Doctor’s clothing is a form of communication with the patient (and affects health)

If the habit doesn’t make the monk, the gown makes the doctor. Every follower of Hippocrates remembers how already in the first years of internship it was enough to wear it to be questioned by the relatives of hospitalized patients with questions that he would have been able to answer much better than the head nurse. Now comes there scientific confirmation of this common experience: researchers from 20 hospitals and medical practices in Italy, Japan, the United States and Switzerland have published in the British Medical Journal the largest international study ever conducted on this often overlooked aspect of medicine. Doctor’s clothing in fact one form of non-verbal communication capable of influencing the relationship with the patient that, even before he opens his mouth, he understands from what he is wearing how well prepared and reliable he is and whether he will be considerate and helpful with him.

Doctor-patient relationship

A good doctor-patient relationship is based on mutual respect, trust and acceptance of treatment by the patient and essential to make him feel at ease when discussing his personal problems. The strength of this relationship has a direct impact su his satisfaction with health care, impacting his health through greater adherence to treatment recommendations leading to a decrease in relapses within 30 days of dischargeor even a reduction in the mortality rate.

The research sample

Under the direction of Sanjay Saint and Nathan Houchens of the University of Michigan, 15 international researchers, including the three Italians Carlo and Stefano Fumagalli and Gianni Virgili of the University of Florence, collected the opinion of over 9,000 patients on clothing of those who treated them in three types of institutions: university hospitals and general medicine or in clinics and specialist studios. Spanning between 13 geographical areas, 4 countries and 3 continents they observed that according to the place of residence, opinions change and influence them are also the gender and age of the patients, as well as their level of education. A first age group of the interviewees ranged from 18 to 64 years and the second from 65 and over. The latter group constituted over a third of the total (36%) with variations from country to country: in Japan, for example, those aged 65 or over were 48.5%, while in Italy 27.8%. Almost half of the patients were women (44.9%), many of whom had a diploma or degree (39.6%).

I study

The study was conducted by distributing a paper form with 22 questions in the local language and photos of a male or female doctor in various types of clothing on which they were asked to express their preference. The doctors photographed had constant expressions with consistent framing for lighting, background, pose, etc. To avoid the so-called anchoring phenomenon whereby the first choice influences the subsequent ones, the gender of the doctor in the first photo to be judged was randomly assigned. Evaluations were based on a scale of 1 to 10 with which patients could express the value that clothing inspired in them on five prerogatives: c
Expertise, reliability, thoughtfulness/attention, availability/accessibility, empathyto. They were later provided 7 photos of the same doctor with various types of clothing and patients had to choose the most suitable for various clinical contexts: the general practice, the emergency room, the hospital ward, the surgical theatre, etc. These preferences were evaluated with the Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

National differences

Comparing the responses of the patients found that, although the lab coat is universally considered the symbol of the medical profession, what is underneath the lab coat also counts and it is precisely on this that the choices of patients differ. Italians and Japanese, for example, agree on almost everything, but under the gown, Italians prefer serious and sober formal clothing such as a t-shirt or shirt without a tie and, in the case of a female doctor, a blazer with trousers or a skirt. Formal clothing is the absolute favorite of American patients, even without a lab coat, as the many medical TV series have shown us, from the old ER to the more recent Grey’s Anatomy or The Good Doctor. Things change in Switzerland where patients, in addition to casual clothing, like to see the characteristic green or blue scrub tunic under the gown that we are more used to seeing surgeons wearing in operating rooms who sometimes also wear it in blue. Not anyway the scrub uniform got the most patient preference for ER doctors (44.2%) and for surgeons (42.4%). The survey highlighted different preferences depending on the doctor: for hospital patients, the scrub jacket is in fact preferred not only by Swiss patients, but also by Italian patients who, moreover, like it in 8.8% more cases.

Formal wear

As for i general practitioners a formal wear under the coat preferred by Italians and Americansi (31.6 and 46.8% respectively), while the Japanese and Swiss especially like doctors who wear casual under their lab coat (34.1 and 24.4% respectively). Patients may not appreciate extreme clothing such as those that are too casual such as overalls or, conversely, those that are too elegant: the double-breasted and bow tie under the coat can inspire excessive detachment and little empathy. Colleagues Sanjay Saint and Nathan Houchens have been dealing with these aspects of assistance for some time, collaborating above all with Swiss centers – concludes Stefano Fumagalli, professor of geriatric internal medicine at the University of Florence and Italian co-author of the study -. Professor Saint has also raised awareness of the WHO on the expectations that patients have on the clothing of their doctors. Although these vary according to socio-cultural norms, context and individual personality, in some cases such as for doctors in the emergency room and for surgeons, they are almost universal. But if preferences vary, seek a tailored approach that matches clothing to context by cultivating a relationship with the patient that increases patient satisfaction, confidence, expectations, and health outcomes.

The impact on care outcomes

Always on British Medical Journal a 2019 study by Portuguese researchers directed by Joao Firmino-Machado of the University of Porto indicates how aappearance and behavior of the doctor they can improve also the age-old problem of compliance, acceptance of therapy. The secret is to present yourself well, so much so that in the studio they use phrases like the first impression that counts. The patient’s expectations towards the doctor and the perception he has of them are constantly linked to how he presents himself to him, a mental attitude underlined by researchers at the Harvard Medical School in Boston since 1987 when they called for the development of deontological guidelines of decorum in professional clothing to improve patient satisfaction which resulted related to improvements in medication adherence and clinical outcomes.