by Elizabeth Hofheinz, M.P.H., M.Ed.
What happens when a team of investigators descends on a sports medicine clinic with pictures of male and female models? Research!
The team, from the University of Wisconsin-Madison, wondered about patients’ reactions to surgeon attire. Showing individuals 10 photos of male and female models in varying attire, the researchers asked patients to identify that person’s most likely role on the healthcare team. The outcome, “The Effect of an Orthopaedic Surgeon’s Attire on Patient Perceptions of Surgeon Traits and Identity: A Cross-Sectional Survey,” appears in the August 3, 2020 edition of the Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews.
“Orthopaedic surgery remains one of the most underrepresented fields in medicine for women at the attending level,” said co-author Andrea Spiker, M.D. to OSN. “Female orthopaedic surgeons are therefore perhaps more aware of the differences in patient perception related to gender, attire, and other subtle factors beyond the scope of our current study. We are extremely fortunate at the University of Wisconsin-Madison to have 25% women orthopaedic surgery faculty, and a number of female orthopaedic surgery residents (including 4 of 6 of our intern class), due in large part to the strong commitment to supporting the best candidates regardless of gender by our Chair, Dr. Tom Zdeblick, and our Senior Vice Chair, Dr. Tamara Scerpella.”
“As a strong advocate myself for our future female orthopaedic surgeon colleagues, I worked with two of our outstanding female orthopaedic residents, Dr. Stephanie Goldstein and Dr. Emma Klosterman, to develop the study published here. We sought to evaluate patient perception associated with surgeon attire, and the differences seen based on surgeon gender.”
“On a personal note, prior to coming to UW-Madison, I spent decades at academic institutions on the east coast. Each institution’s orthopaedic department seems to have its own ‘dress code.’ I was curious to see if we would find patient perceptions that would support one ‘dress code’ over another, and it turns out our study did identify some interesting revelations.”
238 participants…All Hail the White Coat
“We found that in all attire, except for business attire without a white coat, men were significantly more likely to be identified as a surgeon than women. Women were more likely to be identified as a nurse, physician’s assistant, or hospital administrator instead of surgeon when compared to men in the same attire. Patients uniformly thought that both male and female surgeons wearing a white coat on top of any attire were more competent and more likely to give a good surgical outcome than those without a white coat. We also found that without a white coat, a woman in scrubs was more likely to be identified as a surgeon than a woman in business attire or feminine attire. However, once a white coat was added on top of any attire worn by a woman, these differences in identification as a surgeon evened out. However, a female surgeon in feminine attire, even with a white coat, resulted in patient perception that the surgeon was less likely to excel in performing the physical parts of surgery than women in scrubs with a white coat.”
“We had hypothesized that women would be less frequently identified as surgeons than males based on our own personal experiences and existing literature, but we were still somewhat surprised that this was still very clearly the case. We had also hypothesized that feminine attire would be associated with the perception that the surgeon would be less likely to excel at the physical aspects of surgery. This also proved to be true – when feminine attire, instead of scrubs, was worn by a female, the patient believed she would be less likely to excel in performing the physical parts of surgery. But we were happy to find feminine attire did not affect patient perceptions of competence, surgical outcomes or trustworthiness.”
Progress…
“One interesting trend we noted was related to the age of the patient taking the survey. Patients under age 50, compared to patients over age 50, were more likely to identify a woman as a surgeon if she wore business attire and a white coat or scrubs only.”
“Our study supports that surgeon attire affects patient perception of surgeon skill and whether the surgeon is correctly identified as a surgeon versus mis-identified as a nurse, physician assistant or hospital administrator. Our study revealed that patients will identify males as surgeons more often than females no matter the attire worn. We also discovered that wearing a white coat over any attire is perhaps more important for women than men in conferring competence to patients.”
Male or Female…the Coat Helps
“Based on our results, male orthopaedic surgeons may choose to wear a white coat to improve patient perception of competence and their ability to provide a good surgical outcome. Women orthopaedic surgeons may choose to wear a white coat over any attire to improve patient perceptions of competence and being identified as a surgeon, and they may choose to wear scrubs instead of business or feminine attire to increase the perception that they will excel in the physical tasks in the operating room.”
Surgeons could use the results of this study to change their behavior. That will serve to augment the perceptions of patients. If we want to change perceptions and not have attire be associated with competence, we can do the opposite and see if the patient experience can separate attire and surgical competence.
As surgical residents in Galveston in the 1970’s-80’s, we weren’t allowed to wear scrubs outside the OR, but our tclean white coats were mandatory. One of the funniest moments of my training occurred on afternoon rounds, when I was the only woman in the group of 6-8 faculty, residents, & med students. We’d just left the room of a male patient in his 60’s when he called down the hall, “Send in that nurse who looks like a doctor!”