Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, Jun 1, 2017
The patient-physician relationship in mental health is an integral part of effective treatment. T... more The patient-physician relationship in mental health is an integral part of effective treatment. Therapeutic alliance hinges on establishing trust and empathic relationships with patients. Studies have shown that physician’s attire has an impact on the doctor-patient relationship, because it is one of the first elements that determine the patient’s impression of the physician [1]. Therefore, presenting a professional image is important to establishing effective relationships [2, 3]. The first impression of the physician is a complex dynamic. Factors that affect this dynamic include neatness, facial expression, body language, and even a smile [1, 4]. However, the debate is ongoing regarding therapeutic alliance [5–7]. During the personal growth phase of mental health in the 1980s and even earlier, mental health professionals discarded more formal attire in favor of casual attire [8]. Clergy also embraced more casual attire with contemporary services, and businesses offered casual attire Fridays for employees. However, with the shift toward evidenced-based skill training approaches in mental health, there has been a shift back to more formal attire [9]. A study conducted in Britain found that children did not dislike their pediatricians wearing a white coat but viewed them as less friendly. Previous research has shown that even when the physician is perceived as being less friendly, less understanding, and less easy to converse with, patients preferred formal attire because it is associated with competence [3, 10, 11]. For years, the white coat has symbolized authority, professionalism, and scientific knowledge [12]. Yet, contrary to earlier studies supporting physicians’wearing white coats, more recent research has shown that patients do not want their psychiatrist to wear a white coat [9, 13]. Hartmans et al. [14] found patients to be comfortable with female general practitioners’ wearing more leisure attire (regardless of age) and semiformal attire for young and middleaged male practitioners. Although the significance of physician attire has been cited since Hippocrates, disagreement continues among medical professionals regarding whether wearing a white coat positively impacts their relationships with patients [7]. According to Rehman et al. [7], the patient-physician relationship is the bedrock of patient care. Therefore, it is important to understand the factors that affect therapeutic relationships, particularly in mental health settings. Studies have shown that the ability to connect with patients increases the likelihood of their adhering to treatment [13]. Part of the dilemma for psychiatry is not only to make patients feel comfortable in a nonsterile atmosphere but also to provide an image of expertise and professionalism. During the outpatient year of training, some residents wear a white coat and some do not. A variety of opinions exists regarding more conservative, traditional attire with or without a white coat. Studies have explored physician attire and perceived friendliness [5], resident-physician attire at an obstetrics and gynecology clinic [4], views on psychiatrists’ dress [3, 6], psychiatrists’ dress at community mental health clinics [9], attire and trust and confidence at a medicine clinic [7], and psychiatric patients’ views of psychiatrists’ dress in Ireland [15]. However, many studies on physician attire and the preference of wearing a white coat have been conducted in countries other than the USA and have focused on specialties other than psychiatry [9]. A comprehensive search of the research literature discovered that no study has been conducted to explore patients’ preference for their psychiatric resident’s attire at a university outpatient clinic. * Jody Long [email protected]
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