July 3, 2019 Hospitalized patients express higher confidence in orthopaedic surgeons wearing white coats, suggests a study in Clinical Orthopaedics and Related Research® (CORR®), a publication of The Association of Bone and Joint Surgeons®. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"We found patients had a moderate overall preference for physicians wearing a white coat, either over scrubs or business attire," according to the new research, led by John D. Jennings, MD, of Temple University School of Medicine, Philadelphia.
Surgeons in White Coats: Patients Express Preference for 'Archetypal Image'
Do clothes affect patients' perceptions of their orthopedic surgeon? To find out, Dr. Jennings and colleagues designed a study using photographs of a male and a female surgeon wearing five different outfits: a business suit, alone or with a while coat; surgical scrubs, alone or with a white coat; or casual attire, eg, jeans and a T-shirt.
The researchers showed the pictures, in random order, to 110 patients undergoing orthopaedic surgery at their hospital. For each photo, patients rated their confidence in the surgeon, as well as their perceptions of his or her intelligence, trustworthiness, safety, skills, and the likely success of surgery. Factors affecting the patients' ratings were assessed, including possible differences in perceptions of the female and male surgeons.
For both pictured surgeons, patients preferred a white coat over a business suit or scrubs, or surgical scrubs alone, compared to business or casual attire. The ratings were similar for all attributes studied.
When asked to rank all five types of attire, patients expressed a "moderate overall preference" for surgeons wearing a white coat, over either a business suit or scrubs. Surgical scrubs alone were preferred over a business suit alone. Casual attire was consistently rated lowest.
The patients' expressed preferences were almost identical for the male and female surgeons. Although that was consistent with other recent studies, the researchers were pleasantly surprised to note the absence of gender bias, "given the known history of sexism in medicine."
Why does it matter what the surgeon is wearing? "Prior research suggests that physician attire has an important effect on patient perceptions, and can influence the patient-physician relationship," Dr. Jennings and colleagues write. Of the "countless factors" affecting this relationship, the physician's attire is one of the most easily studied and most easily changed.
"We found that the patient's perception of the physician's competence was affected by what the physician wore, with an overall preference for white coat over either scrubs or professional attire," the researchers conclude. "We believe this is consistent with the archetypal image of a surgeon and is thus what patients expect from their treating physician."
In a CORR Insights® perspective piece, R. Justin Mistovich, MD, MBA, of Case Western Reserve University, Cleveland, notes that the physician's "uniform" has traditionally met the demands of their work while also mitigating the spread of disease. He adds, "Physician attire must also meet patients' social expectations, which may be culture-bound, and may change over time." Dr. Mistovich suggests further studies addressing not just perceptions and preferences, but also "the most logical and appropriate clothing choice in specific settings."
Devoted to disseminating new and important orthopaedic knowledge, Clinical Orthopaedics and Related Research® is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons®. CORR® brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system.
About the Association of Bone & Joint Surgeons®
The mission of The Association of Bone and Joint Surgeons® is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopedic specialties. Founded in 1947 as the "American Bone and Joint Association," ABJS membership is offered by invitation only to orthopaedic surgeons who have been certified by the American Board of Orthopaedic Surgery.