Patients' perspectives on how doctors dress
Introduction
Infection control is increasingly important in UK hospitals. It has been estimated that healthcare-associated infection (HCAI) led to 5000 patient deaths in 2006. Moreover, longer patient hospital stays and treatment of HCAIs is thought to cost the National Health Service (NHS) more than £1 billion each year. A number of small studies have suggested that neckties may contribute to the spread of infection between doctors and patients, and white coats have been shown to be colonised with multiple organisms.1, 2, 3
In September 2007, the Department of Health published uniform and dress-code guidelines intended to reduce infection transmission.4 Despite stating that there is ‘… no conclusive evidence that … work clothes … pose a significant hazard in terms of spreading infection …’ it was felt that public anxiety regarding infection was sufficient to warrant new dress-code policy. The report advises that those coming into contact with patients should wear short-sleeved shirts/blouses and avoid wearing white coats. The guidelines also state that it is inadvisable to wear hand or wrist jewellery and wrist-watches, and that neckties are unacceptable during patient contact. Based on this report, many NHS trusts adopted a ‘bare-below-the-elbows’ and necktie-free dress policy.
Although the risk of infection spread through clothing has been debated, patients' opinions regarding dress-code have not been extensively investigated. Thus, a survey was undertaken at Great Western Hospital, Swindon, UK (GWH) to assess awareness of the new policy, its relationship to infection control and expectations from doctors' appearance.
Seventy-five inpatients at GWH were interviewed. The patients were from both surgical and medical wards. Basic demographic information was collected and they were asked to state whether they agreed or disagreed with six statements. Patients were given the opportunity to comment generally on infection control policy and the new dress-code.
Section snippets
Patient sample
Seventy-five randomly chosen inpatients at Great Western Hospital, Swindon, UK were interviewed over a three-week period. Thirty-eight were female, 37 were male. Age ranged from 23 to 93 years. Thirty-two of those interviewed were inpatients on surgical wards, 43 were on medical wards.
The study was considered by the Wiltshire Research Ethics Committee and deemed not to require ethical review.
Survey design
The survey was anonymised, and consisted of basic demographic information with six targeted statements,
Patient demographics
Seventy-five patients from GWH were interviewed from several wards with 32 on surgical and 43 on medical wards. Thirty-eight (50.7%) were female and 37 (49.3%) were male. The average age of all patients was 66.6 years (range: 23–93; SD: 18.0). The female patients were slightly older than the males (mean: 68.3 vs 64.8 years; range: 23–91 vs 28–93; SD: 19.9 vs 16.0).
Is doctors' dress important?
Patients were presented with a statement, not a question. The exact wording of the statement is as it appears here i.e. ‘Doctors’
Discussion
Infection control in hospitals is an important topic. Beyond the use of alcohol gel and regular ‘deep cleans’, dress-code has come under scrutiny. Following the publication of Department of Health guidelines on uniforms and dress-code in the workplace, many NHS trusts have adopted a ‘bare-below-the-elbows’ policy.4 This new dress-code has been adopted by GWH.
Research into the relationship between clothing and infection has concentrated on bacterial colonisation of garments, and the potential
Conflict of interest statement
None declared.
Funding sources
None.
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Cited by (30)
Bare below the elbows in an academic medical center
2019, American Journal of Infection ControlCitation Excerpt :Studies evaluating the burden of bacterial colonization on the hands of physicians who practiced BBE compared with a group who did not practice BBE did not find any significant differences in the number of bacterial colony-forming units on the hands between the groups,4,5 and no change in the presence of clinically significant organisms was identified.4 Furthermore, there is concern that physicians who do not wear traditional attire, such as a white coat, may be perceived as unprofessional by their patients, yet evidence has shown that patients do not feel that white coats and neckties are necessary.6 Studies have found that patients who are educated on the potential benefits of BBE shift their opinion to favor physicians who adhere to a BBE approach.7,8
The Journal of Hospital Infection – a history of infection prevention and control in 100 volumes
2018, Journal of Hospital InfectionCitation Excerpt :It became expected that staff would be bare below the elbows to facilitate hand hygiene, although a study found no evidence that being bare below the elbows improved hand hygiene [59]. Although later work did not support the hypothesis that healthcare workers’ clothing could be a vehicle for the transmission of infections [60], doctors’ attire changed in many countries, as ties and white coats were outlawed; these changes were found to be generally acceptable to the public [61]. From the outset, MRSA featured heavily in JHI.
Doctor's attire influences perceived empathy in the patient-doctor relationship
2012, Patient Education and CounselingCitation Excerpt :Our results are also consistent with other studies, reporting higher scores in trustworthiness and confidence ratings for doctors wearing the white coat [17,32,33,41–43]. However, considering the recent discussions about the dangers of hospital infections due to the white coat, especially in the UK, and the negative connotation of the ‘white-coat effect’, the results could be different depending on where this kind of study was conducted [44–47]. The social perception of the doctor in patients differs from society to society [48].
Do patients understand the changes in the way doctors dress?
2010, Journal of Hospital InfectionPants, policies and paranoia...
2010, Journal of Hospital InfectionCitation Excerpt :Formal attire has been shown to be associated with greater trust and confidence. Patients do not necessarily approve of new dress-code-compliant uniforms unless suitably informed of the rationale behind such changes.29–31 Furthermore, the prohibitive policy on wristwatches creates substantial inconvenience and lack of precision for staff when engaged in estimating important vital signs and clinical appointments.32