Figure 3 Preference for white coat by clinical care setting and physician gender. ED, emergency department.

Doctors should wear a white coat when seeing patients in the hospital, the majority of respondents (62%) agreed or strongly agreed with this statement (table 3).

Variations in patient preferences of physician attire

Important variations in patient preferences for attire were noted. For example, female respondents more often preferred scrubs with white coats in emergency room and hospital settings than males (41% vs 31% (p<0.001) and 32% vs 27% (p=0.001), respectively). However, both genders indicated formal attire with white coat was overall most preferred (43% and 44%, respectively). In hospital settings, respondents 65 years of age or older frequently preferred formal attire with white coats than younger patients (44% vs 36%, p<0.001). Conversely, younger patients more often preferred scrubs and white coats than formal attire overall (28% vs 21%, p<0.001). Some differ- ences in preferences regarding physician dress based on respondent education level were also noted. Specifically, respondents with a college degree preferred formal and white coat for their primary care provider more often than those without a college degree (48% vs 42%, p<0.001).

No differences in preferences between those with three or more physician visits in the preceding year versus those with less frequent visits were noted. Similarly, preferences for attire did not vary by setting in which respondents were polled, although respondents in the outpatient setting more often preferred doctors in the hospital to wear scrubs and a white coat compared with hospi- talised respondents (32% vs 27%, p=0.002). However, preferences for attire did vary by geographical region. For example, while formal attire and white coats were preferred across all regions, 50% of respondents in the West and 51% in the South selected this as their preferred option compared with 38% and 40% in the Northeast and

Midwest, respectively. Conversely, over half of all respon- dents in the Northeast selected scrubs as their preferred attire for surgeons compared with a quarter of respon- dents in the South (54% vs 25%, p<0.001).

dIsCussIOn

This study of over 4000 patients receiving medical care in diverse academic medical centres is the largest to report preferences regarding physician attire in the USA. Over half of the participants indicated that how a physician dresses was important to them, with over one in three stating that this influenced how happy they were with care received. Overall, respondents indicated that formal attire with white coats was the most preferred form of physician dress. However, in settings such as surgery or emergency rooms, scrubs with white coats were most preferred. Although variation in preferences by respon- dent age, gender, education and geography were noted, these findings indicate that most patients have expecta- tions regarding doctor attire, and that a ‘professional’ look matters most. Given the size, methodological rigour and representativeness of these data, policies addressing physician attire should be considered to improve patient satisfaction.

Previous studies have shown that patients harbour conscious and unconscious biases when it comes to provider dress.10 11 Thus, our finding that patients have specific preferences regarding physician attire was not surprising. What this study highlights, however, is the potential importance of physician attire to the physician– patient relationship. Indeed, specific clinical and contex- tual aspects appear to influence a patient’s preconceived notion of ‘professional attire’.



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Petrilli CM, et al. BMJ Open 2018;8:e021239. doi:10.1136/bmjopen-2017-021239