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Thursday, March 7, 2013

Doctor's Wearing White Coats Considered More Knowledgeable Patients Say

Doctor Appearance: MDs In White Coats, Names Tags Preferred, Study Finds

Doctor White Coat

TORONTO - Appearances count, it seems, even when a loved one's life may be hanging in the balance.
A new study shows that family members of people in hospital intensive care units place more trust in doctors who are well groomed, in a white coat or scrubs and wearing an easy-to-read name tag.

First author Dr. Selena Au said evidence suggests the public's expectations of what doctors should wear — how doctors should look — differs depending on where in the hospital they work.

In pediatrics, say, a white coat is a no-no. And in the emergency department, people don't seem to care what doctors are wearing; they just want to be helped.

But in the ICU, where patients are critically ill and families are often faced with heart-stopping news and gut-wrenching decisions, it appears people want to deal with professionals who look like the quintessential doctors portrayed on TV.

"I think more than anyone in the hospital, that we are having very intense discussions where we're talking about end-of-life care, where we may be talking about treatment options where decisions have to be made quickly," said Au, who is with the University of Calgary's department of critical care medicine.

"And so family members have to make some quick judgments as to whether or not they trust us.... So things that are part of non-verbal communications come into play quickly."

Au did the work with two colleagues from the University of Calgary and Alberta Health Services, Calgary zone. The research was supported by a grant from Alberta Innovates and is published in this week's issue of the journal JAMA Internal Medicine.

The team surveyed 337 people visiting family members in three Calgary-area ICUs between Nov. 1, 2010 and Oct. 31, 2011.

They asked people to rate in importance 10 factors related to the outward appearance of doctors in general, not specific physicians. Those factors were things like age, race, gender, dress, the presence or absence of a name tag, tattoos or visible piercings and overall first impression.

Respondents were then asked to select, from panels of pictures of models posing as doctors, which appeared most knowledgeable, most caring, most honest, most competent and best overall.

The panels of photos portrayed doctors in white coats, scrubs, business suits and casual clothing, such as jeans.

Those wearing stereotypical doctors' garb were judged to be most knowledgeable and most honest.
"Traditional attire was associated with perceptions of knowledge, honesty and providing best overall care," the authors wrote.

"Physicians wearing (surgical) scrubs were a second choice among participants and were perceived as being caring and competent to perform a lifesaving procedure."

The study found that even when respondents said they didn't care whether a doctor was wearing a white coat, most strongly favoured the models wearing white coats.

"These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs," the authors noted.

Interestingly, doctors in business suits were not terribly well received, and didn't fare much better than doctors in casual clothing.

Respondents explained the aversion to doctors in suits by describing them as less approachable, and looking as if they would not get their hands dirty to help save a patient, Au said.

The authors suggested physicians' appearances in ICU settings may be especially crucial. Patients and their families do not have pre-existing relationships with these doctors, but circumstances may demand that families work through tough decisions very quickly with these physicians.

"Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence," the authors wrote.

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