Doctor’s Attire And Patient Perceptions: Confusions In A Country With High Multi Drug Resistance

Background: Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in tradition and culture. The wearing of white lab coats has a long history in medicine. Many believe that it enhances professional appearance, and in most institutions in India, white coats are mandatory. However white coats have been shown to harbor potential disease causing bacteria and may play a role in the nosocomial transmission of pathogens. SHEA recommendations on “Bare below elbows” approach in patient care has been adopted in a few countries, but in a country like India where doctors are considered exalted, professional attire has stronger connotations. Changes in doctors attire may influence more than patient’s perception of infection control. We need to tailor doctor’s attire to suit patient preferences.

Methods: We conducted a closed format questionnaire based survey in a South Indian tertiary care centre. 185 patients (117 males and 68 females) completed the survey. The survey assessed patient preferences for doctors wearing white coats. Participants' attitudes were then reassessed after they were given information about potential disease transmission by white coats

Results:

The participants mean age was 50.24 years, range 20-80 years. Eighty percent (n=149) of the participants preferred physicians in a white coat whereas only 8 patients felt tense during consultations and preferred doctors in semi-formal attire and 27 participants however had no specific preferences. Patients expressed preferences for a white coat, as they felt it conveyed a professional image (41%) and made it easy to distinguish doctors from other HCP (48%). Others reasons were that white coat was traditional attire for doctors and made them look more knowledgeable (11%).

The role of white coats in transmitting infections was not perceived as a reason to avoid them and in spite of explaining the potential risks; they were unwilling to change their preferences (56%).

Conclusion: In India, patients overwhelmingly favoured physicians attired in white coats. Recent evidence based recommendations on “getting rid” of white coats due to potential risk of transmission of multi drug resistant bacteria need to be re-evaluated in India due to cultural preferences which may have a stronger impact on the perceived aspects of professional care rendered.