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The Doctor’s New Clothes: Professional or Fashionable?

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Abstract

Abstract Objective: To investigate the influence of the GP’s attire on the confidence that patients have in their GP as a medical expert and on the patient’s comfort level (defined as ‘feel at ease’). Design: A cross-section study without control group. Methods: Participants (n=1506 ) completed a survey on the internet or in paper after seeing images of six models of three different age categories, each in five different clothing styles (leisure clothing, casual, semiformal, formal and professional). The following questions were asked for each model: “In which doctor do you have the most confidence as a medical expert?” and “With which doctor do you feel most at ease?”. Results: Patients trusted a female doctor and the older male doctor most when wearing professional clothing (white coat). The young and middle aged GP’s were preferred to wear semiformal attire. Patients were most at ease with a female GP wearing leisure clothing. They preferred the young and middle aged male GP to wear semiformal attire, while patients were most at ease with the older male GP wearing casual clothing. Conclusion: The GP’s attire has an influence on the patient’s confidence and comfort level. In general patients still mainly prefer a doctor in a professional outfit.
Primary Health Care: Open Access
Hartmans et al., Primary Health Care 2014, 3:3
http://dx.doi.org/10.4172/2167-1079.1000145
Volume 3 • Issue 3 • 1000145
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
Open Access
Research Article
The Doctors New Clothes: Professional or Fashionable?
Chantal Hartmans1, Stefanie Heremans1, Marieke Lagrain1, Kristin Van Asch1 and Birgitte Schoenmakers2*
1Department of Public Health and Primary Care Academic Centre of General Practice, University of Leuven, Leuven, Belgium
2Academic Teaching Practice, Department of Public Health Academic Centre of General Practice, Leuven, Belgium
*Corresponding author: Schoenmakers B, Department of Public Health,
Academic Centre of General Practice, University of Leuven, Kapucijnenvoer
33, block J, box 7001, Leuven, Belgium, Tel: +32495235639; E-mail:
Birgitte.schoenmakers@med.kuleuven.be
Received November 25, 2013; Accepted December 30, 2013; Published January
07, 2014
Citation: Hartmans C, Heremans S, Lagrain M, Asch KV, Schoenmakers B (2014)
The Doctor’s New Clothes: Professional or Fashionable? Primary Health Care 3:
145. doi:10.4172/2167-1079.1000145
Copyright: © 2014 Hartmans C, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Keywords: General practitioner; condence; wellbeing; clothing
style; communication; medical sociology
Introduction
e clothing style of each professional has an important impact on
presentation, credibility and appearance. Formal health care providers
who are not wearing professional gear, have to guard and defend their
professional attitude. General practitioners opted many years ago to
abandon their white coats. Besides, a general practitioner is for many
patients the counselor and trusted person par excellence. Patients
expect a GP to prove scientic medical knowledge and skills, as well
as to perform with a listening ear and moral support. Moreover, a
good doctor-patient relationship is a basic requirement for good
care provision. Without white coat, the way a GP dresses will have a
signicant inuence on the development of the physician-patient
relationship [1-3].
e clothing style is determined by tradition and fashion. For
centuries, the white coat is seen as the symbol of the physician.
Previous studies on the clothing style of doctors showed dierent
results. Various studies have shown that a white coat is still preferred by
many patients [4-6]. Others, one study revealed that the disappearance
of medical paternalism has caused lower popularity of the white coat
[7]. Particularly, in the case of pediatricians and psychiatrists, the white
coat has lost its importance [8,9]. A study conducted in New Zealand
demonstrated that patients prefer a semi formal outt for their treating
medical doctor [7]. All the above mentioned studies have been carried
out in a specialist setting. Little research has been done on the clothing
style of GP’s. A single study from the Netherlands showed that formal
attire generates more condence in patients. e white coat, however,
was omitted here [10].
e major research question of this study was: do the clothes make
the family doctor? is study examined whether the attire of the GP
aects the condence and the ‘feel at ease’ of patients
Methods
Research questions and outcome
In this study, two issues were examined:
Has the clothing of GPs an eect on the condence that patients
have in a GP?
Do patients feel more at ease with a certain clothing style of
the GP?
e outcome measures were dened as the condence of the patient
in the doctor as a medical expert and the patients’ feeling ‘at ease’ with
the doctor.
e following questions were formulated for each model: “In which
doctor/clothing style do you have the most condence on the level
of medical aairs?” and “Which doctor/clothing style makes you feel
most at ease?”. e participants were asked to make a single preference.
Finally, socio-demographic information was requested: age, sex,
occupation, highest educational level and whether the participant has a
regular GP. Participants completed the survey independently, without
interview, to avoid any interference and to guarantee anonymity.
Study Population
A questionnaire was developed based upon earlier research and
with additional items. is questionnaire was distributed from 11-
04-2013 until 28-05-2013 through social media (Facebook, Senioren
Net) and e-mail. In addition, from 15-04-2013 until 17-05-2013
paper versions of the survey were deposited in the waiting rooms of
medical polyclinics and of ve representatives (certied as regional
Abstract
Objective: To investigate the inuence of the GP’s attire on the condence that patients have in their GP as a
medical expert and on the patient’s comfort level (dened as ‘feel at ease’).
Design: A cross-section study without control group.
Methods: Participants (n=1506 ) completed a survey on the internet or in paper after seeing images of six models
of three different age categories, each in ve different clothing styles (leisure clothing, casual, semiformal, formal and
professional). The following questions were asked for each model: “In which doctor do you have the most condence
as a medical expert?” and “With which doctor do you feel most at ease?”.
Results: Patients trusted a female doctor and the older male doctor most when wearing professional clothing
(white coat). The young and middle aged GP’s were preferred to wear semiformal attire. Patients were most at ease
with a female GP wearing leisure clothing. They preferred the young and middle aged male GP to wear semiformal
attire, while patients were most at ease with the older male GP wearing casual clothing.
Conclusion: The GP’s attire has an inuence on the patient’s condence and comfort level. In general patients still
mainly prefer a doctor in a professional outt.
Citation: Hartmans C, Heremans S, Lagrain M, Asch K V, Schoenmakers B (2014) The Doctor’s New Clothes: Professional or Fashionable? Primary
Health Care 3: 145. doi:10.4172/2167-1079.1000145
Page 2 of 5
Volume 3 • Issue 3 • 1000145
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
reference and academic teaching practices) group practices of general
practitioners. e questionnaire could be completed by anyone aged
18 or more. Since in Belgium all citizens are equally insured by the
national social security system, all medical houses and polyclinics are
accessible to all patients.
Design
e study was performed in a cross-section without control group.
e survey showed six doctor-models presenting with ve dierent
clothing styles. Images were taken against a neutral background and
models were presented in the same position, with a similar facial
expression by a professional photographer. e six models represented
each a dierent category of general practitioners: the very young female
doctor (25-35 years), the female doctor (35-50 years), the older female
doctor (>50 years), the very young male doctor (25-35), the male doctor
(35-50 years) and older male doctor (>50 years).
e ve clothing styles were dened as follows:
Leisure Clothing: for men a T-shirt, jeans and sneakers, for
women T-shirt, jeans and ballet ats, boots or sneakers.
Casual: for men casual shirt or sweater dressed with shirt
underneath, a casual pants or dark jeans and sporting dressier
shoes, for women T-shirt, skirt or dressy pants and ats or
boots.
Semi-formal: for men a shirt with possibly a sporty jacket,
pants and dress shoes, for women blouse, skirt with tights or
possibly a smart pants and shoes with a small heel.
Formally: for the men dressed with a shirt jacket, trousers and
dress shoes, the women a smart dress with a blazer or a suit.
Professional: aforementioned semi-formal outt with white
coat.
All models were asked to choose the outts from their own
clothing collection. If necessary, the authors revised the
personal clothing choice to guarantee a representative and
conform look (Appendix 1).
e images were printed in color, format A4, sorted by model
and bundled in the above mentioned and x sequence for the paper
questionnaire. e online questionnaireshowedfor each model the ve
images next to each other, in the same order as listed above.
Statistical analysis
A univariate analysis was used to in answer to the primary
research question and to describe the socio-demographic features
of the participants. Furthermore, a multivariate analysis was applied
by a logistic regression in SAS 9.3, with the independent variables
being gender, age and education and dependent variables being
condence in the doctor in the medical eld and to feel at ease with
the doctor. Odds ratios with 95% condence intervals were described
for each dependent variable in relation to the subsequent independent
variables.
Ethical approval
e Medical Ethics Committee of K.U. Leuven University Hospital
approved the study as part of the Master esis to achieve the title
of Master in Medicine. A written informed consent of the study
participants is in Belgium only required when medical data on patients
are involved.
Results
Study population
e total group consisted of 1506 patients. 1324 of them have
completed the entire questionnaire. e data of the incomplete
questionnaires were handled as ‘missings’ (computation of missings in
SAS 9.3).
e average age of the patients was 38.35 years and 68.29% of the
participants were female (n = 911). With regard to education, the majority
of participants were highly skilled: 32.46% had a higher education
diploma (n=436) and 38.64% obtained a university degree (n=519).
Of all participants 27.58% were employees, 26.02% students, 13.53%
ocials, 7,14% independent professionals, 4.83% laborer and 20.90%
housewife or –man, unemployed, disabled, retired or otherwise.
91,14% (n=1224) of all participants group had a regular general
practitioner (Table 1).
Condence in the doctor as medical expert (appendix 2)
e study found that patients have the most condence in a female
doctor wearing a white coat. As regards model 1, 49.56% (n=730) chose
the professional outt, in our second model 51.52% (n=745) and in
model 3 amounted this 44.22% (n=631). e age of the female doctor did
not aect this preference (Appendix gure 1). e remaining sequence
diered in function of the age of the female doctor. It appeared that
patients chose as second option the formal clothing in the young female
doctor (26.14%, n=385). As third choice the leisure outt was chosen
(9.98%, n=147), followed by the casual (7.47%, n=110) and semi-formal
clothing (6.68%, n=101). Regarding the middle-aged female doctor,
patients secondly selected the leisure outt (17.57%, n=254), followed
by the semi-formal attire (14.04%, n=203), casual wear (9.75%, n=141)
and formal clothes (7.12%, n=103).
Concerning the elderly female general practitioner nally, leisure
clothes were most trust worthy, aer the professional outt (23.06%,
n=329). ese choices were followed by the semi-formal attire (18.50%,
n=264), the formal attire (10.79%, n=154) and casual clothing (3.43%,
n=49).
As regards the male doctor, there was in terms of condence rather
a preference for semi formal attire: in both the younger doctor (43.41%,
n=606), as the middle-aged doctor (48.15%, n=662), the majority of
Feature % of total group
Male 31.75
Female 68.29
18-25y 34.59
26-45y 31.12
46-65y 28.93
>65y 5.36
Diploma elementary or secondary school 28.89
Diploma graduate school or university 71.10
Employee 27.58
Student 26.02
Ofcial 13.53
Independent 7.14
Laborer 4.83
Housewife, unemployed, retired, disabled or others 20.9
Regular general practitioner 91.14
Table 1: Socio-demographic data of participants group.
Citation: Hartmans C, Heremans S, Lagrain M, Asch K V, Schoenmakers B (2014) The Doctor’s New Clothes: Professional or Fashionable? Primary
Health Care 3: 145. doi:10.4172/2167-1079.1000145
Page 3 of 5
Volume 3 • Issue 3 • 1000145
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
patients chose semi-formal clothing as most condent outt. e
professional clothing endedona second place in both models (model
4 32.16% n=449; Model 5 27.56% n=379). Regarding the older male
doctor, the patients chose the white coat (38.11%, n=519) as most
condent outt, but the casual clothing was a good second choice
(38.03%, n=518) (Appendix gure 2). e semi formal attire followed
in third place (16.01%, n=218).
Wellbeing: feeling at ease with the doctor (appendix 2)
Patients were most at ease with a female doctor wearing leisure
outt, regardless of age (model 1 30.69% n=452; Model 2 31.33%
n=453; Model 3 48.49% n=692) (Appendix gure 3). For all three age
groups the professional outt was chosen as third option (model 1
20.23% n=298; Model 2 23.65% n=342; Model 3 18.22% n=260).
In male general practitioners, there was again a distinction between
the younger doctor and middle aged doctor, compared to the older
male general practitioner. Patients indicated that they were most at
ease with a young or middle aged general practitioner in semi formal
attire (model 4 38.18% n=533; Model 5 41.31% n=568). In both cases,
there was also an equal preference sequence: aer semi-formal attire
most patients opted for leisure clothing (model 4 26.93% n=376; Model
5 26.47% n=364), followed by casual clothes (model 4 19 , 13% with
n=267; model 5 17.24% n=237), professional clothing (model 4 12.32%
n=172; model 5 11.05% n=152) and formal attire (model 4 3.44% with
n=48, model 5 with 3.93% n=54).
Patients felt most at ease at a older male general practitioner,
wearing casual clothes (61.01%, n=831) (Appendix gure 4). is
decision was followed by the white coat (14.98%, n=204) and semi-
formal clothing (14.24%, n=194). Leisure clothing was now chosen as a
last option (4.7%, n=64) (Table 2).
Factors inuencing the preference of the participants
e analysis showed that a number of socio-demographic data
had an impact on the choices patients made. Regarding the outcome
‘condence’ participants with a diploma of higher secondary education
less oen chose professional clothing, compared with participants who
had a university degree (odds ratios: model 1 0,670; Model 2 0.735;
model 5 0.729; model 6 0.636). Age also appeared to be important:
participants between 18 and 25 years chose less oen a white coat when
it came to condence than participants being older than 65 years (odds
ratios: 0.602 Model 1, Model 3 0.703, 0.587 Model 5). e other features
did not signicantly inuence the preference of the participants (Table
3).
Regarding the outcome ‘feel at ease’, there were also a number of
socio-demographic data which were found to inuence preference
of the participants. In particular, the age played a major role in the
preferences: for all six models participants between 18 and 25 years and
26-45 years chose more oen a white coat to feel at ease, compared to
participants older than 65 years (odds ratios: model 1 2,886 and 2,091,
3,377 and 2,666 model 2, model 3 2.344 and 2.565, 3.605 and 3.021
model 4, model 5 2.172 and 1.675, model 6 2.702 and 2.009). In model
2, 3 and 4, participants between 46 and 65 years chose more oen a
white coat compared to those over 65 years (odds ratios: 1.898 Model
2, Model 3 1.972, 1.919 Model 4). e results also showed that gender
plays a role: men chose less oen professional clothing to feel at ease
than women (odds ratios: model 1 0,695; Model 2 0.689, 0.785 Model
3, model 6 0.747). e other features did not signicantly inuence the
preference of the participants (Table 4).
Model 1 Model 2 Model 3 Model 4 Model 5 Model6
%
Leisure Condence 9.98 9.75 23.06 5.80 7.05 0.95
wellbeing 30.69 31.33 48.49 26.93 26.47 4.70
Casual Condence 7.47 17.57 3.43 13.68 7.49 38.03
wellbeing 19.35 27.66 8.27 19.13 17.24 61.01
Semi-formal Condence 6.86 14.04 18.50 43.41 48.15 16.01
wellbeing 7.47 11.62 19.62 38.18 41.31 14.24
Formal Condence 26.14 7.12 10.79 4.94 9.75 6.90
wellbeing 22.27 5.74 5.40 3.44 3.93 5.07
Professional Condence 49.56 51.52 44.22 32.16 27.56 37.11
wellbeing 20.23 23.65 18.22 12.32 11.05 14.98
Table 2: Percentage distribution by clothing for condence and wellbeing.
OR (95%CI) P
Effect Model 1 Model 2 Model 3 Model 4 Model 5 Model 6
Male vs female ns ns ns ns ns ns
Primary school vs university ns ns ns 0.3 (0.1-0.7) p 0.08 ns ns
Lower second vs university ns ns ns ns ns ns
Upper second vs university 0.7 (05-0.9) p 0.5 0.7 (0.6-0.9) p 0.4 ns ns 0.7 (0.6-0.9) p 0.9 0.6 (0.5-0.8) p 0.7
Graduate vs university 0.7 (0.6-0.9) p0.9 ns ns ns ns ns
18-25y vs >65y 0.6 (0.4-0.9) p 0.0009 ns ns ns ns ns
26-45y vs >65y ns ns ns ns 0.6 (0.4-0.9) p 0.03 ns
46-65 vs >65y ns ns ns ns ns ns
OR: odds ratio; ns = OR not signicant (95%CI containing 1); p = p value
Table 3: Odds ratio, 95% condence interval and p-value, as regards condence
Citation: Hartmans C, Heremans S, Lagrain M, Asch K V, Schoenmakers B (2014) The Doctor’s New Clothes: Professional or Fashionable? Primary
Health Care 3: 145. doi:10.4172/2167-1079.1000145
Page 4 of 5
Volume 3 • Issue 3 • 1000145
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
Discussion
In this study, the impact of GP-clothing style on the condence
and on the ‘feel at ease’ of patients was observed. Results showed that
there are clear dierences between clothing styles regarding the ‘feel at
ease’ of patients and the condence they have in the medical expertise
of their General Practitioner (GP). Here, the gender of the physician
played a role. Patients had most condence in a female GP when she
wore a white coat, while the male young and middle-aged practitioner
was trusted when presenting in semiformal attire. In case of the older
male doctor, patients preferred the white coat.
On the ‘feel at ease ‘level of the patient, the gender of the GP
determined the preferences. Leisure clothing is opted for the female
doctor, while the semiformal outt is preferred for the young and
middle-aged male practitioner. Patients also preferred to see the older
male doctor in casual attire (Table 2).
Regarding these results and in agreement with other research, the
white coat still seemed to be the symbol of a trustworthy doctor [2,3].
Still, this was quite surprisingly, since it was stressed that each model
represented a general practitioner and not a specialist. An explanation
of this odd observation might be that in Belgium the specialist can
also be consulted in a primary care setting. Specialists, considered
as a higher echelon of care in the society, wear the white coat more
oen than GPs do [3,11]. is combination might mean that patients
in Belgium are accustomed to the image of the white coat, relate this
garment to a specialist and therefore grant more trust to the owner of
it. e popularity of the white coat was also observed in other studies.
e dierence lied in the fact that these latter studies took place in a
specialized setting [4]. Unlike these studies most participants in our
study choose a non professional gear to feel at ease with a GP. It could be
concluded that the white coat was experienced as an additional barrier
in the doctor-patient-relationship in the GP setting.
ere is a remarkable dierence in the preferences made for the older
male doctor, for both ‘condence’ and ‘feel at ease’ in comparison with
his younger and female colleagues. As with the female doctors, the white
coat was opted when it comes to condence in the medical expertise.
is clothing was considered as more decent compared to the clothing of
his younger colleagues (Table 2). A Dutch study also noted a dierence
regarding the older male doctor: casual clothing was little appreciated
when worn by the older male doctor [10]. In this latter study there
was no white coat included and only the ‘condence’ of the patient was
questioned. In this Dutch study a there appeared a major population bias:
in one study group all participants were over 65 years, the other group
only consisted of professionals in the healthcare sector. Finally, in our
study less formal attire was chosen, when it comes to feel at ease with the
doctor. A casual outt is then preferred for the older male doctor.
Socio-demographic data aected the preferences of the participants.
In the nal analysis, profession was omitted as a variable, considering that
it was too little discriminatory with the educational level. Similarly, the
question “Do you have a regular GP?” was removed from the analysis,
given nearly all participants had a regular family doctor. Regarding
to condence, older and higher educated patients prefer a white coat-
doctor. e eect of age was also reported in a study in Britain where
over-70s also opted signicantly more the white coat [5]. is might be
explained by a more traditional view on society and role patterns. e
higher educated patient preferring white coats was a rather surprising
observation. Perhaps these patients mirror themselves and their social
and professional position to the doctor in front of them and expect him/
her toclearlyexceed them in expertise. Patients with al lower educational
level might settle with ‘doctor’ as a trustworthy title and personality.
Regarding ‘feel at ease’, the age and gender of the participant aected
the preferences for some models. Younger and female participants
preferred a white coat to feel at ease with a doctor. Apparently, younger
patients didn’t want to ‘friend’ their doctor and preferred to keep a
certain distance when it comes to personal interaction. Female patients
also might, motivate by a more traditional background, feel more at
ease when a doctor is dressed up professionally.
e eect of educational level seemed not a predictor of the patients’
preference. A possible explanation was that health care in Belgium is
aordable and open for all citizens. e threshold for visiting a doctor is
therefore low for all socio-economic classes. All people felt at ease with
their doctor regardless of his clothing style. An additional remark is
that the low educated group in this study was rather under-represented,
making it dicult to give a meaningful statement.
Limitations and Recommendations
is study also has some limitations. Some clothing styles resembled
too much and a meaningful discrimination of preferences was therefore
compromised. Leisure and casual attire were rather similar in both
female and male doctors. Another weakness in the study is a possible
sequence bias. However, the xed order, as mentioned above, also
provide a certain visual rest in the large amount of images.
In this study it was decided not to add the option “no preference.
is could be a limitation but on the other hand it also allowed obtaining
more signicant results. Finally, this study was based on images and
cannot be unconditionally translated to the daily practice. Moreover,
the doctor-patient relationship (at long notice) is not only based on a
rst impression.
Strengths of the study are the large and representative study sample,
the rm instructions given to the doctor models concerning the
clothing style and the professional recordings.
OR (95%CI) P
Effect Model 1 Model 2 Model 3 Model 4 Model 5 Model 6
Male vs female 0.7 (0.6-0.9) p0.0008 0.7 (0.5-0.8) p 0.0006 0.8 (0.6-0.9) p 0.08 ns ns 0.7 (0.6-0.9) p 0.01
Primary school vs university ns ns ns ns ns 0.4 (0.1-0.9) p 0.05
Lower second vs university ns ns ns ns ns ns
Upper second vs university 0.7 (05-0.9) p 0.1 ns ns ns ns ns
Graduate vs university 0.7 (0.6-0.9) p0.9 ns ns ns ns ns
18-25y vs >65y 2.9 (1.8-4.6) p<0.0001 3.4 (2.1-5.5) p<0.0001 2.3 (1.4-3.8) p 0.02 3.6 (2.2-5.9) p<0.0001 1.1 (0.8-1.4) p 0.3 2.7 (1.6-4.4) p<0.0001
26-45y vs >65y 2.1 (1.3-3.3) p 0.02 2.7 (1.6-4.3) p 0.004 2.6 (1.6-4.1) p 0.0008 3.0 (1.8-4.9) p 0.003 1.7(1.03-2.7) p 0.2 2.0 (1.2-3.3) p 0.04
46-65 vs >65y ns 1.9 (1.2-3.1) p 0.5 2.0 (1.2-3.2) p 0.5 1.9 (1.2-3.1) p 0.3 ns ns
OR: odds ratio; ns = OR not signicant; (95%CI containing 1); p = p value
Table 4: Odds ratio, 95% condence interval and p-value, as regards wellbeing.
Citation: Hartmans C, Heremans S, Lagrain M, Asch K V, Schoenmakers B (2014) The Doctor’s New Clothes: Professional or Fashionable? Primary
Health Care 3: 145. doi:10.4172/2167-1079.1000145
Page 5 of 5
Volume 3 • Issue 3 • 1000145
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
As far as we know, this is also the rst study in Belgium and
worldwide that assessed the inuence of clothing on the ‘condence
and ‘feel at ease’ with general practitioners. As already mentioned, a
good doctor-patient relationship is essential. If clothing contributes
to the condence of the patient, it is denitely important to perform
further research on this topic. For instance, does clothing style of their
own GP inuence the preference of the patients? Is the white coat
more selected by patients who are oen in a hospital setting? ere are
few studies on this subject so far. Given the eect shown in this study,
further research is therefore recommended.
Conclusion
is study showed a clear inuence of the GP’s attire on the patient’s
condence in the GP as a medical expert and on the patient’s comfort
level (feel at ease). Female doctors were expected to wear a white coat in
order to be trusted while male doctors can aord a more relax clothing
style. To feel at ease, patients preferred female doctors in leisure wear
while male doctors were expected to be more dressed up. It seems that
female doctors still have to ‘earn ‘patients’ condence while they are at
the same ‘this nice woman from next door’ when patients are in need
for a talk.
Finally, it is appropriate for a GP to pay attention to his/her
attire, seen the inuence of the clothing style on the doctor-patient
relationship. Because of the eect found in this study and the limited
amount of studies about this topic, further investigation is strongly
recommended.
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Citation: Hartmans C, Heremans S, Lagrain M, Asch KV, Schoenmakers B
(2014) The Doctor’s New Clothes: Professional or Fashionable? Primary
Health Care 3: 145. doi:10.4172/2167-1079.1000145
... On the other hand, the younger patients are more likely preferred surgical scrubs and lab coat than formal attire (28% versus 21%; p < 0.001). This result was expected as the age-dependent preference has been previously observed with physician attire in Britain, Belgium, Italian and Japan (Douse et al. 2004;Sotgiu et al. 2012;Hartmans et al. 2014;Kurihara, Maeno and Maeno 2014) where this might be explained by a more traditional view on society and role patterns (Hartmans et al. 2014). Although lab coat with formalwear is preferred, there is increasing evidence of disease transmission through lab coat and lab coats have been shown to harbour microorganisms (Zahrina et al. 2018). ...
... On the other hand, the younger patients are more likely preferred surgical scrubs and lab coat than formal attire (28% versus 21%; p < 0.001). This result was expected as the age-dependent preference has been previously observed with physician attire in Britain, Belgium, Italian and Japan (Douse et al. 2004;Sotgiu et al. 2012;Hartmans et al. 2014;Kurihara, Maeno and Maeno 2014) where this might be explained by a more traditional view on society and role patterns (Hartmans et al. 2014). Although lab coat with formalwear is preferred, there is increasing evidence of disease transmission through lab coat and lab coats have been shown to harbour microorganisms (Zahrina et al. 2018). ...
Article
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Different attires may bring different perceptions, level of trust, status and transmits social signals towards pharmacist in a community pharmacy setting. The objectives of the study were to explore the public perception of community pharmacist attire and the association of respondents’ sociodemographics with their preferences for community pharmacist attire. This was a cross-sectional, convenience sampling study among 200 general public adults (> 18 years old) in community pharmacies setting in Malaysia. A face validated Likert-type questionnaire was administered to assess the public perceptions and their preferences on community pharmacist attire. Four sets of model photographs with variation in gender, ethnicity and attire formality (i.e., formal wear with lab coat to casual attire) were used to assess respondents’ preferences. The most preferred attire of pharmacists was formal wear with a lab coat compared to other styles of attire (74% versus 36%). The older the respondents were, the more likely they prefer pharmacists in the formal wear with lab coat attire compared to formal (OR: 0.943; 95% CI: 0.899, 0.989; p < 0.05) and semi-formal wear (OR: 0.912; 95% CI: 0.840, 0.989; p < 0.05). Male respondents prefer pharmacists in formal wear without the lab coat (OR: 3.893; 95% CI: 1.449,10.491; p < 0.01) compared to female. A neat and proper attired pharmacist will gain a positive impression from patients. Respondents favour pharmacists in formal attire with a lab coat. Pharmacists in formal wear with a lab coat able to display professionalism and instil feelings of trust, confidence and comfort among the public in a community pharmacy setting.
... The age difference might be one reason for different results. Another study in Belgium found that people felt more comfortable with doctors with normal clothes [18]. This is to some extent in line with our findings on the preference of colored coats by parents and children which seem to be more informal rather than the formal white coat. ...
... The parents' unpleasant dental memories may lead to white coat fear. As mentioned before, we can see in the literature that people feel more comfortable with doctors' informal attire [18]. This might be the reason why parents who are afraid and are uncomfortable with dentistry, preferred colored coats to help their children feel more comfortable. ...
Article
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Objectives: For decades, the white coat has been the uniform of medical professionals. Recently, medical professionals show interest to use alternatives. We aimed to evaluate the perspectives and preferences of children and their parents regarding dentists’ attire and gender. Materials and Methods: This cross-sectional study was performed on 4-to 6-year-olds and their parents referred to dental clinics of Tehran School of Dentistry in 2018. Parents completed a questionnaire on demographics and dental fear, and both parents and children were asked about their preferences regarding the gender of dentist and the color of the dentist’s attire. Statistical analysis was performed by the logistic regression model. Results: Totally, 148 children (mean age of 5.42±0.71 years, 48% girls) and their parents participated in the study. Most of the participants (81.2% of the children and 68.0% of the parents) preferred colored coats compared with white coat. More than half of the parents preferred a female dentist for their children (56.5%) while most children preferred a male dentist (54.8%). Boys preferred a male dentist as well (P=0.01). The children were reluctant to go for a dental visit and preferred to be visited by a dentist of the same gender as themselves (P=0.041). Conclusion: Wearing colored coats by dentists and giving a chance to choose the gender of dentist in polyclinics may increase the children’s cooperation in pediatric settings. Keywords:
... In particular, a soar in the usage of scrubs, and a general shift away from professional attire, which can be defined as follows: for men, a shirt with or without a tie and jacket, trousers and dress shoes. For women, a blouse, skirt with tights or possibly smart pants and shoes with a small heel, or a smart dress with a blazer or a suit [1]. ...
... Historically, professional attire has been the standard for most Irish hospital doctors, based on the assumptions that patients prefer such attire [8], while scrubs have only been provided to doctors working in the theatre setting, intensive care or in the emergency department. Other allied healthcare professionals, such as staff nurses, healthcare assistants, physiotherapists and occupational therapists are provided * Ola Løkken Nordrum ola.nordrum@ucdconnect.ie 1 University Hospital Galway, Galway, Ireland separate uniforms. However, these other clinical staff, alongside most doctors in Irish hospitals, are required to launder their hospital attire at home. ...
Article
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Background: The debate on current doctors' attire in Irish hospital resurfaced alongside COVID-19, as a shift in doctors' attire from professional attire to scrubs was observed. Aim: The current study aimed to explore whether COVID-19 has changed the way in which hospital doctors perceive their personal attire, and whether this group wish for changes implemented during COVID-19 to become permanent. Methods: Hospital doctors (n = 151), across all specialties and seniority at University Hospital Galway (UHG), filled out a ten-point online questionnaire exploring their experience of and attitudes towards hospital attire during COVID-19. Data collected and analysed in August-September 2020. Results: Seventy-six percent (119) changed their attire during COVID-19 to scrubs (54% to hospital provided; 22% to private). Thirty-eight percent (56) reported feeling uncomfortable with bringing clothing home, highlighting the infection control risk. Seventy-four per cent (110) wanted the change to scrubs as standard attire to become permanent (65% to hospital provided; 9% to private). Thirty-two percent (47) noted a change in patients' perception when wearing scrubs. Conclusion: Hospital doctors changed their attire during COVID-19, and 75% would like these changes to become permanent. Most (67%) did not notice a change in their patient's perception of them, raising questions about the longstanding beliefs surrounding 'professional attire'. A large number of doctors are also worried about bringing clothing home. The humble hospital scrubs have shown their worth amidst the COVID-19 pandemic. Why not continue to wear them?
... 8,9,11,14 On the other hand, some studies found that patients' comfort and con dence are in uenced by their doctors' attire. 10,17,19,23 There has been little research evaluating the effect of civilian versus military attire on patients' ...
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Objectives Military healthcare professionals often consult patients while wearing their full military uniforms, which may affect patients’ clinical experience. This study aims to understand patients’ opinion concerning clinicians’ attire with regard to patients’ preference, ease in declaring personal or private information, comfort in asking for further information or raising concerns, and confidence in maintaining privacy and confidentiality in a military setting. Methods Patients attending outpatient clinics in two military medical facilities in Kuwait were asked to complete a questionnaire regarding their preference for clinician attire and any effect on their comfort or confidence in the clinicians. The study took place in 2021. Results The overall response rate was 94.6% (n = 937). Most participants were neutral regarding all statements. However, female participants preferred their doctors to be in military uniforms in comparison with males (P = 0.000). Non-Kuwaiti participants felt more comfortable sharing private/personal information and asking for clarification or raising concerns with a doctor in military uniform (p = 0.007). Civilian participants also preferred doctors in military uniform (p = 0.000). Officers preferred their doctor to be in military uniform (p = 0.014), whereas non-commissioned officers preferred their doctor to be in civilian attire (p = 0.000). Conclusion Patients visiting military medical facilities do not prefer a certain attire, and attire does not influence their perception of the physicians’ competence. This may lead us to conclude that doctors’ attire, regardless of being civilian or military, may not be the most concerning factor regarding the patient’s confidence and comfort and that the doctor-patient relationship is more vital. Therefore, further investigation of the psychological impact of doctor’s attire is highly recommended.
... These preferences are similar with previous studies' findings. 15,[17][18][19] in addition, formal attire and surgical scrubs are the most preferred attires across among participants compared to business and casual attires (p<0.001) as shown in (Tables 3 and 4), which is inline with most previous studies, 4,11,20,21 but a study in South Carolina and Ohio shows that there is no any consistent preference for their physicians' attire 18 the possible difference might be cultural difference, national policy regarding physician attire and their study is in clinic level. The patients' preference for formal physician attire in male surgeons' confidence, willingness to discuss confidential information, and safeties of the surgeon to do the procedure were 76.2%, 75.7%, and 70.5% respectively, while scrub physician attire choice of patients on the caring ability of the surgeon, confidence on the surgeon, and willingness if he is his/her surgeon were 65%, 64.2%, and 58.5% respectively, which is in line with study findings 3,11,14 but in contradict with these studies, 3,18 the difference might be explained with the sample size difference, educational status and norms of patients. ...
Article
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Background In Ethiopia, physicians commonly wear formal attire, surgical scrubs, casual attire, or business attire during patient care, but there is no evidence to show which attire is preferred within the patients. So this study aims to assess the influence of physicians’ attire on patients’ perceptions. Methodology After ethical approval, a cross-sectional study was conducted with written informed consent; data were collected and checked for its completeness, later entered into SPSS version 25 for statistical analysis. Descriptive statistics was presented with frequency, percentage, tables, graphs, and texts based on the nature of the data. All the four attires were compared using the Friedman test and pair wise comparisons were conducted with Bonferroni correction for multiple comparisons, and Mann–Whitney U-test was used to know the preferred attire on patients’ perception about physicians’ skill, with 95% confidence and a p-value of less than 0.05 were considered as statistically significant. Results In this study, out of the total respondents 66.7% are males and 71.9%, 50.3% of the respondents were degree or diploma holders, and aged 18–34 years respectively. Among participants’ 77.1% and 55.9% preferred formal attire and surgical scrub respectively. For male surgeons, formal attire and surgical scrub have an equal preference in surgical patients (p<0.001), but business and casual attire have no statistically significant difference. The patients’ preference in male formal physician attire in surgeon’s confidence, willingness to discuss confidential information and safeties of the surgeon were 76.2%, 75.7%, and 70.5% respectively, and for female surgeons, formal attire on surgical patients’ confidence in the surgeon, safety, and willingness to discuss confidential information were 74.9%, 73.8%, and 71.8% respectively. Conclusion Physician attire is one of the important factors that inspire surgical patient confidence, smartness, surgical skill, discussion of confidential information, and caring ability in physicians. Formal attire and surgical scrub were the most preferred physician’s outfits.
... Moreover, cultural factors seem to influence attire preferences. Research suggests that formal attire or white coat has been preferred even more consistently in several European countries (including the United Kingdom, Belgium, and Netherlands) than in the United States (Gallagher et al., 2008;Gherardi et al., 2009;Kocks et al., 2010;Hartmans et al., 2013). Studies from Australia (Gooden et al., 2001) and Brazil (Yonekura et al., 2013) revealed a clear preference of patients for white coat, whereas patients from Saudi Arabia preferred formal attire (Al-Ghobain et al., 2012). ...
Article
Full-text available
Research in social psychology demonstrates that physical environmental factors – or “artifacts” such as provider clothing and office décor – can influence health outcomes. However, the role of artifacts in augmenting or diminishing health outcomes is under-explored in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts may carry significant potential in informing how placebo effects can be maximized, and nocebo effects minimized in clinical settings. We discuss the potential mechanisms, including classical conditioning, response expectancy, and mindsets, by which artifacts might enhance or diminish these effects. Next, we propose testable hypotheses to investigate how placebo and nocebo effects might be elicited by artifacts in care settings, and conclude by providing innovative research designs to advance this novel research agendum.
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Pedagogical agents are often used to enhance social cues in learning materials. The inclusion of pedagogical agents raises several design questions, for example on what kind of clothing the agent should wear. Further, it is not yet clear how the setting of an animated learning video (i.e., the digitally created background) affects learning. In an online experiment (N = 200), we investigated whether creating thematically appropriate clothing and setting has some added value in that it improves learning outcomes in comparison to more neutral assets. Whereas all participants acquired knowledge from the animated video, there were no main effects of clothing and setting for any of the dependent variables, but an interaction for learning outcomes (ηp2=0.02), indicating that the appropriately dressed agent worked better combined with the inappropriate setting than with the appropriate setting. Overall, given those non-significant main effects and the small effect size of the interaction, there seem to be some degrees of freedom for designers of pedagogical agents in animated learning videos. However, these degrees of freedom may be limited to at least moderate (i.e., neutral) levels of appropriateness.
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Physicians’ attire seems to play an important role in the success of patient treatment. The classic doctor’s white coat initiates a strong signal to the patient and can have a determining effect on a successful doctor–patient relationship. In a quantitative online questionnaire study comprising 52 questions, participants were shown four photos of an interprofessional German family medicine team in varying attire. One important study feature relating to the ongoing coronavirus pandemic was that the team was portrayed wearing FFP2 masks in one photo. We measured core values regarding the team’s perception in terms of sympathy, competence, trust, choosing the practice as a personal health care provider, and wanting to participate in the team. The questionnaire was posted online between March and May 2021. It was accessed 1435 times and 906 sheets were qualified for statistical analysis. For the first time in this field of research, a practice team’s attire was investigated. We found a significant influence of different clothing on the perception of sympathy, competence, trust, elective practice, and team participation. Wearing an FFP2 mask promotes feelings of security and competence. The study shows that in times of fast social changes due to rapid digitalization and an ongoing pandemic, we should present ourselves in different ways as a medical team depending on the patient groups we are targeting and the feelings we want to evoke.
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Objectives To understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation. Setting An interventional study was conducted with a representative sample of the population attending primary care in central Portugal. Participants The sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included. Interventions Every other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the ‘Trust in physician’ scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician. Outcomes Planned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation. Results The sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001). Conclusions There was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician. Trial registration number ClinicalTrials.gov ID number: NCT03965416 .
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To compare the views of doctors and patients on whether doctors should wear white coats and to determine what shapes their views. A questionnaire study of 400 patients and 86 doctors was performed. All 86 of the doctors' questionnaires were included in the analysis but only 276 of the patients were able to complete a questionnaire. Significantly more patients (56%) compared with their doctors (24%) felt that doctors should wear white coats (p<0.001). Only age (>70 years) (p<0.001) and those patients whose doctors actually wore white coats (p<0.001) were predictive of whether patients favoured white coats. The most common reason given by patients was for easy identification (54%). Less than 1% of patients believed that white coats spread infection. Only 13% of doctors wore white coats as they were felt to be an infection risk (70%) or uncomfortable (60%). There was no significant difference between doctor subgroups when age, sex, grade, and specialty were analysed. In contrast to doctors, who view white coats as an infection risk, most patients, and especially those older than 70 years, feel that doctors should wear them for easy identification. Further studies are needed to assess whether this affects patients' perceived quality of care and whether patient education will alter this view.
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The aim of this study was to determine how acceptable patients found different styles of doctors' dress and whether patients felt that a doctor's style of dress influenced their respect for his or her opinion. A total of 475 patients from five general practices in Lothian were surveyed using photographs of different styles in a male and female doctor and questions about their attitudes to doctors' dress in general. Overall, patients seemed to favour a more formal approach to dress, with the male doctor wearing a formal suit and tie and the female doctor in a white coat scoring the most high marks. This was particularly true of older patients and those in social classes 1 and 2. The male doctor wearing a tweed jacket and informal shirt and tie scored fewer low marks and this was therefore the least disliked of the outfits. There was a marked variation between preferences of patients registered with different practices. When asked, 28% of patients said they would be unhappy about consulting one of doctors shown, usually the ones who were informally dressed. However, some patients said they would dislike their doctor wearing a white coat. Although there are more important attributes for a general practitioner than the way he or she dresses, a majority of patients (64%) thought that the way their doctor dressed was very important or quite important. Given that 41% of the patients said they would have more confidence in the ability of one of the doctors based on their appearance it would seem logical for doctors to dress in a way that inspires confidence.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study evaluates the effect of physician dress and other variables (i.e., sex of physician and patient, age, and type and site of visit) on patient-physician rapport. Three hundred eighty-six teens filled out a questionnaire, at the end of an office visit, which evaluated their attitudes regarding their physician and their preference for physician dress. The physicians alternated between very informal, informal, formal-white coat, and formal-suit/dress styles. Dress style made no statistical difference in patients' attitudes toward their physician. When asked what they preferred their doctor to wear 43% responded "makes no difference," 26% said "white coat," 14% said "pants and shirt," 10% said "jeans and shirt," and 4% said "suit and tie." Female patients were significantly more comfortable (3.6 versus 3.3, p less than 0.01) with female physicians. Male patients did not show a preference for a same-sex physician.
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This study was performed to examine the preferences of patients regarding physician attire, and if their perception of physician competence was influenced by the physicians' clothing style. Patients attending the obstetrics and gynecology clinic in which residents provided the majority of direct patient care were invited to participate in this study by completing a questionnaire. Patients were first asked to respond to 3 questions about their preference regarding physician attire. They were then asked to examine a series of photographs illustrating a variety of physician clothing styles worn by a model. Patients were asked to respond to 2 questions: 1). If your doctor is dressed in this outfit, would that make you more or less comfortable talking to your physician?, and 2). If your doctor is dressed in this outfit, would it make you feel more or less confident in his/her abilities? The majority of the respondents expressed no preference for their physician wearing a white coat (60%/110/183), or they did not respond that a physician's dress influenced their comfort level (63%/111/179) or the confidence (62%/114/181) they had in their physician. However, for both male and female physician models, the comfort level of patients and their perceptions of physician competence were the highest in response to images of physicians dressed in scrubs with a white coat, and least for casual dress. Resident physician attire makes a difference to patients. Our patients prefer the white coat with surgical scrubs. Casual clothing is less well liked by our patients.
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There are very few studies about the impact of physicians' attire on patients' confidence and trust. The objective of this study was to determine whether the way a doctor dresses is an important factor in the degree of trust and confidence among respondents. A cross-sectional descriptive study using survey methodology was conducted of patients and visitors in the waiting room of an internal medicine outpatient clinic. Respondents completed a written survey after reviewing pictures of physicians in four different dress styles. Respondents were asked questions related to their preference for physician dress as well as their trust and willingness to discuss sensitive issues. Four hundred respondents with a mean age of 52.4 years were enrolled; 54% were men, 58% were white, 38% were African-American, and 43% had greater than a high school diploma. On all questions regarding physician dress style preferences, respondents significantly favored the professional attire with white coat (76.3%, P <.0001), followed by surgical scrubs (10.2%), business dress (8.8%), and casual dress (4.7%). Their trust and confidence was significantly associated with their preference for professional dress (P <.0001). Respondents also reported that they were significantly more willing to share their social, sexual, and psychological problems with the physician who is professionally dressed (P <.0001). The importance of physician's appearance was ranked similarly between male and female respondents (P=.54); however, female physicians' dress appeared to be significantly more important to respondents than male physicians' dress (P <.001). Respondents overwhelmingly favor physicians in professional attire with a white coat. Wearing professional dress (ie, a white coat with more formal attire) while providing patient care by physicians may favorably influence trust and confidence-building in the medical encounter.
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To document patients' preferred dress styles of their doctors and modes of address. Descriptive survey. Inpatients and outpatients at a tertiary level hospital, New Zealand. 202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years. Ranking of patients' opinions of photographs showing doctors wearing different dress styles. A five point Likert scale was used to measure patient comfort with particular items of appearance. Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress. Patients were more comfortable with conservative items of clothing, such as long sleeves, covered shoes, and dress trousers or skirts than with less conservative items such as facial piercing, short tops, and earrings on men. Many less conservative items such as jeans were still acceptable to most patients. Most patients preferred to be called by their first name, to be introduced to a doctor by full name and title, and to see the doctor's name badge worn at the breast pocket. Older patients had more conservative preferences. Patients prefer doctors to wear semiformal dress and are most comfortable with conservative items; many less conservative items were, however, acceptable. A smile made a big difference.