Most of us have probably heard the saying, "Actions speak louder than words." But have you ever known anyone to say, "Appearance speaks louder than words"? That phrase, at least with respect to patient attitudes toward what physicians wear, may have some validity.

It did hold weight in earlier centuries. According to Hippocrates, the physician should "be clean in person, well-dressed, and anointed with sweet-smelling unguents." Moreover, the masters of the School of Salerno (Italy) in the 11th and 12th centuries said that if the physician were poorly dressed he would receive poor fees.

Today, a physician's pay is unlikely contingent on what he or she wears, but a survey shows that appearance may affect patients' initial perception of physicians' professional competence.

"In the physician-patient interaction, the physician's appearance is a key symbol that not only identifies the individual as a physician, but also defines certain characteristics of the physician," according to the study's investigators. "The clean, carefully dressed physician might give the message, 'This is an important event, and I took the time to prepare for it,' while the unkempt, careless appearing physician can be perceived as unskilled and uncaring."

The 1984 survey of 404 participants, 292 patients as well as 112 staff physicians and residents (doctors who have medical degrees but are in advanced specialty training) was conducted at Bethesda Hospital in St. Paul, Minn., and at family practice clinics in Milwaukee and Kenosha, Wis. Bethesda is affiliated with the Department of Family Practice and Community Health at the University of Minnesota and the Wisconsin clinics are associated with the Medical College of Wisconsin.

According to one of the study's directors, Dr. Dwenda K. Gjerdingen of Bethesda, opposing attitudes on the issue as well as the lack of any solid data on patient-physician attitudes about physicians' professional appearance, spurred her interest in doing the survey.

In the early 1980s, says Dr. Gjerdingen, there was a popular debate between many staff and resident physicians over what is appropriate professional attire for physicians. The older staff physicians have typically opted for the more traditional dressed up look, says Dr. Gjerdingen, while younger resident physicians have frequently chosen to be more casual. Prior to her study, those varying attitudes were fervently discussed in a meeting she held with Bethesda's resident physicians and clinic staff.

"When I proposed that physicians not wear jeans to work, to my surprise it was met with a great deal of emotion. Overall, the clinic staff and a few resident physicians tended to agree with me. However, most of the resident physicians opposed my suggestion, insisting that a physicians' attire had no bearing on one's professionalism."

While the study found that the surveyed patients were less discriminating in their attitude toward physicians' appearance than the physicians themselves, it still confirmed her notion that appearance is an important factor in physician-patient communication.

"Appearance is an important aspect of the way doctors communicate with patients, and doctors should pay attention to it," says Dr. Gjerdingen. "If doctors look good, they are taken seriously by their patients and the patients believe they will be well taken care of."

Methodology

Receptionists at the three clinics asked all English-speaking adult patients who appeared for scheduled visits over a one-week period if they would complete the questionnaire. Besides demographic data, the questionnaire asked for information about professional appearance for both male and female physicians. The appearance items used were selected on the basis of their having been used in previous research or their having been observed by Dr, Gjerdingen or Dr. Deborah E. Simpson, Ph.D., who also directed the study.

Many of the patients using the three clinics in the survey had below-average incomes yet a fourth of them had at least some college education. Although seven out of 10 of the respondents were women, the survey found little difference in the responses of the patients based on sex, age, income, or education.

First visit

Participants were asked to assume that they were visiting a new physician for the first time and to rate each component of that physician's appearance on a three-point scale: 1. desirable, 2. neutral; and 3. undesirable.

Staff physicians (defined as nonresidents who were on staff at one of the study hospitals and who were affiliated with the family training program at the hospital) and residents affiliated with the family practice at Bethesda received the questionnaires through the mail. Wisconsin resident participants received and completed their questionnaires at a noon conference. The Wisconsin staff physicians, who were volunteer faculty for the residency, received their questionnaires by mail. Physicians who did not respond were not contacted again.

Name tags and coats

The survey showed that the two most important items patients like to see physicians wear are a name tag and the traditional white coat. These items are symbols, says Dr. Gjerdingen, which make physicians clearly identifiable as physicians and speak "more than all the words people say."

"These symbols are very important to patients," adds Dr. Gjerdingen. "They tell people who we are." Name tags, for example, tell patients that the physician is qualified and is properly trained. They also enable patients to use the physician's name during appointments and knowing names makes setting up appointments easier as well.

The ever familiar stethoscope hanging around one's neck or from one's coat pocket is also a desirable item for physicians to wear, patients revealed.

What were some of the things the patients didn't like to see? They said for male physicians, the No. 1 most undesirable trait was going without socks. Cologne for male physicians and perfume for female physicians was also rated low on the list of undesirable things to wear. So were scrub suits, unless of course the physician is in the operating room. Being overweight, whether you're male or female, was not a desirable trait among the surveyed patients either.

Favorable traits

In the breakdown between male and female physicians, here are the things patients most like to see in their dress and appearance:

Male MDs

  • Name tag (which also says MD)
  • Hair above the collar
  • White coat
  • Dress shoes
  • Groomed mustache (if he has one)
  • Groomed beard (if he has one)
  • Shirt and tie
  • Dress pants
  • Visible stethoscope.

Female MDs

  • White coat
  • Nylons
  • Lipstick
  • Dress shoes
  • Skirt-blouse
  • Skirted suit
  • Blush-rouge
  • Dress.

Unfavorable traits

Below are the things patients said were negatives in the dress and appearance of male and female physicians.

Male MDs

  • No socks
  • Clogs
  • Earrings
  • Sandals
  • Scrub suit
  • Long hair, at or below shoulders
  • Athletic shoes
  • Blue jeans
  • Overweight
  • Jewelry (except watch or ring).

Female MDs

  • Blue jeans
  • Athletic shoes
  • Prominent ruffles
  • Scrub suit
  • Clogs
  • Dangling earrings
  • Boots
  • Sport socks
  • Overweight
  • Patterned hose
  • Sandals
  • Corduroy pants.

Dr. Gjerdingen adds that while the precise findings of the survey may not apply in all types of doctors' offices, they do show that appearance functions to define physicians' role and is an important element of communication between the healer and patient.