Abstract
Objectives: To assess Saudi mother’s preferences regarding Saudi children’s physicians’ attire, and its influence on the parents’ level of trust and confidence.
Methods: A cross-sectional survey was conducted from January to April 2014. Our sample comprised mothers of pediatric patients in both inpatient and outpatient settings at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Mothers answered multiple questions, including their preferences regarding male and female pediatric physicians’ attire, their preferences regarding their children’s physician’s gender, and the impact of physician’s appearance on mothers’ confidence.
Results: There were 259 female participants. Of all caregivers, 51.4% were 32-years-old or younger. Of those, 170 (65.6%) were educated (had completed high school or higher). Forty-four percent preferred that male physicians wear scrubs, while 5.4% preferred formal attire (tie, shirt, and trousers) and 27.8% preferred Saudi national attire (Thobe and shemagh). Most caregivers (57.9%) preferred that female physicians wear long skirts. Most caregivers (87.6%) preferred physicians to wear a white coat. Most (89.2%) believed that a physician’s appearance is very important.
Conclusion: Gender of the treating physician is insignificant to mothers. However, the level of trust in a physician is related to his/her external appearance. Most mothers prefer their children’s physicians to wear scrubs.
A good doctor-patient relationship must have a strong foundation to foster trust and allow good care provision. It is very challenging to gain patient’s trust to optimize the most significant healthcare outcomes within the goal of treatment.1 Therefore, physicians much desire the most beneficial strategies that help in gaining patient’s confidence. Several studies have measured patients’ perceptions and preferences concerning their physician’s attire. Some studies suggest that whether a doctor wears a white coat can have an important influence on the development of the physician-patient relationship and help gaining patient trust and satisfaction.Physicians traditional attire1-3 which were the white coats and ties, but today different types of attire has become more common. Medical practitioners appear with more casual dresses in their working time along with white coats. Well-dressed physician may provide an impression that patient contact is an important event and that it takes time to prepare for it, whereas the disheveled physician can be perceived as unskilled and incurious.4-6 In a pediatric population, the appearance of a pediatrician is a crucial element that may affect the trust and the comfort of both children and parents. This study was aimed to assess Saudi parent’s preferences and perceptions for their children regarding Saudi physician’s attire, and to evaluate the influence of physician’s attire on the parents’ level of trust and confidence in their children’s physicians.
Methods
This was a survey-based cross sectional study with convenience sampling technique, evaluating mothers preferences toward different physicians attire. The study was conducted from January to April 2014. Our study population comprised mothers accompanying their hospitalized children between birth to 14 years, in an inpatient pediatric service and mothers who were waiting for their children to be seen by a physician in the outpatient pediatric clinics at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia (KSA). We excluded all parents who were unable to answer the questionnaire due to acute illness or dementia, or those who refused to participate in the study. Two trained female medical students conducted face-to-face interviews.
The Institutional Review Board of King Abdullah Research Center Research Center, Riyadh, KSA reviewed and approved our study. We reviewed the literature and adopted a survey that addresses parents’ preferences and perceptions of physician’s attire. We modified the survey to suit the Saudi local culture and attire. To ensure the clarity and suitability of the survey, we pretested our survey using 20 parents. The Questionnaire consists of 4 parts. First part, demographic data collection, including mother age, and educational level. Second part, asking the mothers to select her most and least preference for physician’s attire from different colored photographs presenting different styles of attire for both male and female physicians. The third part, consisted of questions related whether doctor’s clothing affect the mothers trust and confidence in doctor abilities and medical knowledge. Lastly, the mothers were asked how they would prefer the doctor introduce his/hem self, and whether or not to wear a white coat.
We analyzed data using Statistical Analysis Software (SAS®, SAS Institute, Inc., USA) version 9.2. We used descriptive statistics, including means, standard deviations (SD), and percentages. Demographic characteristics and the associations with patients’ preferences for physician’s attire were all analyzed using chi-square tests. We consider a statistical test to be significant if p<0.05.
Results
A total of 262 mother were approached, 259 agree to participate in the study, yielding response rate of 98% participants. Of those, 170 (65.6%) were educated (had completed high school or higher) (Figure 1). Most participants (44%) preferred that male physicians wear scrubs. Interestingly, only 5.4% preferred that male physicians wear formal attire (tie, shirt, and trousers). Saudi national attire (thobe and shemagh) was preferred in 27.8% of the time. The percentages of participants who did not prefer the male physician to wear scrubs, formal attire, or semi-formal were shown in Table 1. Most caregivers preferred that female physicians wear long skirts, whereas others expressed their preference for scrubs and pants. Most caregivers preferred that the physician wear a white coat. Most believed that how a physician displays himself or herself physically is very important. They thought physicians’ attire reflects respect for their patients.
Educational level of caregivers.
Caregivers’ preferences regarding physicians’ attire according to location (inpatient, or outpatient).
Respondents considered physicians’ attire aa a sign of degree of professionalism (90.3%), knowledge (68%), and confidence (65.6%). The percentage of caregivers who wanted their physician to wear a name tag was 91.1%. Moreover, 65.5% of participants would like to hear the doctors’ first and last name plus their title when they introduce themselves. Regarding gender preference, 59.5% expressed no preference, whereas the remaining preferred malin and female in physicians. Statistical analysis revealed significant differences between patient location (inpatient or outpatient) regarding caregivers’ preference for physician gender, and the effect of clothing on patients’ confidence in the physician, (p=≤0.001, p=0.004). More than half of the respondents (57.9%) preferred that female physicians not wear pants, with a statistically significant difference with respect to patients location (p=0.021) (Table 1). Of all caregivers, 51.4% were 32-years-old or younger. Statistical analysis revealed no significant relationship between the age of caregivers and their preferences for physicians’ attire. Moreover, there was no statistical significance regarding caregivers’ level of education and their preferences for physicians’ attire. However, highly educated caregivers were more likely to believe in the importance of physician appearance than less educated caregivers (68% versus 32%, p=0.009).
Discussion
The physician-patient relationship is considered as the foundation for all patient care and it depends on multiple factors including common culture definitions, evolving social norms, and physician professionalism. Physician appearance is a fundamental component of the general concept of physician professionalism. Patients’ first impressions of their physicians are based upon physicians’ verbal and nonverbal communication, as well as their personal appearance including clothing, grooming, and cleanliness. Our dress style is affected by many factors, such as weather, fashion, tradition, and culture. However, the white coat is symbolic of the physician.7-9 Several studies have measured patients’ perceptions and preferences concerning their physician’s attire. Some studies suggest that whether a doctor wears a white coat can have an important influence on the development of the physician-patient relationship.10 In New Zealand, a study revealed that patients prefer a semi-formal outfit for their treating medical doctor.11 Previously, it was thought that children may be disturbed and scared by physician coats; however, this appears to be inaccurate.12
A recent study evaluated patients attitudes to surgeons’ attire in the outpatient settings showed that the most of (419/612; 68%) patients felt it was appropriate for surgeons to wear scrubs while they were seeing them, but they showed no preference regarding their surgeon’s attire in different settings (71%). Approximately half of the patients felt that white coats should be worn (53%), and the minority of patients felt that their surgeon’s clothing influenced their opinion of the care that they received (37%).13 Another study conducted in an inpatient surgery setting showed that 69% of respondents stated that the white coat should be worn by surgeons, and 41% agreed that scrubs are appropriate attire while seeing patients; 35% disagreed and 24% had no opinion.14
In Japan, a recent study recruited patients from a variety of clinical departments asked patients to rank their preference for each different type of pictured attire, using a 5-point Likert scale from 1 (least) to 5 (most preferred). Most patients in Japan preferred a formal appearance with a white coat (76.7%), followed by surgical scrubs (19%), and casual and semi-formal equally (2.1%). Approximately 70% of the study participants reported that their physicians’ attire influenced their confidence in them.15 Respondents’ trust and willingness to discuss intimate social and sexual problems has been found to be significantly associated with their preference for professionally dressed doctors.7 Douse et al8 reported that 56% of patients felt that doctors should wear white coats.This finding was similar to those of Harnett 16 who found that 59% of oncology patients favored white coats.
In Saudi Arabia, most male Saudi physicians wear Saudi national attire (composed of a thobe and shemagh) during work, whereas most female Saudi physicians wear conservative dress (a long skirt and niqab [veil]) reflecting the conservative Saudi culture. A recent study in Saudi Arabia showed that most patients in medical clinics prefer formal attire for male doctors (62%) and long skirts for female doctors (73%). Only 9.7% prefer customary Saudi attire (Thobe and shemagh).17 Our findings showed that most parents prefer male physicians to wear scrubs while Saudi national attire was less preferred. On the other hand, parents prefer female physicians to wear long skirts more than they prefer scrubs, and most of them agreed on the importance of wearing white coats in the hospital for both female and male physicians.
Physician’s attire and physical appearance have an important influence on patients’ trust and perceptions of their physicians as the research literature and our data show. Another important aspect that should be considered regarding physician’s attire besides patient’s preference is the bacterial contamination and the risk of infection transmission. For example, wearing white coats by physicians have always been accepted practice but actually studies showed they may play a big role in transmitting infections within and outside hospital settings. An education regarding the risk of crossing infection should be carried out among health workers and patients. Also, educating patients regarding the significance of attire to cross-infection may change their preference to favor attires that have less likelihood to transmit infection without affecting their patient doctor relationship.18 Based on our results, pediatric physicians may consider wearing scrubs (skirts for female physicians), white lab coats, and name tags, and introducing themselves by their full name and title while seeing their patients’ parents to increase their comfort and trust in them and their knowledge. However, further studies are needed to confirm the validity of this study and evaluate the generalizability of its findings. Future studies would need to include a different multicenter hospital to detect possible differences in parents’ preferences and perceptions compared with the present study sample.
A larger sample size and inclusion of both parents (mothers and fathers) would increase the strength of our study findings. We also must acknowledge that our findings derive from one tertiary care center in the capital and may not reflect other communities or primary hospitals, and may not apply to all regions and cultures of Saudi Arabia. In a future study, we would like to determine if there are significant differences between inpatient and outpatient preferences. Additionally, we aim to include children’s perspectives on physician attire and study the differences between parents’ and children’s preferences. Furthermore, it would be interesting to see if meeting the child’s preference would have an effect on the child-physician relationship and on compliance with the management plan and medications.
In conclusion, most mothers prefer children’s physicians to wear scrubs. However, the gender of the treating physician was not shown to be of particular importance. In addition, the level of trust in a physician is related to his/her external appearance.
Ethical Consent
All manuscripts reporting the results of experimental investigations involving human subjects should include a statement confirming that informed consent was obtained from each subject or subject’s guardian, after receiving approval of the experimental protocol by a local human ethics committee, or institutional review board. When reporting experiments on animals, authors should indicate whether the institutional and national guide for the care and use of laboratory animals was followed.
Footnotes
Disclosure. Authors have no conflict of interest, and the work was not supported or funded by any drug company.
- Received August 2, 2016.
- Accepted November 2, 2016.
- Copyright: © Saudi Medical Journal
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