“A good first impression can work wonders,” author JK Rowling writes in Harry Potter and the Order of the Phoenix.1 Conversely, a negative first impression can have long-lasting adverse repercussions.2 “First impressions” are based not only on the verbal content of the interaction, but also on appearance and demeanor and other nonverbal components.3 This is true in most social and professional settings, and healthcare is no exception. Doctors’ attire is a “vital part of the first impression the patient will develop of the doctor.”3 During the first clinical encounter, “the patient and the doctor not only exchange medical information about the treatment, but also build up trust and confidence for future therapeutic relationship,”3 and the relationship between patients and physicians is “key to high-quality healthcare.”4
Communication is central to the physician-patient relationship, and attire is “an influential source of nonverbal communication, especially in the absence of other information.”3 What a doctor wears can also be “an important factor in the degree of trust and confidence” among patients.5
To shed further light on the role of physician attire in the medical setting, MPR interviewed Nathan Houchens, MD, Assistant Professor of Internal Medicine at the University of Michigan in Ann Arbor. Dr Houchens is also Associate Chief of Medicine at the Veterans Affairs Ann Arbor Healthcare System as well as the Director of the University of Michigan Internal Medicine Residency Patient Safety and Quality Improvement Learning Program.
What interested you in this area of focus?
One of my areas of interest and career emphasis involves relationship-focused domains of medicine—communication skills, empathy, resilience, and patient safety.
The background for this line of research is that relationships and interpersonal communication are paramount for effective health outcomes, and the relationship between patients and physicians are key to high quality healthcare. Multiple studies have shown the association between patient satisfaction with care and outcomes—the rates of engaging in preventive screenings, adherence, and even mortality. The concept is quite ancient, in fact, it goes all the way back to Hippocrates, who said that the physician “must be clean in person, well dressed, and anointed with sweet-smelling unguents.”6 And today, in the era of patient-centered care, it is especially important to build rapport and foster relationships with patients.
First impressions are an important part of the patient-physician relationship, because they can affect the quality of the relationship well beyond the initial encounter. Estimates vary, but previous research suggests that an impression can be formed in as little as 50 milliseconds.7 Another study2 found that judgments made after a 100-ms exposure were correlated with similar judgments that were made after longer exposure. The authors implied that the short exposure time was sufficient for participants to form an impression. Light travels very quickly and the first cues we get about another person are visual. So my colleagues and I wanted to take that seriously and see what patients do or do not appreciate about the dress of clinicians.