How a physician’s appearance influences treatment success

Physicians’ items of clothing are not just a matter of taste. The right outfit choice can even influence the success of treatment. This is shown by a study of hospital hygiene conducted by the Zurich University Hospital.

Attire’s style and color influence trust relationship and a patient’s adherence to instructions

Physicians’ items of clothing are not just a matter of taste. The right outfit choice can even influence the success of treatment. This is shown by a study of hospital hygiene conducted by the Zurich University Hospital.

A physician in a business suit, or in shorts? For most, this does not fit in with the image of the white coat. In a study, a team of researchers at the Zurich University Hospital, Switzerland, investigated which clothes physicians wear are most popular with hospital patients. However, the aim of the study was not to find out what visually pleases patients. Patients react - mostly unconsciously - to the appearance of physicians. If the physicians are very formal, patients may not have the courage to address problems on their own, and on the other hand, a casual outfit may lead to instructions for taking medication not being strictly followed.

"Clothing also has an influence on the success of the treatment. In the study, we, therefore, investigated which clothing among hospital physicians arouses confidence in patients, which clothing makes them feel accessible and caring, and whether they also attach professional competence to a certain outfit," explains Prof. Dr. Hugo Sax, Head of Hospital Hygiene at the Zurich University Hospital. The study, he remarked, seemed unusual at first sight.

In the hospital setting, white attire is still preferred

For their study, a hospital hygiene team interviewed patients from the outpatient clinics for dermatology, neurology and infectious diseases at the Zurich University Hospital using a standardized, anonymous questionnaire with pictures of a physician in various clothing combinations. 834 patients provided information.

More than a third of the participants stated that the appearance of their physician was important to them. A quarter thought that clothing also influenced their judgment of treatment. In a comparison of the different appearances, the combination of a white top and a traditional physician's coat is the preferred option. The white coat also scored best across all categories of "trust", "accessibility", "caring" and "expertise". White was also undisputed when it came to the question of which clothing physicians in hospitals should generally wear; depending on the area of use, coats (e.g. in consultation) or white tops (e.g. in the emergency ward) are accepted. "The white physician's coat is not just a tradition or a status symbol", Hugo Sax is convinced. "Because people with different medical professions appear in the hospital, the clothing helps to recognize and distinguish their functions.”

The conscious choice of clothing has received little attention so far

What conclusions does Sax draw from the study? "We were able to show that the appearance of physicians is perceived by patients - partly consciously and partly unconsciously. Because it can even have an effect on the success of the treatment, it is worth to adapt the clothing to the environment and the patients' expectations. This aspect has not been given much consideration in the choice of clothes so far," Sax says as a summary. 

The study confirms the results of 30 comparable studies that the research team around Hugo Sax systematically evaluated in addition to the survey. The surveys also showed that clothing has a great influence on the relationship between physicians and patients.

White or colorful, clean is the key

Which clothing is considered appropriate for physicians, however, varies according to environment and country. In the USA, physicians tend to wear formal clothing and men often wear shirts and ties under their smocks, while nurses work in simple, colored tops, or "scrubs". In Switzerland, medical staff in hospitals outside the operating theatre traditionally wear white. In general practitioners' surgeries, colorful clothing is increasingly worn, and if white, then rather a T-shirt; the physician's gown is now almost a rarity there. Whether this trend towards more informal clothing has a similarly positive effect as white clothing in hospitals has so far only been suspected and not investigated.

White or colored: Are there any hygienic objections to colored clothing? "Although it is easier to see impurities on white, green is usually worn in the surgical area because the color does not dazzle. But more important than the color are regular changes of clothes and hygiene measures such as hand disinfection,” indicated Sax.

Zollinger M, Houchens N, Chopra V et al. Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study. BMJ open 2019;9:e026009. 
doi: 10.1136/bmjopen-2018-026009.