In terms of inspiring confidence and trust, participants rated a doctor’s speech, reputation and attire as quite important, but age, title and gender less so. However, each factor may make an important contribution to a patient’s judgment of his/her doctor. Shah and Ogden reported that patients consider age and gender to be important because these factors relate to personal manners, as well as technical and explanatory skills. In another study, the tone of voice was significantly associated with malpractice claim history, whereas Torres et al. found that a physician’s reputation is positively associated with patient trust and satisfaction. Many studies have investigated factors affecting patient faith in doctors. However, few studies have been comparative. In the present study, we show the importance of attire in relation to other factors. The importance of attire is not inferior, but actually rather high.
Our finding that patients tend to prefer that doctors wear white coats is similar to that reported by many other studies worldwide[1, 6, 7, 15–19]. Despite differences between countries, the white coat is a symbol of doctors, and it may create a sense of ease or confidence in patients. In the present study, only 5% of participants regarded the white coat as inappropriate. Considering that physician attire is important to patients, white coats are an appropriate clothing style for doctors.
In the present study, almost 40% of participants considered a semiformal style, which is often seen in Japanese hospitals, as less appropriate. The preference for this clothing style has varied among studies[1, 6, 14]. For example, Lill et al. reported that the semiformal was the favourite style in New Zealand, yet Yamada et al. found that patients do not like this style of clothing in Japan. The findings of Yamada et al. were echoed in the present study in other regions in Japan.
Patients tended to think that scrubs were almost as appropriate as white coats, but the inappropriateness of scrubs differed according to age and regions. Elderly people regarded scrubs as less appropriate than did younger people. The same finding has been reported in the UK. Doctors could consider this when attending elderly patients. With regard to the difference between regions, this could reflect different levels of recognition of scrubs, which are relatively new attire for doctors, although identifying such reasons was beyond the scope of the study design.
In 2007, the British Department of Health published guidelines for good practice regarding uniforms and work wear. Because cuffs become heavily contaminated and are more likely to come into contact with patients, the guidelines recommend wearing short-sleeved shirts or blouses and to avoid wearing white coats when providing patient care. Surgical scrubs are more hygienic and comfortable for doctors; thus, they may become more common attire in the future. In this case, it may be necessary to inform elderly patients of the medical virtues of this type of clothing.
There are several limitations to the present study. First, the response rate was only 35% and so there may be a problem with internal validity. However, the results (i.e. white coats and scrubs are the preferred clothing style) are similar to those reported in a previous study conducted in Japan. Thus, we think the reliability of the study is acceptable.
Second, we are unsure whether the pharmacies chosen for subject recruitment accurately represent the regions in which they are located or even all areas of Japan. Settings (inpatient vs outpatient), cultural differences and physician specialties may limit the applicability of our results regarding the preferences for doctors’ attire. However, the survey was conducted in three, not just one, regions of Japan to collect a wider sample.
Third, the colour of the scrubs (dark red) in the present study may have contributed to the generational reaction to them, with different colours perhaps eliciting different reactions. So, using only one colour for the scrubs is also a limitation of the study. Patients, especially elderly patients, may have found it odd that doctors were not wearing white clothing, although scrub colours vary. Because younger people have seen colourful scrubs in TV dramas, such as “ER”, they may not find the red scrubs incongruous. Thus, it may be necessary to clarify the relationship between patient age and their preference for the colour of physicians’ attire.
The present study has demonstrated the importance of physician attire in patient perceptions. However, the influence of a particular style of attire may last only a short time. Thus, it is necessary to clarify whether clothes can influence long-term patient–doctor relationships.