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MAMC Journal of Medical Sciences

Original Article

Patients Preference for Doctor Attire in an Outpatient


Department of a Government Hospital in New Delhi, India
Sandeep Sachdeva, Neha Taneja, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To assess patients preference for preselected doctor attire in outpatient department (OPD) setting of a government hospital.
Materials and Methods: An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years)
ambulatory coherent patients. The brief questionnaire captured selected sociodemographic details of patients, department visited, and use of
aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in OPD wearing apron (white
coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the
possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. The patients were
shown four colored pictures each for male and female doctor in different dress. They were probed regarding their preference that they would
like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 =
professional formal. Result: The mean age of 547 patients was 35.34 (±12.81) years; 322 (58.9%) were males. Out of 547 patients, nearly 395
(72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were
actually wearing the apron in the outpatient department. Only 152 (27.7%) patients responded that it does not matter to them whether attending
doctor was wearing white coat (apron) or not. Majority of patients preferred male doctor to be wearing professional formal (42.3%) and
professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal
(37.5%), respectively. Casuals were the least preferred attire. Conclusion: It is reiterated that majority of patients in our OPD setting preferred
formal attire of attending doctor with apron, a clear and loud message for future physician in training.

Keywords: Attitude, physician attire, professional, white coat

INTRODUCTION of their patients preferred that their doctors should wear white
coat.[2-5] They accounted professionalism, easy identification
The white coat remains a powerful symbol of physician,
and hygiene as the reasons for their belief. Over the past 2
despite dramatic changes in medicine during the last century.
decades, there has been a declining use of the white coat, even
Wearing a white coat during the medical practice began in the
in the hospital setting.[6,7] For some authors, this decline has
late 1880s when surgeons began wearing white coats in their
quest for new “aseptic” methods. By the beginning of the 20th
century, the use of the white coat had spread to most
physicians and the white coat was firmly established as the Address for correspondence: Dr. Sandeep Sachdeva, Department of
“doctor’s uniform.”[1] The white color was specifically Community Medicine, North Delhi Municipal Corporation Medical College and
chosen to associate physicians with purity and cleanliness. Hindu Rao Hospital, New Delhi-110007, India.
White coats have been acknowledged as an integral part of E-mail: sachdevadr@yahoo.in
physician dress. Several studies have shown that 36% to 80%
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How to cite this article: Sachdeva S, Taneja N, Dwivedi N. Patients


DOI: Preference for Doctor Attire in an Outpatient Department of a
10.4103/mamcjms.mamcjms_31_18 Government Hospital in New Delhi, India. MAMC J Med Sci
2018;4:88-92.

88 © 2018 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow


Sachdeva, et al.: Doctor attire in hospital

been so marked that the “white-coated” doctor is now satisfaction with outpatient hospital services. Taking the 95%
considered an “endangered species.”[2] confidence level with ±5% precision and using the formula,
the desired sample size computed was 384 patients.
It has been now established that physician attire and dressing
However, we were able to mobilize more than the desired sample
style has an important role in the relationship and
size and cover 550 study patients.
communication with his patients.[8] Since the time of
Hippocrates, doctors have been given advice on the way Ananonymous, predesigned,pretested, semistructured interview
they should dress.[9] However, there are conflicting findings schedule was administered to adult (>18 years) ambulatory
in the literature about the dressing style of physician. Some coherent patients after obtaining an informed consent and
studies reported that patients preferred to see their physician in ensuring nonduplication of same patients. We conducted the
traditional or formal dress, whereas others report to see their exit interview in a convenient, comfortable, confidential, and
doctor in more casual outfit.[10-13] British and American studies nonjudgmental manner among patients who agreed to participate
conducted up to the late 1990s showed that patients were more in the study. During the process of interaction, doubts were
comfortable with traditional styles of appearance, such as white clarified, appropriate health education and counseling was
coats, formal suits, short hair, shirts, and ties.[14,15] Casual items undertaken, and all possible help was also extended.
such as sandals, sports shoes, and jeans evoked negative The questionnaire captured selected sociodemographic details
responses. Other factors, such as neatness, smile, or facial of patients, department visited, and use of aprons (white coat)
expression, were also considered important and had the by attending doctor observed and desired practice. To the
potential to override the effects of attire.[16,17] There are item—“Was your attending doctor in outpatient department
limited studies available in India assessing the patients’ (OPD) wearing apron (white coat)?”, the possible response was
preference for doctor’s attire including white coat. With this yes/no. For the item—“Would you like to see your attending
background, a study was undertaken among patients visiting the doctor wearing apron (white coat)?”, again the possible answer
outpatient department of a government hospital to assess their was yes/no. When a patient responded to this item as “no,” we
preference for doctor’s attire. further explored their reason for the same. Based on a previous
study, the patients were shown four colored pictures each for
MATERIALS AND METHODS male and female doctors.[18] The patients were further probed
A cross-sectional study was conducted in a midlevel government regarding the preference of dress code/attire they would like to
hospital of New Delhi (India) between October and December see their attending doctor to be wearing. These attires were
2017. The present hospital is equipped with all the basic labeled as 1 = cool casual, 2 = casual, 3 = professional informal,
specialties and caters to local and nearby population from and 4 = professional formal [Figures 1 and 2].
primarily lower socioeconomic strata of society. The sample The attires included in the study were
size was estimated based on a conservative assumption that 50% Cool casual dress: Jeans and T-shirt with white coat
(P = 0.05) of patients reporting to hospital have overall Casual dress: Shirt–pant, out shirt, and slippers with white coat

Figure 1: Male doctor dress code

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Sachdeva, et al.: Doctor attire in hospital

Figure 2: Female doctor dress code

Table 1: Use of apron by doctor in outpatient department as reported by patients


Doctor wearing apron (white coat) in OPD Total
Yes No
Would you (patient) like to see your attending doctor Yes 195 (49.4%)(76.1%) 200 (50.6%)(68.7%) 395 (100%)(72.2%)
wearing apron (white coat)? No 61 (40.1%)(23.8%) 91 (59.9%)(31.2%) 152 (100%)(27.7%)
Total 256 (46.8%)(100%) 291 (53.2%)(100%) 547 (100%)(100%)
P = 0.052; table showing both column and row percentage. OPD, outpatient department.

Professional informal dress: Shirt–pant tucked in and shoes Out of 547 patients, nearly 395 (72.2%) wanted (desired) to
with white coat see their attending doctor to be wearing apron; however, only
Professional formal dress: Shirt-pant, tie, and shoe with white 256 (46.8%) reported that attending doctors were actually
coat wearing the apron in the outpatient department; nearly 152
Cool casual dress: Jeans and T-shirt with white coat (27.7%) patients responded that it does not matter to them
Casual dress: Salwar and jeans with white coat whether attending doctor was wearing white coat (apron) or
Professional informal dress: Salwar kameez with white coat not. Details are shown in Table 1 and Figure 3.
Professional formal dress: Sari with white coat
Out of 547 patients, majority preferred male doctor to be
The data were analyzed using SPSS (IBM, New York, New wearing professional formal (42.3%) and professional
York, USA) ver. 20.0 software by calculating descriptive and informal (40.9%) attire, whereas for female doctor, also
bivariate statistics. However, three case records were found to majority preferred professional formal (38.7%) and
be incomplete at the end of survey, and hence, a total of 547 professional informal (37.5%), respectively. Details are
were finally analyzed. shown in Table 2 and Figure 4.

DISCUSSION
RESULTS Our cross-sectional descriptive study conducted in a
The mean age of 547 patients was 35.34 (±12.81) years; the government hospital of New Delhi (India) among 547
age distribution was as follows: 241 (44.1%) between 18 and patients constituting a mix of young and middle-aged
30 years, 236 (43.1%) between 31 and 50 years, and 70 population from low socioeconomic strata visiting outpatient
(12.8%) above 51 years; 322 (58.9%) of patients were males; department during October to December 2017 reported only
466 (85.2%) were Hindu by religion. Regarding department, about half (46.8%) of the attending doctors were wearing apron.
146 (26.7%) visited surgery department, 161 (29.4%) However, as high as 72.2% patients desired that they would like
medicine, 83 (15.2%) orthopedic, 62 (11.3%) dermatology, to see their attending doctor wearing apron, whereas remaining
etc. (27.7%) patients responded that it does not matter to them

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Sachdeva, et al.: Doctor attire in hospital

Figure 3: Patients preference for doctor wearing apron (white coat)

Table 2: Preference of patients for doctor’s attire


Variable Patients preference for doctor’s attire
Cool casual Casual Professional informal Professional formal
Overall preference among patients (n = 547)
Attire M (male) doctor 40 (7.3%) 52 (9.5%) 224 (40.9%) 231 (42.3%)
Attire F (female) doctor 54 (9.9%) 76 (13.9%) 205 (37.5%) 212 (38.7%)
Response of male patients (n = 322)
M-doctor attire 20 (6.2%) 28 (8.6%) 134 (41.6%) 140 (43.4%)
F-doctor attire 23 (7.1%) 43 (13.3%) 132 (40.9%) 124 (38.5%)
Response of female patients (n = 225)
M-doctor attire 20 (8.8%) 24 (10.6%) 90 (40.0%) 91 (40.4%)
F-doctor attire 31 (13.7%) 33 (14.6%) 75 (33.3%) 86 (38.2%)

whether the doctor was wearing white coat (apron) or not. With accordance with many previous findings including Landry,
regard to attire, majority of patient’s preferred formal dress for Rehman, and Abha who found that 69.9%, 76%, and 82.3% of
male (83.2% with/without tie) and female (76.2% Indian sari/ the patients in their study preferred white coats for their
salwar kameez) doctors, respectively. doctor.[20-22] It is reported that patients felt more confident
and communicated better with doctors who wore white coats.
The size of our study provides a good cross-section of
Likewise, patients rated images of doctor with apron higher
opinions and gave sufficient power to detect small
than those of casual attire in measures for comfort and
differences in patient preferences. However, some
perception of competence.[23,24] The current available
limitations of this study are regarding the photograph of
evidence has not conclusively linked white coats with
doctor dress; the age of physician may have been a
increased infection rates. However, 2007 dress code
confounding factor. Photographs in our study were of a
guidelines in England were issued banning white coats and
younger looking physician, and it is unclear whether the
bare-below-the-elbow policy for all workers in the hospitals;
respondents would have given the same importance to
however, detailed scrutiny on the risk of infection
attire if the photographs had shown older physicians. In
transmission and objections eventually led to revision of
addition, studies have demonstrated the importance of
these guidelines in 2010.[21]
physician attire in patient perceptions. However, the
influence of a particular style of attire may last only a The genesis of this study emerged by authors sustained
short time and needs further clarification whether clothes observance of unprofessional attire and conduct of our
can influence long-term patient–doctor relationships.[19] The medical students during last 10 years. Our college is
seasonality factor may be another determinant among doctor geographically situated near different Delhi University
for wearing apron. Recall bias may not be applicable in our colleges (arts, commerce, management courses, etc.) where
situation, but heterogeneous patient mental agility and dress and attire of students is not an issue but has a wider
attention may have an influence. These findings are in influence and ramifications on our medical students.

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Sachdeva, et al.: Doctor attire in hospital

Figure 4: Patients preference for doctor’s attire in outpatient department

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Conflicts of interest
of house officers. Am J Dis Child 1987;141:830.
There are no conflicts of interest. 18. Sudhir KM, Mohan GC, Fareed N, Shanthi M. Dental students’
perception towards dress code in a private dental institution in
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