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   Table of Contents      
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 88-92

Patients Preference for Doctor Attire in an Outpatient Department of a Government Hospital in New Delhi, India


Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Date of Web Publication28-Aug-2018

Correspondence Address:
Dr. Sandeep Sachdeva
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi-110007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_31_18

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  Abstract 


Objective: To assess patients preference for preselected doctor attire in outpatient department (OPD) setting of a government hospital. Materials and Methods: An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years) ambulatory coherent patients. The brief questionnaire captured selected sociodemographic details of patients, department visited, and use of aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in OPD wearing apron (white coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. The patients were shown four colored pictures each for male and female doctor in different dress. They were probed regarding their preference that they would like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 = professional formal. Result: The mean age of 547 patients was 35.34 (±12.81) years; 322 (58.9%) were males. Out of 547 patients, nearly 395 (72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were actually wearing the apron in the outpatient department. Only 152 (27.7%) patients responded that it does not matter to them whether attending doctor was wearing white coat (apron) or not. Majority of patients preferred male doctor to be wearing professional formal (42.3%) and professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal (37.5%), respectively. Casuals were the least preferred attire. Conclusion: It is reiterated that majority of patients in our OPD setting preferred formal attire of attending doctor with apron, a clear and loud message for future physician in training.

Keywords: Attitude, physician attire, professional, white coat


How to cite this article:
Sachdeva S, Taneja N, Dwivedi N. Patients Preference for Doctor Attire in an Outpatient Department of a Government Hospital in New Delhi, India. MAMC J Med Sci 2018;4:88-92

How to cite this URL:
Sachdeva S, Taneja N, Dwivedi N. Patients Preference for Doctor Attire in an Outpatient Department of a Government Hospital in New Delhi, India. MAMC J Med Sci [serial online] 2018 [cited 2018 Sep 20];4:88-92. Available from: http://www.mamcjms.in/text.asp?2018/4/2/88/239995




  Introduction Top


The white coat remains a powerful symbol of physician, despite dramatic changes in medicine during the last century. Wearing a white coat during the medical practice began in the late 1880s when surgeons began wearing white coats in their quest for new “aseptic” methods. By the beginning of the 20th century, the use of the white coat had spread to most physicians and the white coat was firmly established as the “doctor’s uniform.”[1] The white color was specifically chosen to associate physicians with purity and cleanliness. White coats have been acknowledged as an integral part of physician dress. Several studies have shown that 36% to 80% of their patients preferred that their doctors should wear white coat.[2],[3],[4],[5] They accounted professionalism, easy identification and hygiene as the reasons for their belief. Over the past 2 decades, there has been a declining use of the white coat, even in the hospital setting.[6],[7] For some authors, this decline has been so marked that the “white-coated” doctor is now considered an “endangered species.”[2]

It has been now established that physician attire and dressing style has an important role in the relationship and communication with his patients.[8] Since the time of Hippocrates, doctors have been given advice on the way they should dress.[9] However, there are conflicting findings in the literature about the dressing style of physician. Some studies reported that patients preferred to see their physician in traditional or formal dress, whereas others report to see their doctor in more casual outfit.[10],[11],[12],[13] British and American studies conducted up to the late 1990s showed that patients were more comfortable with traditional styles of appearance, such as white coats, formal suits, short hair, shirts, and ties.[14],[15] Casual items such as sandals, sports shoes, and jeans evoked negative responses. Other factors, such as neatness, smile, or facial expression, were also considered important and had the potential to override the effects of attire.[16],[17] There are limited studies available in India assessing the patients’ preference for doctor’s attire including white coat. With this background, a study was undertaken among patients visiting the outpatient department of a government hospital to assess their preference for doctor’s attire.


  Materials and Methods Top


A cross-sectional study was conducted in a midlevel government hospital of New Delhi (India) between October and December 2017. The present hospital is equipped with all the basic specialties and caters to local and nearby population from primarily lower socioeconomic strata of society. The sample size was estimated based on a conservative assumption that 50% (P = 0.05) of patients reporting to hospital have overall satisfaction with outpatient hospital services. Taking the 95% confidence level with ±5% precision and using the formula, the desired sample size computed was 384 patients. However, we were able to mobilize more than the desired sample size and cover 550 study patients.

An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years) ambulatory coherent patients after obtaining an informed consent and ensuring nonduplication of same patients. We conducted the exit interview in a convenient, comfortable, confidential, and nonjudgmental manner among patients who agreed to participate in the study. During the process of interaction, doubts were clarified, appropriate health education and counseling was undertaken, and all possible help was also extended.

The questionnaire captured selected sociodemographic details of patients, department visited, and use of aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in outpatient department (OPD) wearing apron (white coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. Based on a previous study, the patients were shown four colored pictures each for male and female doctors.[18] The patients were further probed regarding the preference of dress code/attire they would like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 = professional formal [[Figure 1] and [Figure 2]].
Figure 1: Male doctor dress code

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Figure 2: Female doctor dress code

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The attires included in the study were
  • Cool casual dress: Jeans and T-shirt with white coat
  • Casual dress: Shirt–pant, out shirt, and slippers with white coat
  • Professional informal dress: Shirt–pant tucked in and shoes with white coat
  • Professional formal dress: Shirt-pant, tie, and shoe with white coat
  • Cool casual dress: Jeans and T-shirt with white coat
  • Casual dress: Salwar and jeans with white coat
  • Professional informal dress: Salwar kameez with white coat
  • Professional formal dress: Sari with white coat


The data were analyzed using SPSS (IBM, New York, New York, USA) ver. 20.0 software by calculating descriptive and bivariate statistics. However, three case records were found to be incomplete at the end of survey, and hence, a total of 547 were finally analyzed.


  Results Top


The mean age of 547 patients was 35.34 (±12.81) years; the age distribution was as follows: 241 (44.1%) between 18 and 30 years, 236 (43.1%) between 31 and 50 years, and 70 (12.8%) above 51 years; 322 (58.9%) of patients were males; 466 (85.2%) were Hindu by religion. Regarding department, 146 (26.7%) visited surgery department, 161 (29.4%) medicine, 83 (15.2%) orthopedic, 62 (11.3%) dermatology, etc.

Out of 547 patients, nearly 395 (72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were actually wearing the apron in the outpatient department; nearly 152 (27.7%) patients responded that it does not matter to them whether attending doctor was wearing white coat (apron) or not. Details are shown in [Table 1] and [Figure 3].
Table 1: Use of apron by doctor in outpatient department as reported by patients

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Figure 3: Patients preference for doctor wearing apron (white coat)

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Out of 547 patients, majority preferred male doctor to be wearing professional formal (42.3%) and professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal (37.5%), respectively. Details are shown in [Table 2] and [Figure 4].
Table 2: Preference of patients for doctor’s attire

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Figure 4: Patients preference for doctor’s attire in outpatient department

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  Discussion Top


Our cross-sectional descriptive study conducted in a government hospital of New Delhi (India) among 547 patients constituting a mix of young and middle-aged population from low socioeconomic strata visiting outpatient department during October to December 2017 reported only about half (46.8%) of the attending doctors were wearing apron. However, as high as 72.2% patients desired that they would like to see their attending doctor wearing apron, whereas remaining (27.7%) patients responded that it does not matter to them whether the doctor was wearing white coat (apron) or not. With regard to attire, majority of patient’s preferred formal dress for male (83.2% with/without tie) and female (76.2% Indian sari/salwar kameez) doctors, respectively.

The size of our study provides a good cross-section of opinions and gave sufficient power to detect small differences in patient preferences. However, some limitations of this study are regarding the photograph of doctor dress; the age of physician may have been a confounding factor. Photographs in our study were of a younger looking physician, and it is unclear whether the respondents would have given the same importance to attire if the photographs had shown older physicians. In addition, studies have demonstrated the importance of physician attire in patient perceptions. However, the influence of a particular style of attire may last only a short time and needs further clarification whether clothes can influence long-term patient–doctor relationships.[19] The seasonality factor may be another determinant among doctor for wearing apron. Recall bias may not be applicable in our situation, but heterogeneous patient mental agility and attention may have an influence. These findings are in accordance with many previous findings including Landry, Rehman, and Abha who found that 69.9%, 76%, and 82.3% of the patients in their study preferred white coats for their doctor.[20],[21],[22] It is reported that patients felt more confident and communicated better with doctors who wore white coats. Likewise, patients rated images of doctor with apron higher than those of casual attire in measures for comfort and perception of competence.[23],[24] The current available evidence has not conclusively linked white coats with increased infection rates. However, 2007 dress code guidelines in England were issued banning white coats and bare-below-the-elbow policy for all workers in the hospitals; however, detailed scrutiny on the risk of infection transmission and objections eventually led to revision of these guidelines in 2010.[21]

The genesis of this study emerged by authors sustained observance of unprofessional attire and conduct of our medical students during last 10 years. Our college is geographically situated near different Delhi University colleges (arts, commerce, management courses, etc.) where dress and attire of students is not an issue but has a wider influence and ramifications on our medical students. Increasing trend of casualness (without apron) and informal clothing including bathroom slippers and sandals were being worn by our students in classroom, medical college, and hospital setting. All directions, instructions, guidance, and counseling in this regard fell on dumb ears. Under these circumstances, authors felt motivated to conduct this study to assess the patient’s preference of doctor’s attire in outpatient department of our hospital. In conclusion, it is reiterated that majority of patients in our setting preferred formal attire of attending doctor with apron, a clear and loud message for future physician in training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Preston SH. Time to hang up the white coat? Med Econ 1998;75:149-50.  Back to cited text no. 1
    
2.
Harnett PR. Should doctors wear white coats? Med J Aust 2001;174:343-4.  Back to cited text no. 2
    
3.
Gooden BR, Smith MJ, Tattersall SJ, Stockler MR. Hospitalised patients views on doctors and white coats. Med J Aust 2001;175:219-22.  Back to cited text no. 3
    
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Dunn JJ, Lee TH, Percelay JM, Fitz JG, Goldman L. Patient and house officer attitudes on physician attire and etiquette. JAMA 1987;257:65-8.  Back to cited text no. 4
    
5.
Najafi M, Khoshdel A, Kheiri S. Preferences of Iranian patients about style of labeling and calling of their physicians. J Pak Med Assoc 2012;62:668-71.  Back to cited text no. 5
    
6.
Brandt LJ. On the value of an old dress code in the new millennium. Arch Intern Med 2003;163:1277-81.  Back to cited text no. 6
    
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Douse J, Derrett-Smith E, Dheda K, Dilworth JP. Should doctors wear white coats? Postgrad Med 2004;80:284-6.  Back to cited text no. 7
    
8.
Short D. First impressions. Br J Hosp Med 1993;50:270-1.  Back to cited text no. 8
    
9.
Hippocrates. 2nd ed. Cambridge, Massachusetts: Harvard University Press 1923. pp 311-2.  Back to cited text no. 9
    
10.
Mayberry WE. The elements of style in medicine. Mayo Clin Proc 1986; 61:666–8.  Back to cited text no. 10
    
11.
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12.
No author listed. Letter: Coats, white or soiled. N Engl J Med 1975;293:563-5.  Back to cited text no. 12
    
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Blondell RD, Humble RS, Roberst DM. Patients and the habits of house officers. JAMA 1987;257:2031-2.  Back to cited text no. 13
    
14.
Gjerdingen DK, Simpson DE, Titus SL. Patients’ and physicians’ attitudes regarding the physician’s professional appearance. Arch Intern Med 1987;147:1209-12.  Back to cited text no. 14
    
15.
McKinstry B, Wang JX. Putting on the style: What patients think of the way their doctor dresses. Br J Gen Pract 1991;41:275-8.  Back to cited text no. 15
    
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Friis R, Tilles J. Patients’ preferences for resident physician dress style. Fam Pract Res J 1988;8:24-31.  Back to cited text no. 16
    
17.
Blondell RD, Humble RS, Roberts DM. How dress affects perceptions of house officers. Am J Dis Child 1987;141:830.  Back to cited text no. 17
    
18.
Sudhir KM, Mohan GC, Fareed N, Shanthi M. Dental students’ perception towards dress code in a private dental institution in Andhra Pradesh: A cross-sectional study. J Educ Ethics Dent 2011;1:68-72.  Back to cited text no. 18
  [Full text]  
19.
Kurihara H, Maeno T, Maeno T. Importance of physicians’ attire: Factors influencing the impression it makes on patients, a cross-sectional study. Asia Pac Fam Med 2014;13:2.  Back to cited text no. 19
    
20.
Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med 2005;118:1279-86.  Back to cited text no. 20
    
21.
Landry M, Dornelles AC, Hayek G, Deichmann RE. Patient preferences for doctor attire the white coat’s place in the medical profession. Ochsner J 2013;13:334-42.  Back to cited text no. 21
    
22.
Shrestha A, Shrestha B, Amatya RC, Chawla CD. Patients perspective on doctors attire. Nepalese J ENT Head Neck Surg 2012;3:23-5.  Back to cited text no. 22
    
23.
Gooden BR, Smith MJ, Tattersall SJ, Stockler MR. Hospitalised patients’ views on doctors and white coats. Med J Aust 2001;175:219-22.  Back to cited text no. 23
    
24.
Cha A, Hecht BR, Nelson K, Hopkins MP. Resident physician attire: Does it make a difference to our patients? Am J Obstet Gynecol 2004;190:1484-8.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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