Here at the PHC Primary Care Blog, we have been remiss. It has been well over one year since we commented on physician fashion. An update is long overdue. When last we visited this subject, Dr. Kubota ruminated on the infection control implications of various items of physician dress. Let us now revisit the subject, but from a different vantage point: Does physician attire affect patient satisfaction?
As may be expected, we will turn for answers to the TAILOR study, published recently by BMJ Open. TAILOR, of course, stands for “targeting attire to improve likelihood of rapport.” This study systematically reviewed all 45 published English and non-English language studies on the subject of how patients perceive physician dress. Two disclaimers must be offered up-front. First, only studies of adult patients were included. Parts of generation Y and all of generation Z were excluded. Second, the lead authors are based in Ann Arbor and New Haven, of all places, not in London. For many, this immediately makes any conclusions suspect. Nonetheless, we may be able to glean some pearls from what is otherwise a very robust study.
The bottom line? Yes, physician attire tends to have an impact on patient satisfaction and patient’s assessment of their physician. In general, patients tend to prefer their physicians be garbed more formally. Casual dress is viewed less favorably.
However, caveats abound in the TAILOR study. Patients’ perceptions are influenced by their age, where they live, and the type of physician involved. Let’s review each caveat.
As far as age, it is probably not surprising that younger patients (defined here as under age 40) attach less significance to formal dress than do older patients. I might as well go out on a limb here and acknowledge the TAILOR study found that younger patients also appear more accepting of their physicians having tattoos, piercings, and wearing athletic shoes.
On the geographic issue, U.S. patients appeared less concerned about formal dress than patients anywhere else in the world. Patients from Asia were most impressed with physicians wearing formal clothing, but this phenomenon was also true throughout Europe. Even our friendly northern neighbors value better dressed physicians more than do patients in the U.S.
Finally, patients in general are more willing to cut procedural physicians some slack when it comes to on-the-job clothing. Scrubs were viewed just as favorably as more formal garb for surgeons, ED docs, and ICU docs. Not so for primary care physicians. For those who dwell in the realm of primary care, dressing more formally appears to generate a higher level of trust.
So, we can each draw our own conclusions from the TAILOR study. Since there is a strong subjective component to the study’s findings, it is unlikely there will be practice guidelines on correct physician attire emanating from the USPSTF or AHRQ. Being well dressed does not give a physician license to practice poor quality medicine. Nonetheless there is something to be said about dressing respectfully for our patients. While some patients were less judgmental than others about casual dress, no patients felt less trust in physician who were nicely dressed. Since patient satisfaction and trust is so important in patient compliance and the experience of health care, why not err on the side of nice attire.
Richard Fleming, MD