The White–Coat Effect: Physician Attire and Perceived Authority, Friendliness, and Attractiveness

What do physicians think about the white coat, about patients' view of the white coat, and how empathetic are physicians toward patients in hospital gowns? An enclothed cognition view

The receipt of the white coat by medical students is a significant milestone. Extensive research has focused on the white coat, its purity, representation of authority and professionalism, its role in consolidating a medical hierarchy, and the professional status attributed to physicians wearing it. Studies suggest that the white coat is a symbol of medical competence, and patients expect physicians to wear it. Research, however, has paid little attention to what physicians think about their white coat, how they perceive the patient's view of the white coat and the hospital gown, within the patient-physician power asymmetry, which is the focus of the current study. In total, 85 physicians from three Israeli medical centers completed a questionnaire (62% Muslims, 33% Jewish, and 5% Christians; 68% men, ages ranging from 21 to 73 years). Employing the enclothed cognition theory and adopting a within-person approach, we found that the more physicians perceived the white coat as important, the more they attributed a positive view of the white coat to patients and the more they perceived the patient's view of the hospital gown as positive. In addition, the higher the perceived importance of the white coat, the higher the reported empathy of physicians toward inpatients, which is consistent with the hospital's values of care. Interestingly, although medicine is a symbol of protection and care for others, the symbolic meaning of the white coat was potent enough to elicit empathy only when physicians perceived it as important. This study extends the theoretical knowledge on the theory of enclothed cognition in healthcare regarding self-perceptions and professional conduct.

Understanding Trust Determinants in a Live Chat Service on Familial Cancer: Qualitative Triangulation Study With Focus Groups and Interviews in Germany

BACKGROUND

In dealing with familial cancer risk, seeking web-based health information can be a coping strategy for different stakeholder groups (ie, patients, relatives, and those suspecting an elevated familial cancer risk). In the vast digital landscape marked by a varied quality of web-based information and evolving technologies, trust emerges as a pivotal factor, guiding the process of health information seeking and interacting with digital health services. This trust formation in health information can be conceptualized as context dependent and multidimensional, involving 3 key dimensions: information seeker (trustor), information provider (trustee), and medium or platform (application). Owing to the rapid changes in the digital context, it is critical to understand how seekers form trust in new services, given the interplay among these different dimensions. An example of such a new service is a live chat operated by physicians for the general public with personalized cancer-related information and a focus on familial cancer risk.

OBJECTIVE

To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigates the 3 dimensions of trust-trustor, trustee, and application-and their respective relevant characteristics based on a model of trust in web-based health information. In addition, the study aims to compare these characteristics across the 3 different stakeholder groups, with the goal to enhance the service's trustworthiness for each group.

METHODS

This qualitative study triangulated the different perspectives of medical cancer advisers, advisers from cancer support groups, and members of the public in interviews and focus group discussions to explore the 3 dimensions of trust-trustor, trustee, and application-and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service.

RESULTS

The results indicate that experience with familial cancer risk is the key trustor characteristic to using, and trusting information provided by, the live chat service. The live chat might also be particularly valuable for people from minority groups who have unmet needs from physician-patient interactions. Participants highlighted trustee characteristics such as ability, benevolence, integrity, and humanness (ie, not a chatbot) as pivotal in a trustworthy cancer live chat service. Application-related characteristics, including the reputation of the institution, user-centric design, modern technology, and visual appeal, were also deemed essential. Despite the different backgrounds and sociodemographics of the 3 stakeholder groups, many overlaps were found among the 3 trust dimensions and their respective characteristics.

CONCLUSIONS

Trust in a live chat for cancer information is formed by different dimensions and characteristics of trust. This study underscores the importance of understanding trust formation in digital health services and suggests potential enhancements for effective, trustworthy interactions in live chat services (eg, by providing biographies of the human medical experts to differentiate them from artificial intelligence chatbots).

Unlocking the benefits of diversity among healthcare workforces: a holistic view

PURPOSE

The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.

DESIGN/METHODOLOGY/APPROACH

This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature.

FINDINGS

Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.

ORIGINALITY/VALUE

The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

Beyond the beauty of occlusion: medical masks increase facial attractiveness more than other face coverings

The sanitary-mask effect (Miyazaki and Kawahara in Jpn Psychol Res 58(3):261–272, 2016) is the finding that medical face masks prompt an image of disease and thus result in lower ratings of facial attractiveness of the wearer. However, during the COVID-19 pandemic, medical masks have been found to increase attractiveness (Patel et al. in Plast Reconstruct Surg Glob Open 8(8), 2020) although this could have been a general effect of occlusion. To further explore this issue, female participants were presented with a series of male faces of low or high attractiveness that were occluded with a medical mask, cloth mask, book or not occluded and asked to rate them on attractiveness. The results show that faces were considered as most attractive when covered by medical masks and significantly more attractive when occluded with cloth masks than when not occluded. Contrary to expectation, base attractiveness did not interact with the type of occlusion, suggesting that this is not simply due to occlusion of negative features. The present findings are contrary to the sanitary-mask effect and explanations in terms of social desirability, and the association of medical masks with caregiving professions is explored.

Investigation of the effects of veterinarians' attire on ratings of trust, confidence, and comfort in a sample of pet owners in Canada

OBJECTIVE

To examine companion animal owners' perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients' ratings of trust in, confidence in, and comfort with a veterinarian.

SAMPLE

449 pet owners.

PROCEDURES

Participants were randomly assigned to complete a questionnaire containing photos of a male or female model veterinarian photographed in 8 attire types (formal attire, white dress shirt with black pants, white casual shirt with khaki pants, surgical scrubs, white casual shirt with jeans, surgical scrub top with jeans, surgical scrub top with khaki pants, and white laboratory coat with khaki pants). Participants were asked to rate their trust in, confidence in, and comfort with the pictured individual on a response scale of 1 (low) to 7 (high), rank photos according to their preferences for attire, and provide input on the importance of attire and other appearance-related subjects. Attire and gender of photographed individual and participant demographics were investigated for associations with trust, confidence, and comfort scores.

RESULTS

Most (317/445 [71%]) respondents indicated veterinarians' attire was important. Attire type was significantly associated with respondents' trust, confidence, and comfort scores. Model veterinarian gender and participant education level were also associated with trust and comfort scores.

CONCLUSIONS AND CLINICAL RELEVANCE

Veterinarians' attire is a form of nonverbal communication that is likely to inform clients' first impressions and may influence clients' trust in, confidence in, and comfort with a veterinarian. Veterinary personnel and veterinary management should consider how attire and general appearance represent staff members or their practice.

Patients' decision to contribute to a biobank in the light of the patient-recruiter relationship-a qualitative study of broad consent in a hospital setting

Findings from recent studies show that the relationship developed with the particular researcher asking for broad consent plays an important role in the participant’s willingness to give consent. Interviews and focus groups were conducted in order to present a description and analysis of meetings in which broad consent took place and to examine the role of recruiters in the patients’ decision-making and in building trust in the Lausanne University Hospital Institutional Biobank (BIL). Our findings suggest that patient broad consent to biobanking is strongly related to its setting. BIL recruiters’ were aware of their role as ambassadors of the BIL and their responsibility towards patients. Patient interviewees were sensitive to the quality of the information delivered, the timing of the consent request and the recruiters’ attitudes and behaviours, including the presence of the white coat. Participating in the BIL also seemed to reinforce the patient’s self-esteem and perceived efficacy, particularly since they are themselves ill and inactive when requested to participate. Recruiters and participants report that participation may be motivated by fundamental (existential) goals. Organisational factors also affected recruiters’ activity and the broad consent procedure raising several ethical issues. This qualitative study suggests that biobanking based on information-based models of decision-making might need to be re-evaluated in order to improve broad consent. Our findings have implications for the practice of broad consent and patient autonomy, as well as for the recruiters’ role and training.

The Interplay Between Economic Status and Attractiveness, and the Importance of Attire in Mate Choice Judgments

Desirable characteristics of "opposite sex others," such as physical attractiveness and economic status, can influence how individuals are judged, and this is different for men and women. However, under various social contexts where cues of higher or lower economic status is suggested, sex differences in judgments related to mate choice have not been fully explored. In two studies, ratings of economic status and attractiveness were quantified for male and female targets that were presented under various social contexts. Study 1 assessed judgments (n = 1,359) of images of nine male and nine female targets in different sized groups containing only opposite-sex others (i.e., group size). While we found no significant effects of group size on male and female attractiveness, target female economic status increased when surrounded by two or more men. An ad hoc analysis controlling for the attire of the targets (business or casual) found that the association between target female economic status and group size occurred when females were in business attire. Study 2 investigates this effect further by presenting images of 12 males and 12 females, in higher and lower status attire (i.e., business and casual clothing) and measured judgments of attractiveness and economic status among women and men (n = 1,038). Consistent with the results of Study 1, female economic status was only affected when women were in business attire. However, female economic status decreased when in the presence of other men in business attire. There were no sex differences in judgments of economic status when judging stimuli in casual attire. Additionally, negative associations between attractiveness and economic status were found for males presented in casual attire. We discuss these results in the light of evolutionary sexual conflict theory by demonstrating how the asymmetrical importance of status between men and women can influence mate choice judgments.

Physician attire in the intensive care unit in Japan influences visitors' perception of care

PURPOSE

The objective of this study is to evaluate the impact of physician attire and behavior on perceptions of care by ICU visitors in Japan.

MATERIALS AND METHODS

Visitors were surveyed including 117 at a community hospital and 106 at a university hospital. Demographic data (age, gender, relationship to patient, length of stay) were collected. A seven-point Likert scale (1=strongly agree, 4=neutral, 7=strongly disagree) was used to judge physician attire (name tag, white coat, scrubs, short sleeve shirts, blue jeans, sneakers, clogs), behavior (addressing a patient, carrying a snack) and overall effect on perception of care.

RESULTS

There are no significant differences (p>0.05) in demographics comparing the two ICUs, except for increased length of stay at the university ICU. Visitors scored the importance of a name tag (median 2, Interquartile Range 1-2), white coat [3,1-4], addressing the patient by last name [2,1-3], wearing scrubs [3,2-4], sneakers [4,3-5], clogs [4,4-5], short sleeves (4,3.5-5), blue jeans [5,4-6], and carrying a snack [6,5-7]. Visitors scored "attire affects perceptions of care" as [3,2-4].

CONCLUSIONS

Physician attire in the ICU affects perceptions of care. Implementation of attire guidelines which require clothing that does not meet visitor preferences should be accompanied by education programs.

Examining the Priority Heuristic in Conditions of Resource Need Levels

Within the domain of risky decision making, there are a number of predictive models which are consistent with the hypothesis that human minds are molded for specific behavioral patterns based on environmental cues. Two models are the priority heuristic and risk sensitive foraging. Using a modified version of the traditional risky choice gambles paradigm, a study was designed to tease apart specific predictions made by each of these two models. It was discovered that the best explanation for choice behavior was consistent with risk sensitive foraging. This was true for risky preferences in gambles. Also, decision time predictions from the priority heuristic were not supported. Collectively, this may show additional support for risk-sensitivity driving some human behaviors. It may also carve out the boundaries for the proper "ecology" of the priority heuristic.

Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context

In medicine, it is critical that clinicians demonstrate both empathy (perceived as warmth) and competence. Perceptions of these qualities are often intuitive and are based on nonverbal behavior. Emphasizing both warmth and competence may prove problematic, however, because there is evidence that they are inversely related in other settings. We hypothesize that perceptions of physician competence will instead be positively correlated with perceptions of physician warmth and empathy, potentially due to changing conceptions of the physician’s role. We test this hypothesis in an analog medical context using a large online sample, manipulating physician nonverbal behaviors suggested to communicate empathy (e.g. eye contact) and competence (the physician’s white coat). Participants rated physicians displaying empathic nonverbal behavior as more empathic, warm, and more competent than physicians displaying unempathic nonverbal behavior, adjusting for mood. We found no warmth/competence tradeoff and, additionally, no significant effects of the white coat. Further, compared with male participants, female participants perceived physicians displaying unempathic nonverbal behavior as less empathic. Given the significant consequences of clinician empathy, it is important for clinicians to learn how nonverbal behavior contributes to perceptions of warmth, and use it as another tool to improve their patients’ emotional and physical health.

Individual Differences in Preventive Jealousy Determine Men's Jealousy after Subliminal Exposure to Rivals Wearing High- or Low-Status Clothes

This study investigated sex differences in jealousy after subliminal exposure to rivals wearing high-status or low-status clothes. It was expected that individual differences in preventive jealousy would moderate the relationship between a rival's characteristics and jealousy. Participants (Men: n = 54, M age = 21.6 yr., SD = 3.5; women: n = 71, M age = 20.7 yr., SD = 1.9) completed a parafoveal subliminal priming paradigm as well as questionnaires about jealousy and preventive jealousy. As predicted, women were not affected by their rival's status, but women high in preventive jealousy reported more jealousy than women low in preventive jealousy. However, whereas men low in preventive jealousy reported equal amounts of jealousy after exposure to a high-status and a low-status rival, surprisingly, and contrary to the expectations, men high in preventive jealousy reported most jealousy after exposure to a low-status rival. To explain these unexpected results, threats to self-esteem were discussed.

Sexual Conflict and Gender Gap Effects: Associations between Social Context and Sex on Rated Attractiveness and Economic Status

Human mate choice research often concerns sex differences in the importance of traits such as physical attractiveness and social status. A growing number of studies indicate that cues to social context, including other people who appear in stimulus photographs, can alter that individual's attractiveness. Fewer studies, however, consider judgements of traits other than physical attractiveness, such as wealth. Here we manipulate the presence/absence of other people in photographs of target models, and test the effects on judgments of both attractiveness and earnings (a proxy for status). Participants (N = 2044) rated either male or female models for either physical attractiveness or social/economic status when presented alone, with same sex others or with opposite sex others. We collectively refer to this manipulation as 'social context'. Male and female models received similar responses for physical attractiveness, but social context affected ratings of status differently for women and men. Males presented alongside other men received the highest status ratings while females presented alone were given the highest status ratings. Further, the status of females presented alongside a male was constrained by the rated status of that male. Our results suggests that high status may not directly lead to high attractiveness in men, but that status is more readily attributed to men than to women. This divide in status between the sexes is very clear when men and women are presented together, possibly reflecting one underlying mechanism of the modern day gender gap and sexist attitudes to women's economic participation. This adds complexity to our understanding of the relationship between attractiveness, status, and sex in the light of parental investment theory, sexual conflict and economic theory.

Children's preferences concerning ambiance of dental waiting rooms

AIM

Despite many advances in paediatric dentistry, the greatest challenge for any paediatric dentist is to remove the anxiety related to a dental visit and have a child patient to accept dental treatment readily. Minor changes made in the waiting room design can have a major effect on the way any child perceives the upcoming dental experience. This study was carried out to determine children's preferences regarding the dental waiting area so as to improve their waiting experience and reduce their preoperative anxiety before a dental appointment.

STUDY DESIGN

This was a cross-sectional descriptive study using survey methodology.

METHODS

A questionnaire designed to evaluate children's preferences regarding the waiting room was distributed to new paediatric patients, aged between 6 and 11 years of age, attending an outpatient dental facility and was completed by 212 children (127 males, 85 females).

STATISTICS

The analyses were carried out on cross-tables using Phi (for 2×2 tables) or Cramer's V (for larger than 2×2 tables) to assess responses to the questionnaire items across age groups and gender.

RESULTS

A majority of children preferred music and the ability to play in a waiting room. They also preferred natural light and walls with pictures. They preferred looking at an aquarium or a television and sitting on beanbags and chairs and also preferred plants and oral hygiene posters Repetious.

CONCLUSIONS

The results obtained from this study may help the dental team decide on an appropriate design of their paediatric waiting room so as to make children comfortable in the dental environment and improve delivery of health care.

Children's perspective on the dentist's attire

BACKGROUND

Despite many advances in paediatric dentistry, the greatest challenge for any paediatric dentist is to remove the anxiety related to a dental visit and get the child patient to accept the treatment readily. The manner in which the dentist presents himself plays an important role in cementing a friendly relation with the child.

AIM

To assess school children's perceptions and preferences towards dentist's attire so as to understand their psych and promote a successful relationship with the patient.

DESIGN

A questionnaire designed to evaluate children's attitudes and preferences towards dentists was distributed in public schools and was completed by 619 children (322 males, 297 females) aged between 6-14 years.

RESULTS

The study found that majority of children preferred dental professionals to wear traditional formal attire with a white coat and name badge. They preferred the use of plain masks and white gloves but disliked protective eyewear or headcaps. Most children liked dentists with closed shoes and no jewellery but preferred the use of a wrist watch.

CONCLUSIONS

The results obtained from this study can help dentists decide what is appropriate to wear when dealing with children so as to minimise their anxiety and improve delivery of health care.

When pictures waste a thousand words: analysis of the 2009 H1N1 pandemic on television news

OBJECTIVES

Effective communication by public health agencies during a pandemic promotes the adoption of recommended health behaviours. However, more information is not always the solution. Rather, attention must be paid to how information is communicated. Our study examines the television news, which combines video and audio content. We analyse (1) the content of television news about the H1N1 pandemic and vaccination campaign in Alberta, Canada; (2) the extent to which television news content conveyed key public health agency messages; (3) the extent of discrepancies in audio versus visual content.

METHODS

We searched for "swine flu" and "H1N1" in local English news broadcasts from the CTV online video archive. We coded the audio and visual content of 47 news clips during the peak period of coverage from April to November 2009 and identified discrepancies between audio and visual content.

RESULTS

The dominant themes on CTV news were the vaccination rollout, vaccine shortages, long line-ups (queues) at vaccination clinics and defensive responses by public health officials. There were discrepancies in the priority groups identified by the provincial health agency (Alberta Health and Wellness) and television news coverage as well as discrepancies between audio and visual content of news clips. Public health officials were presented in official settings rather than as public health practitioners.

CONCLUSION

The news footage did not match the main public health messages about risk levels and priority groups. Public health agencies lost control of their message as the media focused on failures in the rollout of the vaccination campaign. Spokespeople can enhance their local credibility by emphasizing their role as public health practitioners. Public health agencies need to learn from the H1N1 pandemic so that future television communications do not add to public confusion, demonstrate bureaucratic ineffectiveness and contribute to low vaccination rates.

Effect of different professions' clothing on children's height perception

Height is a biological factor that can affect how others perceive and behave toward an individual. Height is a biological factor that can affect how others perceive and behave toward an individual. Clothing, as a non-biological factor, can affect these perceptions of height. In this study weClothing, as a non-biological factor, can affect these perceptions of height. In this study we investigated the effect of different professions' clothing on children's perceptions of height. One investigated the effect of different professions' clothing on children's perceptions of height. One hundred and eighty primary school students participated in this study and estimated the height of an actor in the clothing of four different professions which differed in terms of prestige. The results of study showed that the difference between the perceived and actual height was larger when participants estimated the height of socially esteemed professions. Also there was no difference between girls' and boys' estimation of different professions' height. The implications of these findings are discussed.

Informed Consent for Anaesthesia in Australia and New Zealand

The legal and ethical requirements related to an anaesthetist's communication with patients in preparing them for anaesthesia, assisting them in making appropriate decisions and obtaining consent in a formal sense are complex. Doing these things well takes time, skill and sensitivity. The primary focus should be to adequately prepare patients for surgery and to ensure that they are sufficiently well informed to make the choices that best meet their own needs. This is just an affirmation of the importance of patient-centred care.

Patient preferences for dental clinical attire: a cross-sectional survey in a dental hospital

AIMS AND OBJECTIVES

This cross sectional descriptive study was designed to survey patient opinion towards dental clinical attire, name badges and commonly used cross-infection control measures.

METHOD

Patients attending a dental hospital for a consultation appointment were asked to complete a questionnaire accompanied by photographs of models portraying a range of clinical attire. A representative sample of patients completed 188 questionnaires over a four week period.

RESULTS

The study found that the majority of patients felt clinical attire was important and that they preferred dental professionals to wear name badges. The majority of patients also preferred dentists to use both safety glasses and face masks. When asked to indicate which clinical attire was most appropriate for a consultant/specialist to wear, the overwhelming opinion was that of smart dress accompanied with a white coat. In addition, most respondents wished their dentist to wear a traditional white, dental tunic.

CONCLUDING REMARKS

It is hoped that this study will be informative for the dental team and that the results will be taken into consideration when considering appropriate clinical attire in accordance with patient opinions.

First impressions in complementary practice: the importance of environment, dress and address to the therapeutic relationship

The aim of the study was to explore patients' views of the importance of environmental and social factors within a complementary and alternative medicine (CAM) practice. A cross-sectional patient survey was conducted in 37 CAM practices across nine geographical areas of the UK using a structured questionnaire. The 219 responders (response rate 59%) were 65% female. The most common treatment modalities were osteopathy and acupuncture. Patients rated telephone manner, practitioner appearance and explanatory literature as very important factors in shaping first impressions and influencing their confidence in the complementary practice. Patients' preferences for practitioner dress code were highly variable. Overall 65% preferred a white coat to casual dress. A multivariate analysis revealed that this preference was statistically significantly greater in two geographical regions and in patients over 70 years old. It was not influenced by gender or treatment modality. Further research is recommended in order to understand how the complex verbal and non-verbal communication implicit in the CAM setting may affect the therapeutic relationship.