Dermatologists wearing white coats on practice websites: current trends.

Physicians wearing white coats are perceived as having more authority, being more friendly and being more attractive than those not wearing white coats, and patients report that they prefer their dermatologist to wear a white coat. The aim of the study was to determine the prevalence of dermatologists wearing white coats on practice websites. We searched Google for dermatology practice websites in six states representing distinct geographic regions in the United States. The first one hundred search results were evaluated, and photographs of dermatologists on these websites were examined for the presence or absence of white coats. Most (77%) of dermatologists did not wear white coats. The highest prevalence was in the eastern states of Massachusetts and South Carolina, with 29% and 39%, respectively. Colorado had the lowest rate at 13%. Rates were essentially equal when segmented by gender. Although patients report that they prefer their dermatologist to wear a white coat, dermatologists often do not wear a white coat on their practice websites.

Introduction

To wear or not to wear – that is the white coat question. Today fewer physicians wear them while more non-physician health care professionals do. Several studies over the past 20 years have addressed patient preferences on the matter. A review of the literature, including two dermatology studies, indicates that patients prefer their physicians to wear white coats, not only for identification purposes but to build trust and confidence.[1-7] This preference holds stable whether studies have addressed general practitioners,[1-4] specialists,[5] or dermatologists specifically.[6,7] A study in which subjects were shown digital photographs of doctors with or without white coats found that subjects perceived the doctors wearing white coats to have greater authority, to be more friendly and to be more attractive.[8] No study has assessed the prevalence of dermatologists wearing white coats on their websites. Given that patient preferences are well known and that websites are a major marketing and communication tool, we conducted an observational study to evaluate the prevalence of dermatologists in white coats on websites.

Materials and Methods

To estimate national trends, we evaluated six states from varying regions: northwest (Oregon), southwest (Arizona), west (Colorado), midwest (Indiana), northeast (Massachusetts), and southeast (South Carolina). State populations ranged from 3.8–6.6 million.[9]

One author (AH) used Google to search the terms Arizona dermatology, Colorado dermatology, Indiana dermatology, Massachusetts dermatology, Oregon dermatology, and South Carolina dermatology. During October 18–24, 2010 she evaluated the first 100 websites for each search term, assessing for relevancy, redundancy, and English language use. She evaluated both photos and videos of dermatologists. If multiple photos or videos of a dermatologist existed on the site, she only recorded one image per dermatologist with the profile image taking priority. She recorded the total number of dermatologists, their gender, and whether they were photographed with or without white coats.

Results

Table 1 summarizes the prevalence of dermatologists wearing white coats in each state. Overall, 23% of dermatologists wore white coats, while 77% did not. Massachusetts and South Carolina had the highest white coat prevalence rate at 29% and 39%, respectively. Colorado had the lowest rate at 13%, one third of South Carolina’s rate. Rates were essentially equal overall and when considering gender. There was moderate variation by gender between various states: Arizona and Colorado had a higher prevalence of women wearing white coats, while the other four states had a higher prevalence of white coat-wearing men.

Table 1

White coat prevalence by state.[a]

	Arizona	Colorado	Indiana	Massachusetts	Oregon	SouthCarolina	Total
Total:WhiteCoats	17% (13)	13% (12)	20% (11)	29% (38)	20% (12)	39% (23)	23% (109)
Total:NoWhiteCoats	3% (64)	87% (82)	80% (43)	71% (91)	80% (48)	61% (36)	77% (364)
Men:WhiteCoats	11% (5)	8% (4)	23% (8)	33% (21)	21% (7)	43% (16)	23% (61)
Men:NoWhiteCoats	89% (41)	92% (47)	77% (27)	67% (42)	79% (26)	57% (21)	77% (204)
Women:WhiteCoats	26% (8)	19% (8)	16% (3)	26% (17)	19% (5)	32% (7)	23% (48)
Women:NoWhiteCoats	74% (23)	81% (35)	84% (16)	74% (49)	81% (22)	68% (15)	77% (160)

Data expressed as percent (number).

Discussion

The results indicate that, on their websites at least, dermatologists are largely not wearing white coats. Prevalence rates vary by state, but in all six states the majority of dermatologists did not wear white coats. The east coast is customarily known for being more traditional, which may account for its relatively high white coat prevalence rate.

Physicians report various reasons for not wanting to wear white coats - infection risk, discomfort, and interfering with the patient-physician relationship.[1] However, a recent study found no statistically significant difference between bacterial or methicillin-resistant Staphylococcus aureus contamination of physician’s white coats versus newly laundered physician attire after an eight hour work day.[1] The study also found no difference in bacterial contamination at the wrists of doctors wearing white coats versus newly laundered attire, suggesting that white coats may pose no greater risk of infection than newly laundered clothing. Further, infection risk and comfort are not significant concerns when posing for a photo for one’s website. A recent study on dermatology patients indicates that most patients prefer their dermatologist to wear a white coat,[2] while a study involving digital images of doctors with and without white coats patients perceive doctors to have more authority, be more friendly and be more attractive when they are wearing a white coat.[8] While white coats can provoke anxiety in some, such as in reported white coat hypertension, they may also have a positive placebo effect in others.[10] Since many non-physician healthcare professionals also wear white coats, white coats may not be as helpful to patients for identification of the physician as they once were. This is not a reason to forgo a white coat. Rather, identification badges clearly marked as doctor or physician may help to alleviate confusion for patients.[1] Our findings are limited by having only examined images on websites in six states. However, we chose states in distinct geographic areas of the country in an effort to measure a representative sample of the entire United States. It is also possible that photographs on websites do not accurately reflect dermatologist attire in the office. Photographs on websites are nonetheless important. As most dermatologists’ websites are designed primarily to market their practice, it would follow that they should accommodate patient preferences. While recruiting new patients through the Internet currently may not be paramount, using practice websites as advertising tools is likely to become more important as younger patients turn to the web to find medical information and recommendations for health care providers.[12] Thus, as dermatologists develop and update their websites, we suggest donning a white coat to visually brand medical professionalism.

Conclusion

In our study sample, most (77%) dermatologists did not wear white coats on their practice website. Our results were approximately equal among men and women, but East coast states had the highest rates of white coat-wearing physicians (29% in Massachusetts and 39% in South Carolina), whereas Colorado had the lowest rate (13%). Since patients report they prefer their dermatologist wear a white coat, and practice websites may be patients’ first introduction to their dermatologists, dermatologists should consider presenting themselves wearing white coats online.