Doctor's attire influences perceived empathy in the patient–doctor relationship

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Abstract

Objective

This study investigated whether doctors’ attire influences the perception of empathy in the patient–doctor relationship during a therapeutic encounter.

Methods

A total number of 143 patients were divided into four groups when they were consulting a Traditional Korean Medicine doctor. Depending on the group, the same doctor was wearing four different attires – Casual, Suit, Traditional dress, White coat – when having a clinical consultation with the patients.

Results

The patients preferred white coat and traditional dress more than other attires, giving highest scores to white coat in competency, trustworthiness and preference of attire and to traditional dress in comfortableness and contentment with the consultation. The “Consultation and Relational Empathy (CARE)” score was significantly higher in the “White coat” and “Traditional” groups, compared to the “Casual” and “Suit” groups.

Conclusion

The strong association between the patients’ preference of doctors’ attire and the CARE score indicates that the doctor's attire plays not only an important role for establishing confidence and trustworthiness but also for the perception of empathy in the patient–doctor relationship.

Practice implications

The doctor's attire can function as an effective tool of non-verbal communication in order to signal confidence, trust and empathy and establish a good patient–doctor relationship.

Introduction

Communication is a crucial component in establishing a positive patient–doctor relationship and various studies have indicated its importance by demonstrating a close association between patient–doctor communication and direct patient health outcomes [1], [2], [3], [4]. However, there are various forms of interactions during a clinical encounter which can determine the patient–doctor relationship [5] and few studies have attempted to analyze the different components of patient–doctor communication separately [6]. Although the verbal component is essential to share important medical information with the patient and enhance ‘patient enablement’ [7], nonverbal behavior has received surprisingly little attention in the field of health communication [8], [9]. Non-verbal behavior encompasses physical appearance, gesture and body movements, facial expressions, eye movements and vocal modifications [10], [11], whereas during the first clinical encounter, the physical appearance of the doctor plays an important role for establishing the subsequent patient–doctor relationship [12].

The doctor's attire is a vital part of the first impression the patient will develop of the doctor [13]. During the first clinical encounter, the patient and the doctor do not only exchange medical information about the treatment, but also build up trust and confidence for the future therapeutic relationship [12], [14]. The attire or clothing in general is an influential source of nonverbal communication [15], especially in the absence of other information about the person such as during the first encounter [16]. For physicians, the doctor's attire functions as a symbol of recognition, professionalism and trust [17], [18], whereas in other professions, the attire or clothing style also functions as a message source of nonverbal communication on credibility, trustworthiness, or likeability [19], [20]. It has been also reported, that dressing more formally in workplaces results in more professional behaviors and changes in self-perceptions of the employees [21], [22]. However, the doctor's appearance is not the only factor influencing the patient-doctor relationship. There are a number of non-specific and psychosocial factors which have been known to play a great role in patient satisfaction and improvement, and along with the different expectations of the patients, the doctor's physical appearance in the patient-doctor relationship is just one of those factors [23], [24]. It has been also known, that patients, who particularly seek alternative treatments such as acupuncture, seem to value the relationship with their practitioner very high [25], [26].

Empathy is also a fundamental and crucial component in establishing a good therapeutic relationship between a patient and a doctor [27], [28]. Empathy in a therapeutic relationship can be defined as following: empathy in the clinical context involves the ability (1) to understand the patient's situation, perspective and feelings (and their attached meanings); (2) to communicate that understanding and check its accuracy; and (3) to act on that understanding with the patient in a helpful therapeutic way [29]. A measure of empathy assessing patients’ perception of the practitioner's empathy in the clinical encounter was developed by Mercer et al. This assessment has been called the ‘consultation and relational empathy’ (CARE) measure and has been tested and validated in several contexts [30]. The CARE measure is considered as being of high relevance to everyday consultations in general practice by both practitioners and patients [31].

There have been many studies about the influence of different doctors’ attire on patients’ perception of competency or trust [13], [17], [32], [33], [34], [35]. However, the question whether the doctor's attire is also associated with the establishment of more empathy in the patient–doctor relationship has not been answered yet. In addition, most of the previous studies on the influence of doctors’ attire were carried out showing the patients different photographs of the doctor, but not tested in real clinics [32], [33], [34], [35].

In the present study, we assessed the possible association between doctors’ attire and empathy in a therapeutic relationship using the CARE measure. We hypothesized that higher ratings of traits such as competency, trustworthiness and preference for a certain dress style should be in compliance with more perception of empathy in the therapeutic relationship for the same attire, and tested this not in an experimental setup but in real clinics.

Section snippets

Participants and groups

A total of 143 patients (male = 48, female = 95) participated in this study. All patients were recruited at a Traditional Korean Medical Clinic in Kyunggido, Korea. Only patients were recruited who visited the clinic for the first time in order to control for prejudgments of the patients toward the doctor. Additionally, only patients were recruited who came for the treatment of pain by acupuncture in order to control for symptoms and treatments. Basic demographic data such as name, age, and gender

Demographic characteristics

The sample population comprised of hundred and forty three (143) outpatients, with the mean age of 37.7 years. The “Casual” group consisted of 38 patients, 17 male (45%) and 21 female (55%), with the mean age of 36.8 years. The “Suit” group consisted of 32 patients, 8 male (25%), 24 female (75%), the “Traditional” group consisted of 35 patients, 10 male (29%), 25 female (71%), and the “White coat” group consisted of 38 patients, 13 male (35%), 25 female (65%), with mean ages of 38.8, 38.1 and 37.1

Discussion

What is the relationship between the first impression of a doctor, and perceived empathy in the therapeutic consultation with the doctor? For sure, it is to be expected that a good first impression should lead to more empathy felt in the therapeutic relationship. However, the answer to this question depends very much on what determines the first impression of a doctor. First impressions, including inferences of specific personality traits such as attractiveness, competency, trustworthiness, or

Conflict of interest

None of the authors have any conflicting of competing interests regarding this article.

Author disclosure statement

The authors declare that no competing financial interests or conflicts of interest exist. The funders had no role in the study design, data collection and analysis and the decision to publish the manuscript.

Role of the funding source

None of the authors have any role of the funding source regarding this article.

Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. 2005-0049404). The first author, named by Heesu Chung, was supported by the Undergraduate Research Program (URP) grant funded by Kyung Hee University College of Oriental Medicine. We also thank Hunter Desmaray for his help in editing and proofreading the paper.

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