The ability to form a trusting, honest relationship is important to any doctor-patient relationship.1,2 This may be even more important in veterinary medicine than in human medicine because of veterinarians' reliance on clients for information regarding history, clinical signs, and environmental factors that may be important for diagnosing an animal's medical condition.
In human medicine, patients prefer that their physician be formally attired and wearing a white coat.3–8 Indeed, many studies3–14 have shown that physicians who wear more formal attire inspire more trust, confidence, and perceived empathy in their human patients than physicians who wear less formal attire. To the authors' knowledge, client preferences regarding their veterinarian's attire and the influence of this attire on their trust and confidence in veterinarians have not been investigated. The purpose of the study reported here was to evaluate preferences of clients of a small animal emergency hospital regarding their veterinarian's attire and to determine whether certain styles of attire affected their perceptions of veterinarians.
Materials and Methods
Participants
Owners of companion animals examined on an emergency basis at the Inland Valley Veterinary Specialists and Emergency Center in Upland, Calif (a rural community), between December 1, 2015, and December 31, 2015, were invited to participate in the study. All clients were free to decline participation in the study without affecting treatment of their animals, and interested clients provided written consent. Reasons for clients declining participation were not evaluated. Clients could participate only once, and in circumstances involving multiple visits (with the same pet or different pets) during the survey period, clients were invited to participate at the first visit during the survey period only. The study protocol was approved by the Institutional Review Board and Committee of the Inland Valley Veterinary Specialists and Emergency Center.
Survey
A survey was developed on the basis of surveys used in previous studies9,11,13 in human medicine, in which investigators asked patients about their age, sex, and preferences regarding various styles of physicians' attire (Supplementary Appendix SI, available at avmajournals.avma.org/doi/suppl/10.2460/javma.253.3.355). In this survey, clients were asked to report their preference for each of 5 styles (with the option of no preference) in various clinical scenarios. To help respondents understand what was meant by the different styles of attire, a laminated picture of the same male and female veterinarian wearing each style was included with each survey, similar to the survey approach in previous studies9,11,13 (Figure 1). The definitions of each type of attire, as described in the photographs of veterinarians, were also similar to those in the previous studies.9,11,13
Photographs of male (A) and female (B) veterinarians in each of 5 styles of attire, as presented to companion animal-owning clients for reference when responding to a survey regarding their impressions of these styles.
Citation: Journal of the American Veterinary Medical Association 253, 3; 10.2460/javma.253.3.355
In addition to asking clients to indicate their preferences, the survey prompted clients to indicate their degree of trust, confidence, and willingness to disclose sensitive personal information with the veterinarian in each of the pictures. Questions were also included asking clients to rate how strongly they felt about the importance of different aspects of their veterinarian's appearance and whether a veterinarian's attire would affect their perception of the quality of the medical care their pet received.
Survey validation
Face validity, which is the degree to which a survey appears to assess the desired qualities,15 was established for the developed survey through informal discussions with veterinarians and technicians and through feedback. Ten staff members consisting of 5 veterinarians and 5 technicians took the survey and reported no trouble understanding the questions and a willingness to retake the survey if needed.
Statistical analysis
For each question, response frequencies were tabulated. Descriptive statistics are reported.
Results
Respondents
A total of 517 owners of companion animals came to the emergency clinic during the study period, and surveys were completed by 160 of these clients during this time, representing a response rate of 30.9%. Six (3.8%) surveys were excluded from the analysis because not all questions were answered, leaving 154 surveys available for evaluation.
Eighty-three (53.9%) respondents were female, and 71 (46.1%) were male. Forty (26.0%) respondents were between 18 and 34 years of age, 53 (34.4%) were between 35 and 50 years of age, 40 (26.0%) were between 50 and 65 years of age, and 21 (13.6%) were < 65 years of age.
Perceptions
For questions concerning the attire of male and female veterinarians, the most common answer in each clinical scenario was that a veterinarian's attire had no impact on their opinion of or trust in that veterinarian (Tables 1 and 2). Among respondents with a preference for a specific type of attire, most consistently indicated a preference for surgical or clinical attire over business and professional attire.
Number (%) of clients of a 24-hour small animal emergency clinic (n = 154) who indicated specific preferences and influences of various styles of attire for male veterinarians in a waiting-room survey.
| Question | Business | Professional | Surgical | Clinical | No preference or no effect | |
|---|---|---|---|---|---|---|
| Which is your preferred style for routine examination? | 3 (1.9) | 9 (5.8) | 27 (17.5) | 47 (30.5) | 54 (35.2) | |
| Which is your preferred style for emergency situations? | 1 (0.6) | 7 (4.5) | 45 (29.2) | 46 (29.9) | 48 (31.2) | |
| Which is your preferred style for discussion of sensitive information?* | 6 (3.9) | 17 (11.0) | 30 (19.5) | 37 (24.0) | 58 (37.7) | |
| Which of these doctors would you trust the most? | 3 (1.9) | 18 (11.7) | 30 (19.5) | 35 (22.7) | 66 (42.9) | |
| Which of these doctors would you be more likely to follow their advice? | 4 (2.6) | 15 (9.7) | 31 (20.1) | 34 (22.1) | 69 (44.8) | |
| Which of these doctors would you have the most confidence in their diagnosis and treatment? | 4 (2.6) | 14 (9.1) | 35 (22.7) | 31 (20.1) | 69 (44.8) | |
| Which of these doctors would you assess as more knowledgeable and competent? | 4 (2.6) | 16 (10.4) | 31 (20.1) | 31 (20.1) | 69 (44.8) | |
| Which of these doctors would you assess as more caring and compassionate? | 5 (3.25) | 8 (5.2) | 33 (21.4) | 33 (21.4) | 70 (45.5) | |
| Which of these doctors would you believe to be more responsible? | 4 (2.7) | 15 (9.7) | 33 (21.4) | 31 (20.1) | 69 (44.8) |
Examples provided included possible exposure of the patient to illicit drugs or abuse by a family member.
Number (%) of clients (n = 154) in Table 1 who indicated specific preferences and influences of various styles of attire for female veterinarians.
| Question | Business | Professional | Surgical | Clinical | No preference or no effect |
|---|---|---|---|---|---|
| Which is your preferred style for routine examination? | 5 (3.2) | 8 (5.2) | 32 (20.8) | 38 (24.7) | 59 (38.3) |
| Which is your preferred style for emergency situations? | 2 (1.3) | 9 (5.8) | 46 (29.9) | 38 (24.7) | 56 (36.4) |
| Which is your preferred style for discussion of sensitive information?* | 5 (3.2) | 20 (13.0) | 31 (20.1) | 32 (20.8) | 62 (40.3) |
| Which of these doctors would you trust the most? | 5 (3.3) | 16 (10.4) | 32 (20.8) | 33 (21.4) | 67 (43.5) |
| Which of these doctors would you be more likely to follow their advice? | 5 (3.2) | 17 (11.0) | 31 (20.1) | 33 (21.4) | 67 (43.5) |
| Which of these doctors would you have the most confidence in their diagnosis and treatment? | 3 (2.0) | 15 (9.7) | 33 (21.4) | 35 (22.7) | 66 (42.9) |
| Which of these doctors would you assess as more knowledgeable and competent? | 3 (1.9) | 16 (10.4) | 30 (19.5) | 38 (24.7) | 65 (42.2) |
| Which of these doctors would you assess as more caring and compassionate? | 5 (3.2) | 9 (5.8) | 34 (22.1) | 34 (22.1) | 68 (44.2) |
| Which of these doctors would you believe to be more responsible? | 5 (3.3) | 15 (9.7) | 31 (20.1) | 31 (20.1) | 70 (45.5) |
See Table 1 for key.
When asked about specific aspects of attire, most respondents indicated no preference for their veterinarian wearing a white coat, blue jeans, sneakers, or ties (Table 3). When asked about specific physical attributes that a veterinarian might have, 40 (26.0%) respondents reported being uncomfortable with facial piercings, 32 (20.8%) with excessive ear piercings, 31 (20.1%) with tattoos, and 22 (14.3%) with dyed or colored hair. Overall, 26.0% (40/154) of respondents indicated that their veterinarian's attire would influence their opinion regarding the quality of care that their pet received.
Number (%) of clients (n = 154) in Table 1 who indicated agreement with various statements regarding veterinarians' attire.
| Statement | Strongly agree | Agree | Don't know or don't care | Disagree | |
|---|---|---|---|---|---|
| When a veterinarian is seeing your pet, he or she should wear a white coat | 8 (5.2) | 38 (24.7) | 82 (53.2) | 25 (16.2) | |
| Sneakers are acceptable and appropriate wear for a veterinarian who is seeing your pet | 21 (13.6) | 68 (44.2) | 52 (33.8) | 13 (8.4) | |
| When a male veterinarian is seeing your pet, he should wear a necktie | 0 (0.0) | 11 (7.1) | 72 (46.8) | 56 (36.4) | |
| Blue jeans are acceptable and appropriate for a veterinarian to see my pet | 10 (6.5) | 44 (28.7) | 58 (37.7) | 36 (23.4) | |
| I am uncomfortable with visible tattoos anywhere on my veterinarian | 4 (2.5) | 27 (17.5) | 66 (42.9) | 39 (25.3) | |
| I am uncomfortable with any facial piercings on a male or female veterinarian | 4 (2.5) | 36 (23.4) | 72 (46.8) | 32 (20.8) | |
| I am uncomfortable with excessive ear piercings (more than 2 on each ear) on a female veterinarian or any ear piercings on a male veterinarian | 1 (0.6) | 31 (20.1) | 73 (47.4) | 36 (23.3) | |
| I believe it is unprofessional for a veterinarian to have dyed or colored hair | 4 (2.6) | 18 (11.7) | 65 (42.2) | 50 (32.5) | |
| I believe that what my veterinarian wears influences my opinion of the care that my pet receives | 3 (2.0) | 37 (24.0) | 51 (33.1) | 43 (27.9) |
Discussion
Contrary to findings in most human medical studies, companion animal-owning clients in the present study had no particular preference regarding styles of attire for male or female veterinarians in the small animal emergency medicine setting. This indifference toward a specific type of attire has also been identified in some studies16,17 in human medicine, but only those involving the attire of physicians in the emergency setting. Differences among studies may reflect the urgent nature of an emergency visit, perceptions of veterinarians versus physicians, or even regional variation in perceptions of veterinarians' attire. Additional investigation is warranted into client preferences regarding veterinarians' attire in various settings and regions and how different styles of attire influence clients' trust in their veterinarian and the quality of care their pet receives.
Approximately 93% of respondents in the present study had no preference or disagreed that male veterinarians should wear a necktie, and approximately 70% also had no preference or disagreed that a veterinarian should wear a white coat when examining their pet. White coats and neck ties have become more controversial attire in human medicine because both have been implicated as a potential source of antimicrobial-resistant and hospital-associated pathogens in human hospitals.18–22 It would have been interesting to determine the reasons veterinary clients believed neckties or white coats were unnecessary, given that previous studies23,24 have shown that human patients feel more confident and communicate better when doctors wear white coats. However, such preferences for white-coat attire in particular can vary on the basis of medical specialty as well as by geographic location.2,13,23,24
Surprisingly, most of the companion animal-owning clients who were surveyed in the present study were neutral on almost all aspects of outward appearance of veterinarians, including tattoos, dyed hair, and facial piercings. On the contrary, a study11 in human medicine revealed that facial piercings, tattoos, and male physicians wearing earrings were the most common physical attributes identified that caused patients to be less confident in their physician.
Although less than a majority, a sizeable percentage of clients in the present study indicated that veterinarians' attire influences their opinion of the quality of care that their pet received. This influence could be considered distinct from other nonmedical aspects, such as the location and appearance of the hospital itself or the appearance of the technical staff. We suspect that the actual percentage reporting an influence could have been underestimated because of social desirability bias, by which some respondents might have been disinclined to admit their true impressions to avoid appearing superficial by basing judgments on outward appearance.
The present study had several limitations that should be considered when interpreting the results. The survey was conducted over a fairly brief period at 1 location, and it is unknown whether the findings could be extrapolated to other client groups during other periods. Internal consistency and test-retest reliability of the survey instrument were not evaluated, so the reliability of the survey results remains unclear. Furthermore, because respondents consisted of companion animal-owning clients of the emergency service, their emotional status at the time of survey completion could have influenced their responses in that they could have been more focused on their pet than on the survey. However, all clients gave their consent before completing the survey. In addition, the emergency hospital in the present study is in a somewhat rural area, and responses of clients in more urban areas could be expected to differ to at least some degree. It would also have been interesting to compare response patterns between large- and small-animal hospitals (or between dog and cat owners) as well as between private practice and academic settings.
The sample size of the present study was rather small, although it was similar to sample sizes in previous studies of the effect of physicians' attire on patients' perceptions. Ideally, we would have explored the reasons underlying clients' perceptions regarding various aspects of veterinarians' attire, such as neckties and white coats. The present study may also have had some bias related to the fact that all veterinarians at the emergency hospital wear scrubs only without white coats, which respondents may have been accustomed to seeing and may have expected. Additionally, the time of survey completion was not recorded, preventing us from exploring whether the clients may have been more accepting of less formal attire during certain times of day, such as in the evening.
The veterinarians in the photographs provided to respondents for reference were employees at the practice, and it remains unknown whether responses could have been influenced by whether the clients were familiar with those veterinarians. We also made no distinction in the survey between clients whose companion animals were having an outpatient procedure performed and those whose pets required hospitalization. Finally, it would be interesting in future studies to evaluate whether clients' perspectives of veterinarians' attire are influenced by the veterinarian's gender.
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