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Orthopaedic Physician Attire Influences Patient Perceptions in an Urban Inpatient Setting

Jennings, John D. MD; Pinninti, Angelica BS; Kakalecik, Jaquelyn BA; Ramsey, Frederick V. PhD; Haydel, Christopher MD

Clinical Orthopaedics and Related Research®: September 2019 - Volume 477 - Issue 9 - p 2048–2058
doi: 10.1097/CORR.0000000000000822

Background Prior research suggests that physician attire has an important effect on patient perceptions, and can influence the patient-physician relationship. Previous studies have established the effect of specialty, location, and setting on patient preferences for physician attire, and the importance of these preferences and perceptions on both the physician-patient relationship and first impressions. To date, no studies have examined the influence of attire in the inpatient orthopaedic surgery setting on these perceptions.

Questions/purposes (1) Do differences in orthopaedic physician attire influence patient confidence in their surgeon, perception of trustworthiness, safety, how caring their physician is, how smart their surgeon is, how well the surgery would go, and how willing they are to discuss personal information with the surgeon? (2) Do patients perceive physicians who are men and women differently with respect to those endpoints?

Methods Ninety-three of 110 patients undergoing orthopaedic surgery at an urban academic medical center participated in a three-part survey. In the first part, each patient was randomly presented 10 images of both men and women surgeons, each dressed in five different outfits: business attire (BA), a white coat over business attire (WB), scrubs alone (SA), a white coat over scrubs (WS), and casual attire (CA). Respondents rated each image on a five-point Likert scale regarding how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and the patient’s willingness to discuss personal information with the surgeon. In the second part, the respondent ranked all images, by gender, from the most to least confident based on attire.

Results Pair-wise comparisons for women surgeons demonstrated no difference in patient preference between white coat over business attire compared with white coat over scrubs or scrubs alone, though each was preferable to business attire and casual attire (WS versus WB: mean difference [MD], 0.1 ± 0.6; 95% CI, 0.0–0.2; p = 1.0; WS versus SA: MD, 0.2 ± 0.7; 95% CI, 0–0.3; p = 0.7; WB versus SA: 0.1 ± 0.9; 95% CI, -0.1 to 0.2; p = 1.0). The same results were found when rating the surgeon’s perceived intelligence, skill, trust, confidentiality, caring, and safety. In the pair-wise comparisons for male surgeons, white coat over scrubs was not preferred to white coat over business attire, scrubs alone, or business attire (WS versus WB: MD, -0.1 ± 0.6; 95% CI, 0–0.1; p = 1.0; WS versus SA: MD, 0 ± 0.4; 95% CI, -0.2 to 0; p = 1.0; WS versus BA: MD, 0.2 ± 0.8; 95% CI, 0–0.4; p = 0.6). WB and SA were not different (MD, 0.0 ± 0.6; 95% CI, -0.1 to 0.2; p = 1.0), though both were preferred to BA and CA (WB versus BA: MD, 0.3 ± 0.8; 95% CI, 0.1–0.5; p = 0.02; WB versus CA: 1.0 ± 1.0; 95% CI, 0.8–1.2; p < 0.01). We found no difference between SA and BA (MD, 0.3 ± 0.7; 95% CI, 0.1–0.4; p = 0.06). We found that each was preferred to CA (SA versus CA: 0.9 ± 1.0; 95% CI, 0.7–1.2; p < 0.01; BA versus CA: 0.7 ± 1.0; 95% CI, 0.5–0.9; p < 0.01), with similar results in all other categories. When asked to rank all types of attire, patients preferred WS or WB for both men and women surgeons, followed by SA, BA, and CA.

Conclusions Similar to findings in the outpatient orthopaedic setting, in the inpatient setting, we found patients had a moderate overall preference for physicians wearing a white coat, either over scrubs or business attire, and, to some extent, scrubs alone. Respondents did not show any difference in preference based on the gender of the pictured surgeon. For men and women orthopaedic surgeons in the urban inpatient setting, stereotypical physician’s attire such as a white coat over either scrubs or business attire, or even scrubs alone may improve numerous components of the patient-physician relationship and should therefore be strongly considered to enhance overall patient care.

Level of Evidence Level II, therapeutic study.

J. D. Jennings, C. Haydel, Temple University Hospital, Department of Orthopaedics and Sports Medicine, Philadelphia, PA, USA

A. Pinninti, J. Kakalecik, Temple University School of Medicine, Philadelphia, PA, USA

F. V. Ramsey, Temple University School of Medicine, Department of Clinical Sciences, Philadelphia, PA, USA

J. D. Jennings, Temple University Hospital, Department of Orthopaedics and Sports Medicine, 3501 N. Broad St., Philadelphia, PA 19140 USA, Email:

One of the authors certifies that he (CH), or a member of his or her immediate family, has received or may receive speaking fees in an amount of less than 10,000 USD from DePuy Synthes (Raynham, MA, USA).

Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Received November 24, 2018

Accepted May 01, 2019

Online date: June 28, 2019

© 2019 Lippincott Williams & Wilkins LWW
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