International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents.

OBJECTIVE: The patient-physician relationship impacts patients' experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings. SETTING: 20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA. PARTICIPANTS: Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices. PRIMARY AND SECONDARY OUTCOME MEASURES: The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics. RESULTS: The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only. CONCLUSIONS: Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study.

OBJECTIVES: We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician-patient relationship. SETTING: The 900-bed University Hospital Zurich, Switzerland. PARTICIPANTS: A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents' ratings of how the physician's attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided. RESULTS: Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively). CONCLUSIONS: Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.

Bioaerosol formation during grape stemming and crushing.

Indoor formation of airborne particles during pre-fermentation grape processing was assessed by particle counting using laser particle sizers. Particle numbers of four different aerodynamic size classes (0.3 to 0.5 microm, 0.5 to 1 microm, 1 to 5 microm, and >5 microm) were determined during unloading of harvest containers and subsequent grape stemming and crushing. Regarding these size classes, composition before grape handling was determined as 87.9%, 10.4%, 1.7%, and 0.1%, respectively, whereas the composition changed during grape handling to 50.4%, 15.2%, 33.0%, and 1.5%, respectively. Airborne bacteria and fungi originating from grape processing were collected by impactor and liquid impinger samplers. Grape handling resulted in a sixfold increase in total (biological and non-biological) airborne particles. The generation of bacterial and fungal aerosols was associated mostly with particles of aerodynamic diameters>5 microm (mainly 7 to 11 microm) as determined by flow cytometry. This fraction was increased 150fold in relation to background levels before grape crushing. Maximum concentrations of culturable bacteria reached 485,000 colony forming units (cfu/m3), whereas 146,000 cfu of fungi and yeasts were detected per cubic meter of air. Culturable Gram-negative bacteria occurred only in small numbers (180 cfu/m3). In relation to the total number of airborne particles emitted, culturable microorganisms comprised 0.1% to 0.2%. As soon as grape crushing was stopped, particle concentrations decreased rapidly either due to passive settling or due to air currents in the occupational indoor environment reaching background levels.