MAMC Journal of Medical Sciences

Original Article

Patients Preference for Doctor Attire in an Outpatient

Department of a Government Hospital in New Delhi, India
Sandeep Sachdeva, Neha Taneja, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To assess patients preference for preselected doctor attire in outpatient department (OPD) setting of a government hospital.
Materials and Methods: An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years)
ambulatory coherent patients. The brief questionnaire captured selected sociodemographic details of patients, department visited, and use of
aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in OPD wearing apron (white
coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the
possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. The patients were
shown four colored pictures each for male and female doctor in different dress. They were probed regarding their preference that they would
like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 =
professional formal. Result: The mean age of 547 patients was 35.34 (±12.81) years; 322 (58.9%) were males. Out of 547 patients, nearly 395
(72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were
actually wearing the apron in the outpatient department. Only 152 (27.7%) patients responded that it does not matter to them whether attending
doctor was wearing white coat (apron) or not. Majority of patients preferred male doctor to be wearing professional formal (42.3%) and
professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal
(37.5%), respectively. Casuals were the least preferred attire. Conclusion: It is reiterated that majority of patients in our OPD setting preferred
formal attire of attending doctor with apron, a clear and loud message for future physician in training.

Keywords: Attitude, physician attire, professional, white coat

INTRODUCTION
The white coat remains a powerful symbol of physician,
despite dramatic changes in medicine during the last century.
Wearing a white coat during the medical practice began in the
late 1880s when surgeons began wearing white coats in their
quest for new “aseptic” methods. By the beginning of the 20th
century, the use of the white coat had spread to most
physicians and the white coat was firmly established as the
“doctor’s uniform.”[1] The white color was specifically
chosen to associate physicians with purity and cleanliness.
White coats have been acknowledged as an integral part of
physician dress. Several studies have shown that 36% to 80%
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of their patients preferred that their doctors should wear white
coat.[2-5] They accounted professionalism, easy identification
and hygiene as the reasons for their belief. Over the past 2
decades, there has been a declining use of the white coat, even
in the hospital setting.[6,7] For some authors, this decline has
Address for correspondence: Dr. Sandeep Sachdeva, Department of
Community Medicine, North Delhi Municipal Corporation Medical College and
Hindu Rao Hospital, New Delhi-110007, India.
E-mail: sachdevadr@yahoo.in
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How to cite this article: Sachdeva S, Taneja N, Dwivedi N. Patients

DOI: Preference for Doctor Attire in an Outpatient Department of a
10.4103/mamcjms.mamcjms_31_18 Government Hospital in New Delhi, India. MAMC J Med Sci
2018;4:88-92.

88 © 2018 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow

 Sachdeva, et al.: Doctor attire in hospital
been so marked that the “white-coated” doctor is now
considered an “endangered species.”[2]
It has been now established that physician attire and dressing
style has an important role in the relationship and
communication with his patients.[8] Since the time of
Hippocrates, doctors have been given advice on the way
they should dress.[9] However, there are conflicting findings
in the literature about the dressing style of physician. Some
studies reported that patients preferred to see their physician in
traditional or formal dress, whereas others report to see their
doctor in more casual outfit.[10-13] British and American studies
conducted up to the late 1990s showed that patients were more
comfortable with traditional styles of appearance, such as white
coats, formal suits, short hair, shirts, and ties.[14,15] Casual items
such as sandals, sports shoes, and jeans evoked negative
responses. Other factors, such as neatness, smile, or facial
expression, were also considered important and had the
potential to override the effects of attire.[16,17] There are
limited studies available in India assessing the patients’
preference for doctor’s attire including white coat. With this
background, a study was undertaken among patients visiting the
outpatient department of a government hospital to assess their
preference for doctor’s attire.
MATERIALS AND METHODS
A cross-sectional study was conducted in a midlevel government
hospital of New Delhi (India) between October and December
2017. The present hospital is equipped with all the basic
specialties and caters to local and nearby population from
primarily lower socioeconomic strata of society. The sample
size was estimated based on a conservative assumption that 50%
(P = 0.05) of patients reporting to hospital have overall
Figure 1: Male doctor dress code
MAMC Journal of Medical Sciences ¦ Volume 4 ¦ Issue 2 ¦ May-August 2018
satisfaction with outpatient hospital services. Taking the 95%
confidence level with ±5% precision and using the formula,
the desired sample size computed was 384 patients.
However, we were able to mobilize more than the desired sample
size and cover 550 study patients.
Ananonymous, predesigned,pretested, semistructured interview
schedule was administered to adult (>18 years) ambulatory
coherent patients after obtaining an informed consent and
ensuring nonduplication of same patients. We conducted the
exit interview in a convenient, comfortable, confidential, and
nonjudgmental manner among patients who agreed to participate
in the study. During the process of interaction, doubts were
clarified, appropriate health education and counseling was
undertaken, and all possible help was also extended.
The questionnaire captured selected sociodemographic details
of patients, department visited, and use of aprons (white coat)
by attending doctor observed and desired practice. To the
item—“Was your attending doctor in outpatient department
(OPD) wearing apron (white coat)?”, the possible response was
yes/no. For the item—“Would you like to see your attending
doctor wearing apron (white coat)?”, again the possible answer
was yes/no. When a patient responded to this item as “no,” we
further explored their reason for the same. Based on a previous
study, the patients were shown four colored pictures each for
male and female doctors.[18] The patients were further probed
regarding the preference of dress code/attire they would like to
see their attending doctor to be wearing. These attires were
labeled as 1 = cool casual, 2 = casual, 3 = professional informal,
and 4 = professional formal [Figures 1 and 2].
The attires included in the study were
Cool casual dress: Jeans and T-shirt with white coat
Casual dress: Shirt–pant, out shirt, and slippers with white coat
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 Sachdeva, et al.: Doctor attire in hospital

Figure 2: Female doctor dress code

Table 1: Use of apron by doctor in outpatient department as reported by patients

Doctor wearing apron (white coat) in OPD Total
Yes No
Would you (patient) like to see your attending doctor Yes 195 (49.4%)(76.1%) 200 (50.6%)(68.7%) 395 (100%)(72.2%)
wearing apron (white coat)? No 61 (40.1%)(23.8%) 91 (59.9%)(31.2%) 152 (100%)(27.7%)
Total 256 (46.8%)(100%) 291 (53.2%)(100%) 547 (100%)(100%)
P = 0.052; table showing both column and row percentage. OPD, outpatient department.

Professional informal dress: Shirt–pant tucked in and shoes
with white coat
Professional formal dress: Shirt-pant, tie, and shoe with white
coat
Cool casual dress: Jeans and T-shirt with white coat
Casual dress: Salwar and jeans with white coat
Professional informal dress: Salwar kameez with white coat
Professional formal dress: Sari with white coat
The data were analyzed using SPSS (IBM, New York, New
York, USA) ver. 20.0 software by calculating descriptive and
bivariate statistics. However, three case records were found to
be incomplete at the end of survey, and hence, a total of 547
were finally analyzed.
Out of 547 patients, nearly 395 (72.2%) wanted (desired) to
see their attending doctor to be wearing apron; however, only
256 (46.8%) reported that attending doctors were actually
wearing the apron in the outpatient department; nearly 152
(27.7%) patients responded that it does not matter to them
whether attending doctor was wearing white coat (apron) or
not. Details are shown in Table 1 and Figure 3.
Out of 547 patients, majority preferred male doctor to be
wearing professional formal (42.3%) and professional
informal (40.9%) attire, whereas for female doctor, also
majority preferred professional formal (38.7%) and
professional informal (37.5%), respectively. Details are
shown in Table 2 and Figure 4.

RESULTS
The mean age of 547 patients was 35.34 (±12.81) years; the
age distribution was as follows: 241 (44.1%) between 18 and
30 years, 236 (43.1%) between 31 and 50 years, and 70
(12.8%) above 51 years; 322 (58.9%) of patients were males;
466 (85.2%) were Hindu by religion. Regarding department,
146 (26.7%) visited surgery department, 161 (29.4%)
medicine, 83 (15.2%) orthopedic, 62 (11.3%) dermatology,
etc.
DISCUSSION
Our cross-sectional descriptive study conducted in a
government hospital of New Delhi (India) among 547
patients constituting a mix of young and middle-aged
population from low socioeconomic strata visiting outpatient
department during October to December 2017 reported only
about half (46.8%) of the attending doctors were wearing apron.
However, as high as 72.2% patients desired that they would like
to see their attending doctor wearing apron, whereas remaining
(27.7%) patients responded that it does not matter to them

90 MAMC Journal of Medical Sciences ¦ Volume 4 ¦ Issue 2 ¦ May-August 2018

 Sachdeva, et al.: Doctor attire in hospital
Figure 3: Patients preference for doctor wearing apron (white coat)
Table 2: Preference of patients for doctor’s attire
Variable Patients preference for doctor’s attire
Cool casual Casual
Overall preference among patients (n = 547)
Attire M (male) doctor 40 (7.3%) 52 (9.5%)
Attire F (female) doctor 54 (9.9%) 76 (13.9%)
Response of male patients (n = 322)
M-doctor attire 20 (6.2%) 28 (8.6%)
F-doctor attire 23 (7.1%) 43 (13.3%)
Response of female patients (n = 225)
M-doctor attire 20 (8.8%) 24 (10.6%)
F-doctor attire 31 (13.7%) 33 (14.6%)
whether the doctor was wearing white coat (apron) or not. With
regard to attire, majority of patient’s preferred formal dress for
male (83.2% with/without tie) and female (76.2% Indian sari/
salwar kameez) doctors, respectively.
The size of our study provides a good cross-section of
opinions and gave sufficient power to detect small
differences in patient preferences. However, some
limitations of this study are regarding the photograph of
doctor dress; the age of physician may have been a
confounding factor. Photographs in our study were of a
younger looking physician, and it is unclear whether the
respondents would have given the same importance to
attire if the photographs had shown older physicians. In
addition, studies have demonstrated the importance of
physician attire in patient perceptions. However, the
influence of a particular style of attire may last only a
short time and needs further clarification whether clothes
can influence long-term patient–doctor relationships.[19] The
seasonality factor may be another determinant among doctor
for wearing apron. Recall bias may not be applicable in our
situation, but heterogeneous patient mental agility and
attention may have an influence. These findings are in
MAMC Journal of Medical Sciences ¦ Volume 4 ¦ Issue 2 ¦ May-August 2018
Professional informal Professional formal
224 (40.9%) 231 (42.3%)
205 (37.5%) 212 (38.7%)
134 (41.6%) 140 (43.4%)
132 (40.9%) 124 (38.5%)
90 (40.0%) 91 (40.4%)
75 (33.3%) 86 (38.2%)
accordance with many previous findings including Landry,
Rehman, and Abha who found that 69.9%, 76%, and 82.3% of
the patients in their study preferred white coats for their
doctor.[20-22] It is reported that patients felt more confident
and communicated better with doctors who wore white coats.
Likewise, patients rated images of doctor with apron higher
than those of casual attire in measures for comfort and
perception of competence.[23,24] The current available
evidence has not conclusively linked white coats with
increased infection rates. However, 2007 dress code
guidelines in England were issued banning white coats and
bare-below-the-elbow policy for all workers in the hospitals;
however, detailed scrutiny on the risk of infection
transmission and objections eventually led to revision of
these guidelines in 2010.[21]
The genesis of this study emerged by authors sustained
observance of unprofessional attire and conduct of our
medical students during last 10 years. Our college is
geographically situated near different Delhi University
colleges (arts, commerce, management courses, etc.) where
dress and attire of students is not an issue but has a wider
influence and ramifications on our medical students.
91
 Sachdeva, et al.: Doctor attire in hospital
Figure 4: Patients preference for doctor’s attire in outpatient department
Increasing trend of casualness (without apron) and informal
clothing including bathroom slippers and sandals were being
worn by our students in classroom, medical college, and
hospital setting. All directions, instructions, guidance, and
counseling in this regard fell on dumb ears. Under these
circumstances, authors felt motivated to conduct this study to
assess the patient’s preference of doctor’s attire in outpatient
department of our hospital. In conclusion, it is reiterated that
majority of patients in our setting preferred formal attire of
attending doctor with apron, a clear and loud message for
future physician in training.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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