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The Impact of Physician Demographic Characteristics on Perceptions Of ORIGINAL ARTICLES The Impact of Physician Demographic Characteristics on Perceptions of Their Attire Paula Varnado-Sullivan, PhD; Michele Larzelere, PhD; Kaly Solek, MA; Shalinder Gupta, MD; Jackson E. Hatfield, MD; Mohammad H. Cheema, MD; Matthew Delfino, MD, MBA BACKGROUND AND OBJECTIVES: Few studies address the impact of physi- preferences for physician attire.6 His- cian attire on ratings of personality characteristics in the presence of varied torically, patients—particularly older physician demographic characteristics (gender, racial/ethnic background). Even ones—preferred physicians wear pro- fewer have examined the boundaries of acceptable physician attire, given re- fessional clothing (collared shirt/tie/ cent loosening of societal standards of dress. slacks, blouse/skirt or slacks) with a white coat and stethoscope.7-11 Afri- METHODS: Using an online survey methodology, adult participants (N=505; 45% medical professionals) were recruited. Participants rated target photos de- can-American patients placed great- picting a male and female individual from three ethnic/racial categories each er importance on the appearance of dressed in business casual (with and without a white coat) or in professional their physician than did Caucasian 8 attire (with and without a white coat) on a number of personality character- respondents. Prior research, how- istics. General willingness to have physicians wear certain apparel items was ever, did not consider how physician- also queried, as was the importance/acceptability of specific clothing items perceived attractiveness or ethnicity and appearance choices. Responses were analyzed by gender, age, ethnicity, might influence results. and profession of respondent. Only a few studies of physician at- tire have considered changing pro- RESULTS: Both business casual and professional attire were rated highly. A vider demographics. For example, name tag had the highest ratings for importance of wear. The results for wear- judgements of non-Caucasian and fe- ing a white coat were not as consistent as earlier studies as physicians were male physicians may be more heav- perceived as warmer and kinder when not wearing a lab coat, particularly with ily influenced by clothing choices.8 professional attire. However, female Caucasian physicians were rated most posi- Female professionals may face great- tively when wearing a lab coat. Consistent with previous studies, attire that was too casual (jeans, t-shirts) was rated negatively. er challenges given a wider variabil- ity of clothing options and rapidly CONCLUSIONS: The current study supports the notion that rules of attire are changing trends. For example, hav- changing, even in the physician’s office. Name tags were perceived to be cru- ing bare legs with dresses/skirts has cial in medical settings, and casual clothing should be avoided. Despite often not been examined as previous stud- being considered a defining component of a physician’s “uniform,” the white ies specified “dress with nylons.”11 In lab coat may not be a universal positive and perhaps even a negative for some addition, female physicians may be physicians. more easily mistaken for other mem- (Fam Med. 2019;51(9):737-41.) bers of the clinical care team when 12 doi: 10.22454/FamMed.2019.650493 wearing certain clothing items. Published Online First August 26, 2019 Additional research is needed to examine this potential mispercep- tion. Physician opinion of colleagues’ ppearance plays a significant be unattractive.1-2 Attire telegraphs dress is also important. Even if more role in social interactions. For cultural markers such as status and example, positive personali- profession.3 Physician attire is one of A From the Department of Psychology, ty characteristics are often attrib- the first markers of professionalism Southeastern Louisiana University, Hammond, uted to people rated as attractive, that patients experience.4-5 Changes LA (Dr Varnado-Sullivan and Ms Solek), and Louisiana State University Family Medicine while negative attributes are as- in societal dress standards warrant Residency, Kenner, LA (Drs Larzelere, Gupta, signed to individuals perceived to investigation of patients’ current Hatfield, Cheema, and Delfino). FAMILY MEDICINE VOL. 51, NO. 9 • OCTOBER 2019 737 ORIGINAL ARTICLES casual dress was preferred by pa- 18 years old or not fluent in Eng- with a mean age of 30.03 years tients, standing among one’s peers lish were excluded. Insitutional re- (SD=13.09; range 18-78 years). For- may be diminished by casual dress. view board approval for the study ty-five percent worked in the med- Prior research has suggested that was obtained from all participating ical field (physician 9%, resident physicians favor traditional appear- institutions, and participants provid- physician 11%, medical student 2%, ance among their colleagues,13 with ed informed consent prior to starting nurse 5%, allied health 3%, other older physicians holding stronger the online survey. 15%). Caucasian/European partic- traditionalist views than younger Nonphysicians of similar ages in ipants comprised 63% of the sam- physicians.11 However, research to six demographic categories (male ple. The remainder of the sample date has not examined physician or and female in three ethnic/racial self-identified as African American patient attitudes about nontradition- categories: Caucasian, African Amer- (12%), Asian/Southeast Asian/Pacific al forms of physical self-expression ican, Indian American) were pho- Islander (5%), Hispanic/Latino (4%), (eg, tattoos, that are becoming more tographed in four modes of attire. Indian Subcontinent (3%), American common). Nonphysicians were used to ensure Indian/Alaskan Native (1%), Middle Previous studies of physician at- participants would not know the Eastern (1%) and African (<1%). The tire have not controlled for physician pictured physician or target. Attire remainder did not specify or chose appearance. Further, these studies was business casual (pullover shirt, “other.” did not consider the changing demo- pants), business casual with a lab graphics of the medical profession. coat, professional (button down shirt, Data Analysis Therefore, the purpose of this study pants), and professional with a lab Data were analyzed using SPSS 22. was to evaluate perceptions of physi- coat. Neutral facial expressions were Multivariate analyses were used to cian dress by physician gender and held. Those photographed were cho- examine hypotheses related to phy- race, while accounting for perceived sen to represent an average appear- sician attire. An initial analysis in- attractiveness. How these character- ance that was determined through dicated that attractiveness ratings istics impacted perceived role and pilot testing. Finally, participants for the images were found to differ comfort with the physician were ex- were asked if they knew the person significantly, with the female photos, amined, as were preferred clothing in the photograph, and yes responses particularly the Caucasian female, type for physicians and other factors were excluded from analyses. being rated more attractive than such as wearing a name tag. Based Participants were randomly as- the males (F [5, 496]=28.25; P<.01 upon prior research,8 it was hypothe- signed to view one of the photo- [Table 1]). Therefore, multivariate sized that non-Caucasian and female graphs. After viewing the image, analyses of covariance (MANCO- clinicians would be judged more neg- they rated the targets on 15 attri- VA) were conducted with attractive- atively when dressed casually. It was butes (eg, kind, competent, profes- ness entered as the covariate for the also hypothesized that medical per- sional, intelligent) using a 7-point primary hypotheses and follow-up sonnel would prefer more traditional Likert scale, as well as for per- analyses by subgroups (medical pro- physician attire and a more standard ceived attractiveness. Participants fessionals, age, physicians only). All physical appearance. It was expected were also asked to indicate the as- post-hoc analyses were conducted by that age would impact ratings for at- sumed health care role of the target examining the Bonferroni-corrected tire and appearance in that both old- (eg, physician, nurse, reception- pairwise comparisons of estimated er medical professionals and patients ist, etc) and their comfort discuss- marginal means. would prefer a more traditional ap- ing physical, emotional, and sexual pearance for physicians. health with the target. Participants Analyses of Physician Attire rated the acceptability of a variety of A principal components factor anal- Methods clothing items for physicians across ysis with Varimax rotation was con- An online survey methodology was settings and chose their preferred ducted on the 15 attributes used in used and all responses were anon- manner of dress for their outpa- rating the target. Two factors were ymous. Subjects were recruited tient physician. Finally, the impor- indicated that accounted for 78% of through flyers in a primary care tance of certain appearance factors the variance. Professionalism had outpatient clinic in a southern city, (eg, wearing a tie, wearing a name an eigenvalue of 10.60, and includ- as extra credit opportunities at a tag, visible piercings, visible tattoos) ed the characteristics professional southern 4-year college, and via ap- in their judgment of a physician was (.79), intelligent (.79), driven (.80), peals on listservs and emails to gar- assessed. disciplined (.84), self-confident (.67),
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