 |
|
Patients' Attitudes Regarding Physical Characteristics of Medical Care Providers in Dermatologic Practices
Matthew H. Kanzler, MD;
David C. Gorsulowsky, MD
Arch Dermatol. 2002;138:463-466.
ABSTRACT
| |
Objective To assess the present attitudes of patients toward physicians' physical
attributes.
Design Written survey offered to all patients seen during a 1-week period.
Setting Two outpatient dermatologic clinical practices (a county hospital and
a private practice).
Participants Of 315 patients offered the survey, 275 agreed to complete it.
Main Outcome Measures Opinions regarding physicians' demographic characteristics and opinions
regarding desirability of 19 and 18 appearance-related characteristics in
male and female physicians, respectively.
Results Analysis of the responses revealed 25 characteristics that were significantly
desirable or undesirable (defined as being selected desirable or undesirable
by at least 25% of respondents). Further analysis revealed that patients in
a private practice setting typically had more polar opinions about providers'
appearances than did patients from a large county hospital. Most patients
had no preference with regard to the sex, age, or race of their medical care
providers. Age and sex of the patient did not independently contribute significantly
to patient preferences, as determined by cross-tabulation analysis. Clinic
site (private practice vs county hospital clinic) alone was the sole or most
important predictor of preferences in 13 of the 25 significant characteristics.
Conclusions Several characteristics of providers' dress and grooming were important
to patients. There seemed to be little attitudinal change from similar studies
performed 2 decades ago. Cognizance of these preferences may facilitate better
interactions between medical care providers and patients.
INTRODUCTION
THE PRIMARY goals of the medical care provider are to prevent and treat
disease. This is most commonly accomplished through direct interactions with
patients. The information obtained from patients during this interaction must
be accurate and complete if we are to provide optimal care. Nonverbal cues
such as physical appearance might influence these short interactions, especially
for patients who have never met the provider previously. Increasing patient
comfort level during patient-provider encounters may facilitate the exchange
of information and hence improve patient care.
The medical care provider's appearance has been found to be a key symbol
that not only identifies the individual as a professional, but also defines
certain characteristics of the provider.1 A
carefully dressed provider might convey the image that he or she is meticulous
and careful. Alternatively, an unkempt appearance might convey impressions
of uncaring or disorganized behavior.1
Several studies from 2 decades ago addressed the subject of physicians'
appearance. Molloy2 found that the most desired
outfit for male physicians was a white coat with slacks, shirt, and tie. Female
physicians' desired characteristics were a white jacket with a male-tailored
shirt and dark wool skirt.3 Taylor4 found a strong association between physician dress
and parents' initial perceptions of physician competence in a pediatric setting
of a university-affiliated hospital. A large study by Gjerdingen et al1 confirmed the importance of the physician's appearance
in physician-patient communication. Patients gave positive responses to physicians
with traditional appearances. Desirable items in the presentation of male
physicians included dress shoes, groomed facial hair, shirt and tie, and dress
pants. Traditionally feminine items found desirable for female physicians
included nylon stockings, lipstick, makeup, skirts, and blouses. A white coat
and name tag identifying the individual as a physician were very desirable
in both sexes.
The public image of how physicians should look may have changed in recent
years because of the informal appearance of physicians on popular television
programs such as ER. The image of physicians portrayed
on ER is far different from that of past television
physicians such as Marcus Welby, MD, and Dr Kildare.
The purpose of the present study was to see to what extent, if any,
patients' views have changed over the past generation with regard to the importance
of physical appearance of physicians. We chose to use the term "medical care
provider" instead of "physician" in our survey since other professionals such
as physician assistants and nurse practitioners now render many services.
In addition, we queried how various demographic characteristics such as race,
education, and income level affected patients' responses. We hoped that information
gleaned from this study would help future providers to better meet patients'
needs.
METHODS
DATA COLLECTION
Questionnaires were distributed to all patients seen in 2 dermatologic
practice settings during 1 calendar week of February 2000: (1) a part-time
private practice office in Fremont, Calif; and (2) an outpatient clinic in
a large county teaching hospital in San Jose, Calif (Santa Clara Valley Medical
Center). Both of these practices were primarily medical dermatology practices
and did not specialize in cosmetic procedures. This type of practice was chosen
to minimize the effect of attitudes that might be present in patients with
greater-than-average cosmetic concerns.
In addition, these 2 settings were compared because, while both practices
were staffed by the same physicians (thus lessening selection bias with regard
to the caregivers), one group of patients (private practice) in theory "selected"
its caregiver, while the other group (county hospital) typically had little
choice in selecting the provider. Questionnaires were available in English,
Spanish, and Vietnamese (the 3 major languages spoken in the geographic areas).
The questionnaires asked for demographic data of the patients as well
as their opinions about various general visual characteristics of providers
in the office/outpatient setting. Requested demographic traits of the respondents
included their age, race, sex, level of education, and type of insurance coverage.
Patients were asked which characteristics they preferred in a medical
care provider with regard to sex (male, female, or no preference), age group
(20-40, 40-60, >60 years, or no preference), and racial background (white,
black, Hispanic, Asian, or no preference). In addition, several physical characteristics
(eg, items of dress and grooming) were evaluated as desirable, neutral, or
undesirable. These characteristics were selected because of their having been
used in previous research. For both sexes, the items were name tag, white
coat, sport coat/blazer, dress pants, blue jeans, surgical scrubs, dress shoes,
tennis shoes, clogs, sandals, traditional hairstyle, and nontraditional hairstyle.
For male providers, patients were queried about open shirt, long hair/ponytail,
mustache, beard, cologne, and earrings. Finally, for female providers, items
were perfume, nylon stockings, lipstick, and makeup.
STATISTICAL ANALYSIS
Data were initially analyzed for all patient responses. Cross-tabulation
analyses were performed between patient age and preference for provider of
a certain age, patient race and preference for provider race, and patient
sex and preference for provider sex. Frequency analyses were performed for
all items of dress or grooming characteristics on the questionnaire.
There exists no predetermined "level of significance" for frequency
analyses. Intuitively, a physical characteristic identified by most respondents
as "neutral" would not be deemed a significant (desirable or undesirable)
physical characteristic of medical care providers. To determine at which point
a physical characteristic would be considered significant, 20 physicians at
one of the 2 clinics (Santa Clara Valley Medical Center) were asked the following
question: "What is the percent of respondents who would have to view a characteristic
as desirable or undesirable before you would feel obliged to display or refrain
from displaying that characteristic?" All responses were either 1 (25%) in
4 patients, or 1 (33%) in 3 patients. Therefore, these percentages were arbitrarily
chosen to determine which items of dress or grooming were deemed significant.
Physical characteristics found to be significantly important by these
criteria were then further analyzed to determine if differences in opinion
regarding their importance were present between various subsets of the patient
population. The following bivariate demographic groups were analyzed: college/graduate
school vs elementary/high school education; white vs other race; private clinic
vs county hospital clinic setting; age younger vs older than 40 years; and
insurance coverage via private vs indigent programs. The last grouping was
used to approximate patients' level of income.
A condition of qualifying for public assistance insurance at the time
of this study was a maximum yearly income of $8352 for an individual, or $17 052
for a family of 4. Private insurance, when present, was provided almost exclusively
through employers, and the average annual salary for workers in the immediate
geographic area (colloquially known as Silicon Valley) at the time of this
survey was $53 700.
Cross-tabulation analysis was performed between each dependent variable
(eg, blue jeans) and each demographic feature (eg, level of education). Those
demographic features determined by cross-tabulation analysis to contribute
individually to patient preferences were further subjected to stepwise linear
regression analysis against the various dependent factors to determine which
demographic features were most important in predicting patient preferences.
All analyses were performed using the SPSS statistical program (SPSS Inc,
Chicago, Ill).
RESULTS
A total of 275 of the 315 patients seen during the week agreed to complete
questionnaires: 84 from the private practice setting (25 refusals; 77% response
rate), and 191 from the county hospital clinic (16 refusals; 92% response
rate). Reasons for refusal were not identified. Demographic data of the patients
are presented in Table 1. Significant
differences between the 2 patient populations (private practice vs county
hospital clinic) were noted for class of insurance (Pearson  21 = 81.6; P<.001), level of education (Pearson 21 = 9.0; P = .002), and race (Pearson 23 = 25.7; P<.001). No significant
differences were noted between the groups with regard to age (Pearson 22 = 1.5; P = .48) or sex (Pearson 21 = 0.5; P = .48).
|
|
|
|
Table 1. Demographic Features of Responding Patients*
|
|
|
The questionnaire responses revealed that most patients had no preference
with regard to the sex, age, or race of their medical care provider. Fifty-seven
percent of all respondents had no preference regarding the age of their provider.
Of the patients who did show a preference for a specific age in a provider,
approximately half wanted a provider in his or her own age category, while
half wanted a provider 40 to 60 years old.
Sixty-six percent of both male and female patients had no preference
regarding the sex of their provider. Twenty-nine percent of male patients
preferred a male provider, while 31% of female patients preferred a female
provider.
Seventy-four percent of white and 80% of Asian patients had no preference
in the race of their provider, while 58% of Hispanics voiced no preference
in this characteristic. Those patients with a preference wanted providers
of their own race. An interesting finding was that while the number of Hispanic
patients requesting Hispanic providers seemed high, this preference disappeared
when these patients were analyzed according to the language in which their
questionnaire was printed. Only 17% of English-speaking Hispanic patients
requested a Hispanic provider, while 65% of Spanish-speaking Hispanic patients
requested someone of that group. Therefore, the ability to speak the same
language seemed more important to patients than the race of the provider.
Twenty-five physical characteristics of male and female medical care
providers were deemed either desirable or undesirable by at least 1 (25%)
in 4 respondents (Table 2). Many
characteristics actually surpassed 1 (33%) in 3 levels, and these highly desirable
or undesirable characteristics are also noted.
|
|
|
|
Table 2. Provider Characteristics Deemed Significant, With Totals From
Survey, by Sex of Provider*
|
|
|
Stepwise linear regression analysis was performed using each of the
25 desirable/undesirable characteristics as dependent variables to determine
whether patients' demographic characteristics predicted preferences for providers'
appearance. Age and sex of the patient did not independently contribute significantly
to patient preferences using cross-tabulation analysis. Therefore, only clinic
site, level of education, race, and type of insurance were chosen as independent
variables. Clinic site (private practice vs county hospital clinic) alone
was the sole or most important predictor of preferences in 13 of the 25 significant
physical characteristics. Level of education was a significant predictor for
4 dependent variables, level of income (insurance class) for 4 dependent variables,
and race for 3 dependent variables.
COMMENT
We have confirmed findings from studies conducted in other settings
2 decades ago.1-4
Despite a general trend in Western society toward more casual attire in public,
very little change has occurred in patients' preferences regarding the preferred
attire of their medical care providers. Patients in the current settings still
find very traditional attire (eg, name badge, white coat, dress shoes, etc)
preferable for their providers, while finding casual attire (eg, blue jeans,
clogs, sandals, etc) undesirable.
One might expect younger patients to show less preference about the
appearance of their medical care providers. However, interestingly, the age
or sex of the respondents did not affect this preference. Responses from different
racial groups were also extremely uniform with regard to this characteristic.
The most significant factor determining patients' preferences was the
setting at which they were seen. However, the differences were merely in degree
of preference. No factor was found to be desirable at one clinical setting
and undesirable at the other. Patients from the private practice setting found
desirable characteristics more desirable than their counterparts at the county
hospital clinic, and undesirable characteristics more undesirable. Significant
differences were noted between the 2 populations with regard to race, level
of education, and income (insurance classification). Stepwise linear regression
analysis revealed that the clinic setting was more important in determining
views than any other item analyzed individually. Therefore, the interaction
of individual demographic factors was more important than any 1 factor itself.
Most patients had no preference with regard to the sex, age, or race
of the provider. Not surprisingly, the minority of patients with a preference
preferred a medical care provider with demographic features similar to their
own. The ability to speak the same language seemed more important to patients
than the actual race of a provider.
This study was carried out in an outpatient medical specialty setting
(dermatology). However, both clinical settings catered to patients referred
by primary care providers for medical dermatologic problems rather than patients
seeking cosmetic consultation. While our findings are similar to findings
from a similar study carried out in a primary care setting,1
these results may not be applicable to all clinical settings. For example,
preference for female providers might be found in a gynecology practice, and
surgical scrubs may not be considered undesirable in a surgical clinic.
Based on the results of this study, to best serve their patients, medical
care providers in similar settings should wear a name badge, white coat, and
dress shoes and should avoid wearing blue jeans, clogs, and sandals while
on duty. Male providers should also wear dress pants and avoid open shirts,
long hair/ponytails, and earrings. These characteristics were preferred or
frowned on, respectively, by more than 1 in 3 patients, and thus may be considered
minimum requirements in standard dress code policies.
Other suggested characteristics found desirable by at least 1 in 4 patients
include traditional hairstyles for both sexes and skirts/dresses or dress
pants for female providers. Tennis shoes were found to be undesirable for
both sexes by at least 1 in 4 patients, as were surgical scrubs, cologne,
and nontraditional hairstyles for male providers.
The results of this study show that some physical characteristics of
medical care providers are important to patients. Respecting patients' preferences
with regard to physical appearance might help put the patient at ease during
the history and physical examination.
AUTHOR INFORMATION
Accepted for publication September 6, 2001.
Corresponding author: Matthew H. Kanzler, MD, Division of Dermatology,
Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128 (e-mail: kanzlerm{at}yahoo.com).
From the Departments of Dermatology, Stanford University School of
Medicine, Stanford, Calif (Drs Kanzler and Gorsulowsky), and University of
California at San Francisco (Dr Gorsulowsky); and Division of Dermatology,
Santa Clara Valley Medical Center, San Jose, Calif (Dr Kanzler).
REFERENCES
| |
1. Gjerdingen DK, Simpson DE, Titus SL. Patients' and physicians' attitudes regarding the physician's professional
appearance. Arch Intern Med. 1987;147:1209-1212.
ABSTRACT
2. Molloy JT. Dress for Success. New York, NY: Warner Books; 1975:30-50, 210-212.
3. Molloy JT. The Woman's Dress for Success Book. New York, NY: Warner Books; 1977:112-114.
4. Taylor PG. Does the way housestaff physicians dress influence the way parents
initially perceive their competence? Pediatr Notes. 1985;9:1.
RELATED ARTICLE
Physician Appearance Is a Matter of Trust and Responsibility
W. Mitchell Sams, Jr
Arch Dermatol. 2002;138(4):518.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
The Physician's Attire and Its Influence on Patient Confidence.
Budny et al.
J. Am. Podiatr. Med. Assoc. 2006;96:132-138.
ABSTRACT
| FULL TEXT
On the Value of an Old Dress Code in the New Millennium
Brandt
Arch Intern Med 2003;163:1277-1281.
FULL TEXT
Are Ties Essential for Good Dermatologic Practice?
Burgdorf
Arch Dermatol 2002;138:1515-1515.
FULL TEXT
No Casual Fridays for Healthcare Providers
JWatch Women's Health 2002;2002:6-6.
FULL TEXT
Physician Appearance Is a Matter of Trust and Responsibility
Sams
Arch Dermatol 2002;138:518-518.
FULL TEXT
|
