Abstract
BackgroundThere is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy.MethodsThis was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy.ResultsA total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000).ConclusionsThis study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully.Trial registrationJapanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.
Highlights
There is limited quantitative research on the effect of physician attire on patient–physician relationships
One study found that some family medicine specialists certified by the Japan Primary Care Association (JPCA), which was established in 2010 following the merger of three primary care academic societies, preferred non-white coat attire, because they felt that casual attire allowed more empathetic interactions with patients [9]
We investigated the use of alternating dress styles in family physician (FP) practice to compare patient-perceived empathy, assessed using the Consultation and Relational Empathy (CARE) Measure
Summary
There is limited quantitative research on the effect of physician attire on patient–physician relationships. Most patients report that physician attire is important and associated with their satisfaction with care [1,2,3]. Patient preference for physician attire is influenced by age, locale, setting, and context of care [1, 3,4,5,6,7,8]. Reports from several countries suggest that patients prefer primary care physicians to wear white coats [4,5,6]. Previous research in Japan shows that most patients prefer physicians to wear white coats in a primary care setting [1]. There are no studies on whether FP attire influences relational empathy as perceived by patients in primary care settings
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