trust in, and comfort with, doctors who wear white
coats. It’s reassuring in a primitive kind of way; it makes
them feel like the physician is a real doctor who is capable
of taking care of them.
[20]
Physicians should wear white
coats for several reasons. First, the white coat reminds
the wearer that med-icine is a special kind of profession
and that doctors have extraordinary obligations to the
patients. Second, the white coat recalls medicine’s basis
in science, from which we wouldn’t want to stray too far.
Third, it’s to protect ourselves: going home to dinner with
the family, loaded with hospital germs, is just not smart.
[20]
Appropriate attire for dentist
In general, the doctor’s dress ranked first (47.2%)
followed by the formal dress, the surgeon’s scrub and
the casual dress in order of preference. These findings
were similar to the findings of studies
[10,7,9]
on patient
preference for the dental clinical attire. The patients
are often in a position of vulnerability, as they may be
quite ill and depend upon the doctors for help and
medical advice. Doctors have the responsibility to put
their patients at ease, and professional appearance may
aid in fulfilling that responsibility. If the patients are
made uncomfortable by a doctor’s appearance, then
the doctors have a duty to consider changing his/her
appearance.
[21]
Originally, the white coat was worn to
symbolize hope and life — an absolute contrast to the
black colour of death and mourning that was widespread
at the time. Hospitals, and the physicians who worked
in them, became places of hopefulness and healing, and
the white coat embodied these sentiments. The patients
significantly favour physicians who dress professionally
and wear white coats.
[22]
Preference regarding attire that portrayed
cleanliness
Formal dress ranked the first (55.3%) followed by the
doctor’s dress, the surgeon’s scrub and the casual dress
for the preference of the attire that portrayed cleanliness.
These findings were similar to the findings of studies
conducted on patients’ preference of the dress code that
portrayed cleanliness where the majority of the patients
have ranked formal dress as the most appropriate and
negligible preference was given to the casual dress.
[21]
Preference regarding the attire that portrayed
trustworthiness
The doctor’s dress ranked the first (44.4%) for the attire
that portrayed trustworthiness. This result was similar to
the findings of studies
[5, 22, 23, 24]
conducted on the patient’s
preference of the dress code that portrayed trustworthiness.
An individual’s choice of clothing should always be
meaningful. Correct choice will allow professionals to
quickly and clearly define their function and it will put the
JIDA_NEW LAYOUT_JULY 2013.indd 30 9/3/2013 11:50:33 AM
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