Comment s’habiller en Neuro-urologie?

25 juin 2020

Auteurs : C. Chesnel, A. Charlanes, N. Turmel, G. Miget, F. Le Breton, E. Tan, C. Hentzen, G. Amarenco
Référence : Prog Urol, 2020, 7, 30, 374-380




 




Introduction


Patient satisfaction with care contributes to therapeutic compliance and adherence leading to better outcomes [1, 2, 3]. Various factors impact on patient satisfaction such as communication with nurses and doctors, pain management, timeless of assistance, explanation of medications administered, cleanliness of room and bathroom, discharge planning, noise level at night [3, 4, 5]... Specific questionnaires were validated in order to explore and quantify patients expectations [6, 7]. With increasing clinics requests and delays, the time available to gain patient confidence is reduced. Petrilli and al. described the role of physician attire on patients' perception and highlighted its importance in patients' confidence, trust and satisfaction [8]. It appears that the knowledge of patients' preference with regards to physician attire could be an asset to improve the patient experience.


In a neuro-urology department with outpatient services and additional explorations (urodynamic, anorectal manometry, electromyographic testing), the physician attire is an important issue because of its non-surgical activity but procedural therapies.


The aim of this study was to assess patient perceptions and preferences regarding physician dress code in a neuro-urology department.


Material and methods


The questionnaire was developed based on expert meetings and literature review of the role of physician attire on patient preference and satisfaction [8, 9]. This led to a short questionnaire with 2 sections and 4 questions. In the first section, 3 photographs of different physician attires were presented: casual attire with white coat, scrubs and scrubs with white coat (Figure 1).


Figure 1
Figure 1. 

Photographs of physician attires used in the survey instrument.




The face of the physician was hidden, pose lighting and environment were similar. Respondents were asked to select their ideal attire and to mention if any attire shock them. The second section sought respondents' general opinions regarding physician attire, its importance and relation with patient satisfaction.


Between January 2019 and April 2019, surveys were filled in a neuro-urology department of a university hospital. Adult patients who were consulting or admitted for a one-day- hospitalization fulfilled the questionnaire. Demographic data (age, sex, occupational category, education level), presence of neurological disease, patient already familiar with the department or first visit, reasons for the external consultation or for the one-day-hospitalization were collected. When the patient came for urodynamic study, learning of urinary intermittent self-catheterization, perineal electrophysiology, intradetrusor injection of botulinum toxin A, urinary sphincter injection of botulinum toxin A or limb injection of botulinum toxin A, the reason for the visit was considered as invasive. Non-invasive reasons of consulting were: medical consultation and learning of posterior tibial nerve stimulation.


The questionnaire and the collected data were anonymous.


R and R Studio softwares were used for statistical analysis. Means, percentages and standard deviations were used to describe the population and the responses to the questionnaire. Differences between the rating and the patients' characteristics were assessed using analysis of variance for quantitative variables or Chi2 tests for categorical variables. A p value of less than 0.05 was considered statistically significant.


This study was approved by a local ethics committee.


Results


One hundred and sixty-three patients completed the questionnaire. The mean age was 52.5 years old (SD 15.6), respondents were mostly women (66.5%), people with neurological disease (66.9%), and patients coming for a urodynamic evaluation (36.3%) (Table 1).


The three physician attires were chosen equally by the respondents. The majority of the respondents (71.4%) wasn't shocked by any attire. However, when an attire shocked, it was in most cases (68.2%) the casual attire with white coat (Figure 2).


Figure 2
Figure 2. 

Preference for physician attire.




The majority (52.5%) of the respondents considered that the way their doctor dressed was important and 36.3% of the patients considered that physician attire influenced how confident they were with the care they received (Figure 3).


Figure 3
Figure 3. 

Respondent opinions regarding importance of physician attire.




The sex of the respondent appeared to influence patients' preferences for an attire (P =0.02). Male respondents preferred scrubs with white coat (44.0%) while female respondents preferred casual attire with white coat (42.0%). No difference between sex of the respondent was observed regarding the shocking attire (P =0.83). Neither the age, the reason of the consult (invasive or not), the knowledge of the department (patient first visit or not), the presence of neurological disease, the occupational category and the education level of the patient were linked with the preference for the physician attire (Table 2).


Discussion


This study focused on patient preferences regarding physician attire in a laboratory of functional neuro-urologic explorations. Heterogenous preferences appeared for physician dress code: casual attire with white coat, scrubs and scrubs with white coat were equally chosen by respondents. The physician attire was important for more than half of the respondents. More than a third of the patients reported that physician attire influenced how confident they were with care received. Variations in preferences linked to the sex of respondent were noted.


Previous studies showed various results concerning how physicians should dress up. Petrilli et al. reported the largest survey about patient preference on physician attire with over 4000 patients in diverse states of the USA [9]. In their study, formal attire with white coat was the most preferred form of dress compared with other forms of attire [9]. For procedural specialties (like dermatology, orthopedy, podiatry, obstetrics and gynecology and surgery) patients didn't show a clear preference for a specific attire [8]. Even though, in the large sample of Petrilli et al. scrubs were preferred for emergency room physicians and surgeons [9]. If we focus on mixed-specialties with both medical activities and invasive but no surgical procedures like dermatology or podiatric, patients showed a preference for formal attire with or without white coat [10, 11]. In obstetrics and gynecology, patients showed a preference for scrubs in 2 of the 3 studies [12, 13, 14]. Hence, our results showing that patients have no specific preferences regarding physician attire in neuro-urology department was not surprising.


In our study, when patients were asked about any shocking attire, over 70% reported no shocking attire. But among the patients reporting shocking attire, almost 70% designed the casual attire with white coat. There was no difference on demographic data between these two types of respondents. Similarly, only the gender of the respondents was linked with different choices of physician attire. Female respondents preferred white coat whereas male respondents preferred scrubs with white coat. No other patient characteristic studied was linked with the preference of physician attire. Gender was already reported as a factor affecting the preference of patient regarding physician attire [8, 9]. Surprisingly, the invasive character of the procedure wasn't linked with a preference for surgical attire as scrubs or scrubs with white coat. The specificity of neuro-urological patients who are used to urodynamic explorations and regular medical follow-ups might explain this result. However, several studies concerning procedural department reported either no specific preference for attire [13, 15, 16].


The physician attire was important for more than half of the respondents and more than a third reported that physician attire influenced how confident they were with the care received. These findings were consistent with previous findings and highlighted the importance of physician attire to the physician-patient relationship [8, 9]. This proportion may be interpreted with caution because of other factors probably underestimated like unconscious biases and stereotypes of the patients [17, 18].


Our study has limitations. Similarly to previous studies of physician attire, our questionnaire was based on photographs of physician with different attire which may have introduced bias into responses. Photographs assess only the first impression of the respondents, which couldn't represent the real patients' impression after an encounter with his physician. Second, as patients fulfilled the questionnaire in a context of receiving care, it is possible that their responses were not the real reflection of their preferences, although the questionnaire was anonymous. In addition, the questionnaire responses were presented on a likert scale, such categorization may restrain the expression of the true feeling of the patients. Another limitation is the missing data. Patients fulfilled alone the survey, and they left out a few questions. However, to our knowledge, our study is the only survey that has focused on patients' preferences regarding physician attire in a laboratory of functional neuro-urologic explorations. Obviously, this study is probably not easily transferable in all countries, on all continents, since cultural approaches are largely different. Thus specific surveys should be conducted in order to verify results in other cultures.


Conclusion


Our study suggests that physician attire in neuro-urology may influence the way patients perceive care. Physicians should not be restricted to one particular attire in a neuro-urology department, however in order not to shock nearly 20% of the patients, casual attire with white coat should be avoided.


Declarations of interest


The authors declare that they have no competing interest.



Appendix A. Supplementary data


(312 Ko)
  




Table 1 - Characteristic of study respondents.
Characteristics  N (%)/mean (SD) 
Age  n =160
52.5 (15.6) 
Gender  n =161 
Female  107 (66.5) 
Male  54 (33.5) 
Occupational category  n =162 
Farmer 
Artisan, merchant, business executive  5 (3.1) 
Executive, intellectual profession  34 (21.0) 
Intermediate profession  3 (1.9) 
Employee  36 (22.2) 
Worker  5 (3.1) 
Retiree  42 (25.9) 
Other non-economically-active  37 (22.8) 
Education  n =161 
Less than high school  39 (24.2) 
High school  26 (16.1) 
Some college  34 (21.1) 
College  24 (14.9) 
Graduate degree or above  38 (23.6) 
Neurological disease  n =154 
Yes  103 (66.9) 
First visit in the neuro-urology department  n =163 
Yes  19 (11.7) 
Reason of the visit  n =160 
Medical consultation  38 (23.8) 
Urodynamic  58 (36.3) 
Learn of urinary intermittent self-catheterization  8 (5.0) 
Perineal electrophysiology  3 (1.9) 
Learn of posterior tibial nerve stimulation  11 (6.9) 
Intradetrusor injection of botulinum toxin A  29 (18.1) 
Urinary sphincter injection of botulinum toxin A  5 (3.1) 
Limb injection of botulinum toxin A  8 (5.0) 



Légende :
n : number of respondents; SD: standard deviation.



Table 2 - Comparison of responses regarding patient characteristics.
Characteristics  Scrubs  Scrubs with white coat  Casual attire with white coat  Preferred attire 
  n (%) or mean (SD)  n (%) or mean (SD)  n (%) or mean (SD)  P  
Age  54.9 (17.3)  54.2 (16.0)  49.6 (14.2)  0.19 
Gender        0.02 
Female  33 (33%)  25 (25%)  42 (42%)   
Male  17 (34%)  22 (44%)  11 (22%)   
Occupational category        0.77 
active  23 (31%)  24 (32%)  27 (35%)   
inactive  28 (36%)  22 (29%)  27 (35%)   
Education        0.05 
No college degree  38 (41%)  24 (26%)  30 (33%)   
College degree  13 (22%)  22 (38%)  23 (40%)   
Neurologic disease        0.69 
Yes  29 (31%)  32 (34%)  34 (36%)   
No  3 (33%)  4 (44%)  2 (22%)   
First visit in the neuro-urology department        0.26 
Yes  7 (41%)  7 (41%)  3 (38%)   
No  44 (33%)  40 (30%)  51 (38%)   
Reason of the visit        0.52 
Invasive  37 (36%)  33 (32%)  34 (33%)   
Non invasive  13 (29%)  13 (29%)  19 (42%)   



Légende :
n : number of respondents; SD: standard deviation. Active occupational category: farmer, artisan, merchant, business executive, executive, intellectual profession, intermediate profession, employee, worker; inactive occupational category: retiree, other non-economically-active. No college degree: less than high school, high school, some college; College degree: college, graduate degree or above. Invasive: urodynamic, learn of urinary intermittent self-catheterization, perineal electrophysiology, intradetrusor injection of botulinum toxin A, urinary sphincter injection of botulinum toxin A, limb injection of botulinum toxin A; Non invasive: medical consultation, learn of posterior tibial nerve stimulation.


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