The Effect of an Orthopaedic Surgeon's Attire on Patient Perceptions of Surgeon Traits and Identity: A Cross-Sectional Survey

Introduction: In orthopaedic surgery, limited research is available addressing how attire, including white coats (WC) and feminine attire such as skirts, affects patient perceptions. It is unknown how surgeon appearance is associated with identification as a surgeon and perception of clinical skills, nor whether this differs between male and female surgeons. Methods: An image-based survey was offered to all adult patients in four orthopaedic surgeons' sport medicine or foot and ankle clinics. Respondents viewed 10 photos of male and female models in varying attire and identified that individual's most likely role on the healthcare team. Then, in 10 photos pairs, respondents selected which surgeon showed more competence, ability to excel in performing the physical components of surgery, likelihood to provide a good surgical outcome, and trustworthiness. Results: Two hundred thirty-eight patients participated in the survey. Men were identified as surgeons significantly more frequently than women in similar clothing (P < 0.05) for all attire except a business attire without a WC (men: 18.2% vs women: 11.2%; P = 0.252). Patients ranked physicians wearing a WC with any attire as more competent and more likely to give a good surgical outcome than those without (all P < 0.005). Patients found women in feminine attire significantly less likely to excel in performing the physical parts of surgery than women in scrubs (P = 0.001). Discussion: Women surgeons who wear feminine business attire instead of scrubs may be perceived less able to perform the physical work of operating, but are otherwise rated comparably with their peers, both male and female. Surgeons wearing WC are generally perceived more favorably than those without WC, an effect that is magnified for perceptions of competence for female surgeons. Men are more readily identified as surgeons than women when wearing a similar attire, except for a business attire without WC. There are continuing differences in how patients perceive male and female orthopaedic surgeons based on their attire.

What do you think is this person's role on the healthcare team? Please select your best guess from the options below. What do you think is this person's role on the healthcare team? Please select your best guess from the options below.

Intro Competence
In the third part of this survey, imagine that you are having an appointment in the orthopedic surgery clinic with the surgeon pictured. You will be asked to pick which surgeon fits with certain characteristics as listed on the slide.
This first section will ask you to pick a surgeon based on who you think is more competent.
Competence Surgeon (doctor) Physician Assistant/PA (non-MD who sees patients under the supervision of a doctor) Nurse Medical Assistant/MA (helps clinic run smoothly by rooming patients, taking vitals, etc.)

Hospital Administrator
Other Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more competent?

Intro Surgical Outcome
This second section will ask you to pick a surgeon based on who you think will give you a better surgical outcome.

Surgical Outcomes 1
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which surgeon seems more likely to give a better surgical outcome?

Intro Physical Aspects
This third section will ask you to pick a surgeon based on who you think is more likely to excel in performing the physical parts of surgery.

Physical Aspects 1
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery? Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery?
Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery?
They seem the same They seem the same Imagine that you are having a clinic visit with the orthopedic surgeon shown below. Which provider seems more likely to excel in performing the physical parts of surgery?

End
Thank you for participating in our survey. There are three final questions.
Think back to your last healthcare experience. Did the providers you met introduce themselves by title or role on the healthcare team?
Is your primary care doctor (PCP, family medicine doctor, or internal medicine doctor): Do you recognize the models featured in these images?
Where do you recognize these models from?