Evidence-based physicians' dressing: a crossover trial

Balakrishnan R Nair, Stephen R Mears, Karen I Hitchcock and John R Attia
Med J Aust 2002; 177 (11): 681-682.


Objective: To describe the effect of physicians' dress on patient confidence and trust.

Design: A prospective crossover trial involving physicians dressed in "respectable" versus "retro" attire.

Setting: A general medicine ward at a tertiary hospital.

Participants: 12 male general physicians and 1680 patients.

Main outcome measures: Patient trust and confidence as measured by a questionnaire mailed after hospital discharge.

Results: Formal attire was correlated with higher patient confidence and trust. Nose rings were particularly deleterious to patients' reported trust and confidence. A minimum threshold of two items of formal attire (dress pants, dress shirt, tie, or white coat) were necessary to inspire a reasonable amount of confidence; this is the NND (number needed to dress).

Conclusions: We highlight the need for more research into the effects of physician dress, and coin the term "evidence-based dressing".

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  • Balakrishnan R Nair1
  • Stephen R Mears2
  • Karen I Hitchcock3
  • John R Attia4

  • 1 John Hunter Hospital, New Lambton, NSW.
  • 2 Centre for Clinical Epidemiology and Biostatistics, Royal Newcastle Hospital, Newcastle, NSW.


The photograph accompanying this article was produced by Stephen McInally of Medical Communications, John Hunter Hospital.

Competing interests:

Professor Nair is a white-coated, bow-tied, greying physician who has received complimentary neckties, boxers and socks from pharmaceutical companies. Dr Attia is a general internist who has never been accused of being fashionable. Mr Mears is an open-shirted, jeans-clad informationist. All teach EBM. Karen Hitchcock is a final-year medical student. Some of her best friends have navel rings.

  • 1. Sackett DL, Rosenberg WM, Gray JA. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-72.
  • 2. Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet 2001; 357: 757-762.
  • 3. Isaacs D, Fitzgerald D. Seven alternatives to evidence based medicine. BMJ 1999; 319: 1618.
  • 4. Taylor PG. Does dress influence how parents first perceive house staff competence? Am J Dis Child 1987; 141: 426-428.
  • 5. Kanzler MH, Gorsulowsky DC. Patients' attitudes regarding physical characteristics of medical care providers in dermatologic practices. Arch Dermatol 2002; 138: 463-466.
  • 6. Harnett PR. Should doctors wear white coats ? Med J Aust 2001; 174: 343-344. <eMJA full text>
  • 7. Druss RG. The magic white coat. Ann Intern Med 1998; 129: 743.
  • 8. Campbell JD. The stethoscope at ease. CMAJ 2001; 164: 748.
  • 9. Wong D, Nye K, Hollis P. Microbial flora on doctors' white coats. BMJ 1991; 303: 1602-1604.
  • 10. Varghese D, Patel H. Hand washing: stethoscopes and white coats are sources of nosocomial infection. BMJ 1999; 319: 519.
  • 11. Dixon M. Neck ties as vectors for nosocomial infection. Intensive Care Med 2000; 26: 250.
  • 12. Biljan MM, Hart CA, Sunderland D, et al. Multicentre randomised double blind crossover trial on contamination of conventional ties and bow ties in routine obstetric and gynaecological practice. BMJ 1993; 307: 1582-1584.
  • 13. McKinstry B, Wang JX. Putting on the style: what patients think of the way their doctor dresses. Br J Gen Pract 1991; 41: 275-278.
  • 14. Streiner D, Norman G; PDQ Epidemiology; Hamilton, Ontario: BC Decker, 1998.


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