Intensive care MDs: More white coats, fewer piercings preferred

It’s not just your mom who’s suspicious of body art: Families of patients in intensive care units said that physicians who don’t display piercings or tattoos make a better first impression, according to survey results released Monday in JAMA Internal Medicine.

In intensive care units, the researchers wrote (subscription required), the stakes are high but patients are unlikely to have a preexisting relationship with their doctors. “Trust needs to be established over a short time frame,” they noted, adding that relatives of seriously ill patients often have to be active in medical decision making.

Hoping to assess the effect of physician attire on this complex doctor-patient-family dynamic, the researchers polled 337 family members of patients in three ICUs in Calgary, Canada, from Nov. 1, 2010, to Oct. 31, 2011.

Relatives were asked to use a 5-point scale to rate the importance of 10 factors in an ICU doctor: age, sex, race, neat grooming, facial piercings, visible tattoos, professional dress, white coat, visible name tag and overall first impression. They were also asked to select the best physician from a series of photographs.

Seventy-three percent of the respondents -- a mostly female, white and college-educated group, related to severely ill male patients -- said that an easy-to-read name tag was important in a first meeting with a doctor; 65% said neat grooming was key; and 59% liked seeing professional dress. About a third stressed the importance of a lack of tattoos and piercings. Age was important to 10% of the relatives. Race and sex were important to only 3%.

When viewing the photos of doctors, more than half selected a doctor in a white coat and traditional clothing as their favorite; a quarter preferred a physician in scrubs. Only 13% preferred a doctor in a suit, and 11% a doctor in casual dress.

The strong preference for white coats and scrubs suggested that families with loved ones in intensive care like to see doctors in medical uniforms, wrote the study coauthors. Although past reports have suggested that families are comfortable with casual dress in acute care settings, they said, “these results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs.... Physicians may want to consider that their attire could influence family rapport, trust and confidence.”

Writing in a perspective piece accompanying the report, San Francisco Medical Center physician Rebecca Lesto Shunk offered a more pointed take. “Maybe I am old-fashioned,” she wrote. “But I think the dress and appearance of health care providers should demonstrate professionalism and support a serious and sacred pact with our patients.... We are not their barista.”

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