Pediatric Sports Medicine Patients' and Caregivers' Explicit and Implicit Preferences for Physician Appearance

Background: Many factors have been shown to influence patients' trust in their physician, including their general appearance and attire. While the literature has explored attire preferences across medical specialties, including pediatric orthopedics, it has largely failed to incorporate popular attire options into surveys. Better understanding of young patients’ and parents’ preferences for physician attire could help improve clinical interactions and lead to increased adherence with physicians’ recommendations. Both presence and strength of apparel preferences were assessed through a series of round-robin comparisons

Methods: Patients and their caregivers were each administered either a female or male physician attire REDCap questionnaire while waiting prior to a sports medicine outpatient clinic visit at single institution between 8/3/2020 and 5/16/2021. The survey included demographics and explicit and implicit attire preference. Ten attire options matched across gender were provided, including business casual (BC), white coat over business casual (WCBC), scrubs (SC) and white coat over scrubs (WCSC). Explicit attire preference was measured by a single question where each attire option was presented and the favored one was selected. Implicit attire preference was measured by 45 round-robin comparisons of two attire options and estimated using Bayesian logistic regression.

Results: We surveyed 212 patient-caregiver dyads, with 104 rating male and 108 rating female physician attire options. 44% of patients were female, 54% were white, and the mean age was 13 (sd=2.4). Overall, patients both explicitly and implicitly preferred WCSC (Explicit: n=49, 23%; Implicit OR=1.59 95% Confidence Interval [1.4, 1.82]). The caregivers preferred WCBC (Explicit: n=58, 27%; Implicit OR=2.42 [2.12, 2.79]). The implicit differences between patient and caregiver preferences were significant (Explicit: χ2(9)=9.78, p=0.37, Implicit: Leave-One-Out Criteria= -4.5sd). Both patients and caregivers had different apparel preferences for male and female physicians (Patients: χ2(9)=24.52, p=0.003; Caregivers: χ2(9)=34.80, p<0.01). Caregivers rated both attire and overall appearance as more important to them than patients did (p < 0.01).

Conclusion: Although white coats are not the preference of all pediatric patients, they are explicitly and implicitly preferred by patients and caregivers in a sports medicine setting. Both groups also demonstrated differing attire preferences based on provider gender. It is vital to recognize how gendered bias may shape expectations and thus assessments of a physician’s appearance and behavior.