Dress and deportment of medical residents: formal or informal?

Purpose: Health care workers, including physicians, have adopted more casual dress. The appearance of a physician may influence patients' opinion of physician knowledge, competence and trustworthiness. We hypothesized that medical inpatients and outpatients would rate these attributes higher in residents who dressed and acted in a more formal manner.

Methods: Prospective cohort included both inpatients and outpatients. One hundred thirty three patients, aged 62.3 ± 16 years, 49% of whom were female, were surveyed. One of two male resident physicians approached each patient, ostensibly to obtain consent to a brief mini-mental status examination. The physician was dressed, and acted, either "formally" (F) or "informally" (I). Patients then completed a six item questionnaire, using a 5 point Likert scale, to assess their confidence in the resident. Total scores could be 6 to 30. Total scores were compared using one-way ANOVA.

Results: Patients' perceptions were high for both F and I: 25.5 ± 3.1 vs. 24.1 ± 3.0, respectively (p=0.013). This difference was driven by the "lab coat" question: patients generally preferred physicians to wear a lab coat (3.9 ± 1.0 vs. 2.8 ± 1.3, p < 0.0001). Responses to four of the other five questions were numerically, but not statistically, higher in F. There was no difference in preference between the two residents: 24.6 ± 2.8 vs. 24.9 ± 3.5, p=0.56.

Conclusion: More formal dress and demeanor by residents leads to a modest, but significant, increase in patient perception of the resident's value. Wearing a white lab coat, in particular, has a positive effect.