Article

Patients’ Perception of Military Doctors in Fracture Clinics - does the Wearing of Uniform Make a Difference?

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  • Swansea Bay University Health Board
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Abstract

We performed a study during our Trauma Week when patients who were referred from the accident department with fractures were reviewed in our fracture clinic. During our Trauma Week, Mister Thomas, Consultant Orthopaedic and Trauma Surgeon or Surgeon Lieutenant Commander McLean, Specialist Registrar in Orthopaedic and Trauma Surgery reviewed a total of 93 patients in fracture clinic. All patients were given an anonymous questionnaire regarding their perceptions of their attending clinician, 77 were completed. Forty-nine questionnaires regarding Surgeon Lieutenant Commander McLean and 28 regarding Mister Thomas were available for analysis. During the Trauma Week all patients were seen in the same location in identical cubicles by either of the two clinicians, consultations were typically brief lasting about five minutes. Throughout the week the clinicians, one military and one civilian, wore differing attire. The military uniform comprised Royal Navy number four action working dress. The civilian attire comprised 'dog-robbers' (jacket, shirt with tie and smart trousers). The hypothesis tested was that the use of military uniform might alter patients' perceptions of their attending clinician. Our results appear to demonstrate that the attire of the attending clinician does not adversely influence patients' perceptions of their attending clinician.

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... 11 Only one study reported patients preferring their doctor in scrubs 8 while fi ve studies found patients preferring professional or formal attire 1,2,5,9,12 and six studies found no difference in patient preference. [13][14][15][16][17][18] Five of these investigations also examined patient confi dence based on physician attire with three showing increased patient confi dence with the white coat 5,7,14 while two showed no difference when a white coat was worn. 12,16 Only one article examined physician attire in a military hospital in the Royal Navy. ...
... 12,16 Only one article examined physician attire in a military hospital in the Royal Navy. 13 The investigators found that patients preferred dress civilian attire compared with a military uniform; however, the survey did not mention any preference for scrubs or white coats. 13 These studies were undertaken in many different specialty clinics including anesthesia, family medicine, podiatry, internal medicine, orthopedics, and obstetrics and gynecology. ...
... 13 The investigators found that patients preferred dress civilian attire compared with a military uniform; however, the survey did not mention any preference for scrubs or white coats. 13 These studies were undertaken in many different specialty clinics including anesthesia, family medicine, podiatry, internal medicine, orthopedics, and obstetrics and gynecology. Patient perception of their physician plays an important role in the patient-physician relationship. ...
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To examine patient preference regarding physician attire and whether perception of medical competence was influenced by the physician's clothing style. New patients presenting to the OB/GYN clinic at the Naval Medical Center Portsmouth were asked to complete a survey regarding patient preference for physcian attire and any effect on their comfort or confidence in the physician. Surveys were collected over a 2-month period. Completed surveys (328) were analyzed with the following results: 86% had no preference whether the physician wore a white coat, 61% preferred scrubs, 13% were uncomfortable talking to a doctor about general topics, and 16% were uncomfortable talking about sexual, psychological, or personal topics based on physician attire. In a comparison between active duty women and dependent wives, a significantly greater number of dependent wives reported the physician attire having no influence on their comfort level discussing general topics with their physician (p = 0.037) or about sexual, psychological, or personal topics (p = 0.035). No difference was seen between groups in the preference to wear a white coat (p = 0.196) or other attire (p = 0.088) or of an influence of the doctors' clothing on the patient's confidence in the doctors' abilities (p = 0.063). Overall, female patients in a military setting do not have a preference for specific physician attire and attire does not influence their perception of the doctor's competence. However, a greater number of dependent wives report physician attire has no influence on their comfort level discussing both general and personal topics when compared with active duty women. This finding highlights the unique role of the military uniform in the eyes of active duty women and their potential discomfort in discussing personal medical issues with a physician in military uniform.
... 6 7 10 12 14 23 25-41 However, some studies reveal no significant preferences, [42][43][44][45] and others indicate that the white coat may even cause higher levels of tension in patients. 44 Some studies have shown that physician attire carries little importance with patients, [46][47][48][49][50] whereas others have shown it has a substantial impact on the patient experience, 30 51 congruent with our results. Literature differs on whether preferences for the white coat change after patients are educated about potential risk of microbial transmission, with some studies showing decreased preference 14 52 and another showing no change. ...
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Objective The patient–physician relationship impacts patients’ experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings. Setting 20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA. Participants Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices. Primary and secondary outcome measures The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics. Results The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only. Conclusions Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.
... Disagree or strongly disagree 857 (21) Neither agree nor disagree 1372 (34) Agree or strongly agree 1774 (44) Doctors should wear a white coat when seeing patients in their office. n=4007 ...
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Objective Several large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience—and how this influences satisfaction—is unknown. Therefore, we performed a national, cross-sectional study to examine patient perceptions, expectations and preferences regarding physicians dress. Setting 10 academic hospitals in the USA. Participants Convenience sample of 4062 patients recruited from 1 June 2015 to 31 October 2016. Primary and secondary outcomes measures We conducted a questionnaire-based study of patients across 10 academic hospitals in the USA. The questionnaire included photographs of a male and female physician dressed in seven different forms of attire. Patients were asked to rate the provider pictured in various clinical settings. Preference for attire was calculated as the composite of responses across five domains (knowledgeable, trustworthy, caring, approachable and comfortable) via a standardised instrument. Secondary outcome measures included variation in preferences by respondent characteristics (eg, gender), context of care (eg, inpatient vs outpatient) and geographical region. Results Of 4062 patient responses, 53% indicated that physician attire was important to them during care. Over one-third agreed that it influenced their satisfaction with care. Compared with all other forms of attire, formal attire with a white coat was most highly rated (p=0.001 vs scrubs with white coat; p<0.001 all other comparisons). Important differences in preferences for attire by clinical context and respondent characteristics were noted. For example, respondents≥65 years preferred formal attire with white coats (p<0.001) while scrubs were most preferred for surgeons. Conclusions Patients have important expectations and perceptions for physician dress that vary by context and region. Nuanced policies addressing physician dress code to improve patient satisfaction appear important.
... 5 17 18 22-24 27-29 31 37 39 Within these 12 studies, only 3 (25%) reported that attire influenced patient perceptions of their physician. 5 27 39 Formal attire without white coat was preferred in one of the three studies 39 ; a white coat with other attire not specified was preferred in two studies. 5 27 However, in the remaining nine studies, patients did not voice any attire preference following a clinical encounter suggesting that attire may be less likely to influence patients in the context of receiving care. ...
Article
The authors of this Views and Reviews describe the evolution of the role of mental health counseling in infertility care. As the use of assisted reproductive technologies and third-party reproduction has grown, so too has the interest and demand for mental health services. A historical perspective is presented that sets the stage for subsequent discussions of key areas where mental health practitioners are able to contribute to the utility and outcomes of infertile patients as well as those involved in their care. This series of articles stresses the value of more comprehensive integration of mental health support into infertility practice and highlights practical opportunities to do so. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
... 5 17 18 22-24 27-29 31 37 39 Within these 12 studies, only 3 (25%) reported that attire influenced patient perceptions of their physician. 5 27 39 Formal attire without white coat was preferred in one of the three studies 39 ; a white coat with other attire not specified was preferred in two studies. 5 27 However, in the remaining nine studies, patients did not voice any attire preference following a clinical encounter suggesting that attire may be less likely to influence patients in the context of receiving care. ...
Article
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Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients' perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... 5 17 18 22-24 27-29 31 37 39 Within these 12 studies, only 3 (25%) reported that attire influenced patient perceptions of their physician. 5 27 39 Formal attire without white coat was preferred in one of the three studies 39 ; a white coat with other attire not specified was preferred in two studies. 5 27 However, in the remaining nine studies, patients did not voice any attire preference following a clinical encounter suggesting that attire may be less likely to influence patients in the context of receiving care. ...
... 5 17 18 22-24 27-29 31 37 39 Within these 12 studies, only 3 (25%) reported that attire influenced patient perceptions of their physician. 5 27 39 Formal attire without white coat was preferred in one of the three studies 39 ; a white coat with other attire not specified was preferred in two studies. 5 27 However, in the remaining nine studies, patients did not voice any attire preference following a clinical encounter suggesting that attire may be less likely to influence patients in the context of receiving care. ...
Article
Full-text available
OBJECTIVES: Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients' perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. SETTING, PARTICIPANTS, INTERVENTIONS AND OUTCOMES: We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. RESULTS: Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. CONCLUSIONS: Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... We have found limited research investigating the relationship between military uniform and its impact on the therapeutic relationship with mental health clients. Thom & Ford carried out a study on staff dress on acute psychiatric wards with 36% of clients indicating that formal dress made staff less approachable (6) Ten years later McLean et al carried out a study in a military orthopaedic fracture clinic (7). There were two clinicians, one in military dress and the other in civilian clothing. ...
Article
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to measure the perceptions of military staff of the impact of wearing military uniform on the therapeutic relationship with mental health clients. a brief questionnaire was distributed to all military clinicians in Departments of Community Mental Health to measure their attitudes. there was a 67.9% (n=70) response rate regarding the impact of uniform on the therapeutic relationship. 20% of responses were positive, 31% negative, 37% mixed and 12% gave no answer. there was no clear pre-existing literature on this issue. Overall, the wearing of uniform appeared to be perceived positively positive. There is a need to assess clients' points of view in future studies.
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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.
Article
Introduction To examine patient preferences and perceptions regarding physician dress code in a neuro-urology department. Material A questionnaire presenting with different physician dress codes was submitted to patients in a neuro-urology department: casual outfit with white coat, scrubs and scrubs with white coat. Respondents selected their ideal dress code and mentioned if any dress code shock them. Respondents’ general opinions regarding physician attire, its importance and relation with patient satisfaction were collected. Results 163 questionnaires were completed. The three physician attires were chosen equally by the respondents. 71.4% of the respondents felt comfortable with the three attires. When an attire appeared to be offending, the casual attire with white coat was mentioned in 68.2%. 52.5% of the patients reported that the way their doctor dressed was important to them. 36.3% of respondents reported that physician attire influenced how confident they felt about the care they received. Male respondents preferred scrubs with white coat (44.0%) while female respondents preferred casual attire with white coat (42.0%), P = 0.02. Neither the age, nor the reason of the consult, the knowledge of the department, the presence of neurological disease, the occupational category and the education level of the patient had an influence on the preference for one specific physician attire. Conclusion Physician attire in neuro-urology may influence the way that patients perceive care. Physicians must not be restricted to one particular attire in neuro-urology department. However since almost 20% of the patients feel uncomfortable with the casual attire and white coat, it should be avoided. Level of evidence 4.
Article
To measure the perception of military mental health clients of the impact of wearing military uniform on the therapeutic relationship between client and clinician and to ascertain if uniform and rank is perceived as a barrier. A brief questionnaire was distributed to Departments of Community Mental Health to be disseminated to their mental health clients to measure their responses. 282 responses from mental health clients were collected over a 30 day period regarding the impact that military uniform makes to the therapeutic relationship with the clinician. 63% (n = 178) regarded uniform as negatively influencing their relationship with the clinician, 37% (n = 104) responded that it did not. 39% (n = 111) believed rank to be a barrier, whereas 61% (n = 171) did not believe it affected the relationship. The majority of military mental health clients regard the wearing of uniform as negative to the therapeutic relationship and a significant minority have similar feelings about rank. Military mental health practitioners should consider the impact of these results on the therapeutic relationship with military patients.
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