Upcoming Program
Healing the Healer, Rhinebeck, NY, September 7 – 12th, 2008.
22.5 Category One CME/CE
For many years I have been offering a week-long program in Hawaii for
health care practitioners. I am delighted to be offering the same
program in upstate New York at summer's end. Bring a friend, bring
your staff!
This workshop is designed for health-care workers of all backgrounds
and trainings to help cultivate a greater sense of life balance;
spouses and significant others are also encouraged to attend. Click
here for more information and to register.
My mother in-law was right; Dress like a doctor
(This article is dedicated to my mother in-law, who passed away last
month. We will miss you.)
My wife is an internist who has been in practice for many years (I
can't say how many because I don't want to sleep outside tonight). Her
mother, a traditional medical spouse, would often criticize her for
not dressing "professionally". This would always agitate my wife and
make her defensive. Does it really matter how we dress or is it our
'way of being' that matters. The answer is, both our dress and our
attitudes matter and it doesn't hurt if you're good looking too!
In a recent study, four hundred outpatients were shown photos of
physicians with different styles of dress. They were then asked which
doctors they would trust more and be willing to share difficult issues
with. This patient group had a mean age of 52.4 years; 54% were men,
58% were white, 38% were African-American, and 43% had greater than a
high school diploma. The patients clearly 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%). This was true
for men and women, physicians and patients and also correlated with
trust, confidence and the willingness to share their social, sexual,
and psychological problems with the physician who is professionally
dressed (1). These correlates also exist in other areas of health care
such as podiatric medicine (2).
A study of OBGYN physicians showed that these correlates may not hold
true in all circumstance (3). These physicians were randomized to wear
business attire, casual clothing, or scrubs on a weekly basis for
three months. The business attire included a tie (for men) and a
buttoned white coat; the casual outfit excluded jeans but otherwise
was typical relaxed clothing and an optional unbuttoned white coat;
and the scrubs were hospital issue with no white coat. Patient
satisfaction scores were then analyzed.
The physician's style of dress had no impact on the patient's
perception of competency, satisfaction or their impression of the
physician's professionalism. This may be due to a skewed population;
younger women versus the more heterogeneous nature of other studies. A
larger effecter may be that, in this study, physician-patient
relationships developed over time and out weighed the initial
impression of style of dress.
In younger physicians and trainees, choice of clothing may actually
matter more than for mature physicians in all practice environments
(4). Dr. Pamela A. Rowland, a behavioral scientist and director of the
office of professional development at Dartmouth Medical School, who
has studied the impact of physician clothing on patient confidence
says: "Patients don't have your C.V. in front of them, and appearance
is all they have to go by," Dr. Rowland said. "If you don't meet their
expectations, their anxiety level increases."
This is particularly true for the younger generations of physicians.
Culturally, their style of dress is more casual than older generations
of physicians and patients. This can lead to the patient feeling
disrespected. In multiple studies, casual clothing decreased the
patients' confidence in the doctor.
Other preferences which enhance respect include:
Name tags
White coat
Visible stethoscopes
Dress pants, dress shoes, and a shirt and tie were ranked high for men
Makeup, lipstick, and stockings were ranked high for women.
Sandals and clogs, earrings or long hair on male physicians, and blue
jeans received the lowest rankings by respondents with regard to
desirability.
Older patients regarded casual attire more negatively than younger patients did.
Private clinic patients considered casual attire much less desirable
than did patients who had Medicaid insurance.
And, by the way, it doesn't hurt if you look like one of those TV
docs! It turns out that if the patient thinks you are attractive, they
trust you more (6). The McDreamy effect.
And then there is the neck tie, that bacteria laden piece of silk…
So all in all my mother in-law was right—sorry I doubted you.
What to wear today? Effect of doctor's attire on the trust and
confidence of patients. S. Rehman, P. Nietert, D. Cope, A. Kilpatrick,
The American Journal of Medicine, 2005 Nov; Volume 118, Issue 11, pp.
1279-1286.
The Physician's Attire and Its Influence on Patient Confidence; Adam
M. Budny, DPM *, Lee C. Rogers, DPM, Vincent J. Mandracchia, DPM, MS
and Steven Lascher, DVM, MPH, Journal of the American Podiatric
Medical Association, 2006, Volume 96, Number 2, pp.132-138.
Does physician attire influence patient satisfaction in an outpatient
obstetrics and gynecology setting? Richard L. Fischer, MD, Clare E.
Hansen, RN, Robert L. Hunter, MD, J. Jon Veloski, MS, Am J Obstet
Gynecol, 2007, 196:186.
Resident physician attire: Does it make a difference to our patients?
Cha Ann; Hecht Bryan R.; Nelson Karl; Hopkins Michael P; American
Journal of Obstetrics and Gynecology, Volume 190, Issue 5, pp.
1484–1488.
Patients' attitudes regarding physical characteristics of family
practice physicians; Keenum AJ, et al., South Med J, December 2003,
96:1190-4.
The white coat effect: Physician attire and perceived authority,
friendliness, and attractiveness. Brase, G.L. & Richmond, J., Journal
of Applied Social Psychology, 2004, 34(12), 2469-2481.
Lee Lipsenthal, MD, ABIHM
