• Users Online: 603
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 93-98

Need for appropriate hospital attire in orthopedic patients


Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

Date of Submission04-Feb-2021
Date of Decision15-Mar-2021
Date of Acceptance30-Mar-2021
Date of Web Publication31-May-2021

Correspondence Address:
Y S Suresh Babu
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110 076
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_10_21

Rights and Permissions
  Abstract 


Introduction: Literature review shows multiple studies on the role of physician attire on patient perceptions. These studies came up with the conclusion that specific dress design might improve the patient-physician bonding. A less likely studied factor in literature was the design of patient attire. The present study aims to design and assess the efficacy of ORTHO dress in orthopedic specialty patients. Patients and Methods: The study population includes 136 patients (62 males and 74 females) presenting to the in-patient department and admitted under orthopedic specialty over 6 months from September 2018 to February 2019 with upper and lower limb illness. The picture-based survey of patient’s preferences regarding choice of attire was conducted on the 3rd day of hospital stay. Results: The mean age of patients was 42.26 ± 10.24 years. The age distribution involves 78 cases (57.35%) were between 15 and 60 years and 58 cases (42.64%) were more than 60 years of age The results show that 124 patients (91.17%) preferred ORTHO dress when dress choice was given when compared with usual hospital dress. Chi-square analysis was used as a test of significance. P < 0.05 was considered statistically significant. Conclusion: Patient attire is the least studied parameter in the medical literature. The influence of specific specialty on patient’s attire is never studied. The ORTHO dress being newly designed and used in orthopedic patients involving upper and lower limb illness plays important role in patient management and has a role in providing better nursing and postoperative rehabilitative care.

Keywords: Ortho dress, patient attire, physician attire


How to cite this article:
Gulati Y, Raina P, Suresh Babu Y S. Need for appropriate hospital attire in orthopedic patients. Apollo Med 2021;18:93-8

How to cite this URL:
Gulati Y, Raina P, Suresh Babu Y S. Need for appropriate hospital attire in orthopedic patients. Apollo Med [serial online] 2021 [cited 2021 Jun 21];18:93-8. Available from: https://www.apollomedicine.org/text.asp?2021/18/2/93/317417




  Introduction Top


The doctor–patient relationship depends on numerous factors varying from the skill of the doctor to the attitude of the physician. It is observed that patients being more compliant with doctors who respect them. Apart from competence, doctor attire and behavior play a very important role in doctor–patient bonding.[1],[2] Strong bonding between the two overcomes many barriers to disease management.[3],[4] Over the past few years and with the advent of technology, the patient has become more intelligent about their illnesses. It benefits the physician as fewer efforts are being needed to explain the procedure but sometimes also become harmful both for patient and physician as inadequate knowledge diverts the mind to one particular direction. The literature review shows that the strategies involved in gaining the patient’s trust and confidence are highly desirable. The studies show that physician attire plays a very important role in building patient confidence as it is the first bonding factor. A professional dress positively reinforces the patient.[5],[6],[7] It is equally important that patients are given appropriate dress during their stay in the hospital so that in-patient procedures such as a change of dressings, suture removal, and plaster application can be carried out by the physician quickly, efficiently and without offending the patient’ modesty. The least likely studied factor in literature is the type of best possible patient attire. The usual designs vary from one place to another. No universal design concept is available. The present study aims at assessing and explaining the benefits of the attire designed by our team (ORTHO dress), in orthopedic patient care. The dress was designed especially for orthopedic patients presenting with limb injuries or elective joint surgeries.


  Patients and Methods Top


The present study includes in-patient department cases admitted for orthopedic illness involving upper and lower limbs. A total of 136 cases (62 males and 74 females) admitted under orthopedic specialty from September 2018 to February 2019 were randomly included in the study. Inclusion criteria involve both male and female patients were included, patients admitted under orthopedic specialty only, cases with either upper and lower limb involvement or both, cases with no documented brain injury. Exclusion criteria include pediatrics patients with age <15 years, cases other than upper or lower limb involvement such as the spine and pelvic disease cases, cases who refused to take part in the study. Patients with an expected length of stay less than 5 days were also excluded from the study [Figure 1]. No upper age limit was defined. Disease pattern included was upper and lower limb diseases such as trauma cases involving limb including both long and short bones fractures, soft-tissue pathologies, joint diseases involving upper and lower limbs including hip and shoulder joints, and tumor cases involving limbs [Table 1] No other specialty cases were included in the study.
Table 1: Patient parameters included in the study

Click here to view
Figure 1: The study distribution

Click here to view


The study design involves a “picture-based survey of patient’s preference” regarding the choice of dress to be used throughout the hospital stay. The picture-based choice of dress was allowed to be done by the patient on the “3rd day” of hospital stay. During the initial stay period, the usual hospital-designed dress was given to the patient on the 1st day of stay. On the 2nd day, ORTHO dress was given to all patients. On the 3rd day, picture–based survey of patient’s preferences was done. Patients were asked to opt for the dress of their choice. The picture-based choice involves three dresses only, two usual hospital dresses, and one specially designed ORTHO dress [Figure 2].
Figure 2: Dress A and B (usual hospital dress), Dress C (ORTHO dress)

Click here to view


The “ORTHO dress”

It involves two components, an upper shirt, and lower trouser. The unique feature specific to ORTHO dress is a modified outer border involving all four limbs that exposes the whole limb as per surgeons need without patient’s discomfort. The orthopedic surgeon has a role in treating diseases, specific to the limbs (upper and lower limbs). Normal dress, when used in patients undergoing limb surgery, causes difficulty in limb exposure without dress removal. It becomes more difficult in female patients undergoing limb surgery as they need regular postsurgery limb dressings and joint physiotherapy. The ORTHO dress has an important beneficial role in these patients. Complete upper and lower extremities can be exposed without dress removal, with ease of any needed position, and modesty is protected and is thus acceptable and comfortable to female patients too. The shirt allows for complete exposure of the limb circumferentially from the shoulder joint to the hand. The lower limb can be exposed from the hip joint to the tip of the toes [Figure 3]. The trouser height for ORTHO dress was kept short of anklelength, i.e., about 5 cm above ankle joint as long length trousers impairs patient walk during postsurgery rehabilitation period.
Figure 3: Design of the shirt from the front

Click here to view


Attire design

It is unisexual, available in three sizes, contemporary utilitarian design made of high-quality cotton fabric and pleasant shades for greater comfort. The shirt and trousers are provided with large pockets anteriorly. One anteriorly for the shirt and one on either side anteriorly for the trouser to accommodate the canister of an epidural or local anesthetic pump during ambulation in the immediate postoperative period.

The shirt is designed to be half sleeved with a wide round neck and completely open at the back for easier donning. The shirt is fastened by simple tie knots of the tags provided at the rear side of the shirt. On the outer side ream of the sleeves on either side, a high-quality smooth zipper with adequate sized pull-tag and the corresponding slider is provided to allow the sleeves to be split open beyond the level of the shoulder to the level of the base of the neck. This allows most surgical wounds of the upper limb to be uncovered [Figure 3] and [Figure 4].
Figure 4: Design of the shirt from the rear

Click here to view


The trousers are of ankle length (about 5 cm from the ankle joint) with a broad soft elastic and a fastening cord at the waist. It is designed to be donned similarly to regular trousers from the foot end. A high-quality zipper runs along the whole length of the outer seam of the trousers. The zipper is provided with a high-quality pull tab and slider [Figure 5] and [Figure 6].
Figure 5: Design of the trousers

Click here to view
Figure 6: Complete lower limb (hip, knee, and foot) and upper limb (shoulder, elbow, and hand) exposure with the patient in ORTHO dress (a) Attire with knee exposed, (b) Attire with hip exposed, (c) Attire with shoulder exposed, (d) Attire with elbow exposed

Click here to view


Statistical analysis

The data were collected and recorded in Microsoft Excel-based software and analyzed using SPSS software. Quantitative nominal data collection and analysis were done [Table 2]. Chi-square analysis was used as a test of significance. Probability value, P < 0.05 was considered statistically significant. The data were collected and calculated by an independent observer other than the author. Type 1 error, alpha was taken as 0.05. Type II error, beta cut-off was set as 0.2, indicating a 20% chance that significant difference is missed. The power of the study was 80%.
Table 2: Day verses choice of patient attire

Click here to view



  Results Top


A total of 136 patients (62 males and 74 females) admitted under orthopedic specialty over 6 months were assessed regarding their choice of attire on the 3rd day of hospital stay. A picture-based survey of patient’s preferences was done. The mean age of 136 patients was 42.26 ± 10.24 years. The age distribution involved was 78 cases (57.35%) were between 15 and 60 years and 58 cases (42.64%) were > 60 years of age. The results show that a total of 124 patients (91.18%) preferred ORTHO dress to be continued over the remaining stay period in the hospital [Figure 7]. The majority of the cases were elective adult reconstruction surgeries and the length of stay was decided by clinical pathway guidelines followed by the institution. The reason for the choice was the same in all patients, i.e., easy limb exposure for dressing and physiotherapy without complete dress removal. Twelve patients (8.82%) with isolated hand and foot injuries opted for the usual hospital dress with no preference regarding ORTHO dress. Quantitative nominal data collection and analysis were done [Table 2]. Chi-square analysis was done. The result shows statistical significance with P < 0.005.
Figure 7: Distribution of the choice of patient attire, vis-a-vis day of admission

Click here to view



  Discussion Top


The doctor–patient relationship plays a very important role in disease management. Positive bonding between the two reinforces the patient to share maximum details about their illness and medication compliance.[5],[6] It also positively reinforces role-playing behavior in patients and helps in disease management.[8],[9] Multiple modalities are being searched to gain the patient’s confidence, to improve healthcare compliance, and achieve better outcomes.[10] A study by Petrilli et al. concluded that perceptions of attire are influenced by age, locale, setting, and context of care. Policy-based interventions that target such factors appear necessary.[11]

In 2009, Mahmud stated that The doctor–patient relationship is central to the practice of medicine and is essential for high-quality health care in the diagnosis and treatment of diseases.[12] Over the period, multiple studies have been conducted over the globe to assess the impact of parameters such as white coats as outpatient department dress, white coat as ward round dress, dresses such as scrubs and blue jeans, slippers or shots, the role of tattoos and piercings, and even attitude of doctor on long-term bonding between doctor and patient and thus indirectly affecting the disease management.[11],[13],[14],[15],[16] Other important parameters include name badges to be worn by the doctor, the shift from white coat to smart casuals, below elbow versus short coats, type of hairstyles, and role of below-knee long length skirts as female attire.[17],[18],[19],[20] Dancer and Duerden argue that the possible harm to the patient–doctor relationship due to the loss of the white coat outweighs the putative benefits in terms of infection control.[20] Although extensive work on the role of physician’s attire is available, literature is sparse about the appropriate in-patient attire. This study makes an effort to address this insufficiency.

Patient attire was defined as the dress to be used by the patient throughout their stay in the hospital for treatment. It can be either personal or hospital-issued clothing. Usual attire varies from one place to another and even within a single geographic area. It can be either a single piece involving a long gown such as a dress or two-piece dress, upper shirt, and lower trouser. The present study involves the assessment of cases presenting to the in-patient department and admitted under orthopedic specialty over 6 months. A total of 136 patients (62 males and 74 females) were included in the study. Patients were assessed regarding their choice of attire on the 3rd day of hospital stay. A picture-based survey of patient’s preferences was conducted. The mean age was 42.26 ± 10.24 years. The age distribution was 78 cases (57.35%) were between 15 and 60 years and 58 cases (42.64%) were more than 60 years of age. The results show that a total of 124 patients (91.17%) preferred ORTHO dress to be continued over the remaining stay period in the hospital. Twelve patients (8.82%) with isolated hand and foot injuries opted for the usual hospital dress with no preference regarding ORTHO dress [Figure 4]. The dress was used uniformly for all patients admitted to the orthopedic department. Many hand and foot surgeries would require proximal exposure for purpose of plaster immobilization and therefore the “Ortho dress” would serve them well. Quantitative nominal data collection and analysis were done [Table 2]. Chi-square analysis was done. The result shows statistical significance.

Literature shows multiple studies regarding the choice of doctor’s attire preferred by patients. A formal dress with a white apron being preferred in many studies. Literature is scarce with studies regarding the choice of the best possible patient’s attire. The orthopedic specialty works with upper and lower limb pathologies. The management options usually involve plasters, splints, regular wound dressings, external fixation methods, muscle strengthening procedures, and joint physiotherapy exercises. Both upper and lower limbs can be involved in the pathological procedure. Because of better patient care, postsurgery wound management, and patient privacy, the ORTHO dress was designed and the results were studied regarding the efficacy and compliance.

The genesis of the study and designing of ORTHO dress emerged by regular observation of patients becoming uncomfortable while limb dressing and physiotherapy sessions. The discomfiture being more obvious in female patients.

The strength of the study lies in the fact that it is the first study in the literature assessing the role of patient’s attire with disease treatment. The study was conducted at a tertiary care hospital providing healthcare to patients from across the globe. The dress has been adopted as the preferred hospital attire for orthopedic patients at the tertiary center where the study was conducted.

Limitations

The limitations specified for the present study are that:

  • It is a single center-based assessment of results
  • Small sample size
  • Specific to a single specialty
  • It needs external validation.



  Conclusion Top


Unlike the doctor’s attire, the patient attire is the least studied parameter in literature. The ORTHO dress being newly designed and used in orthopedic patients involving upper and lower limb illness plays important role in patient management. The dress is designed to give patients comfort and providing better nursing care. In cases of polytrauma, the use of any type of attire is difficult, but when some form of hospital attire is to be used the “Ortho dress” offers a distinct advantage over other designs. Further study in the case of polytrauma patients as to the need and type of hospital attire is suggested.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kurihara H, Maeno T, Maeno T. Importance of physicians’ attire: Factors influencing the impression it makes on patients, a cross-sectional study. Asia Pac Fam Med 2014;13:2.  Back to cited text no. 1
    
2.
Chang DS, Lee H, Lee H, Park HJ, Chae Y. What to wear when practicing oriental medicine: Patients’ preferences for doctors’ attire. J Altern Complement Med 2011;17:763-7.  Back to cited text no. 2
    
3.
Edwards RD, Saladyga AT, Schriver JP, Davis KG. Patient attitudes to surgeons’ attire in an outpatient clinic setting: Substance over style. Am J Surg 2012;204:663-5.  Back to cited text no. 3
    
4.
Gallagher J, Waldron Lynch F, Stack J, Barragry J. Dress and address: Patient preferences regarding doctor’s style of dress and patient interaction. Ir Med J 2008;101:211-3.  Back to cited text no. 4
    
5.
Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med 2005;118:1279-86.  Back to cited text no. 5
    
6.
Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag 2008;4:269-86.  Back to cited text no. 6
    
7.
Baevsky RH, Fisher AL, Smithline HA, Salzberg MR. The influence of physician attire on patient satisfaction. Acad Emerg Med 1998;5:82-4.  Back to cited text no. 7
    
8.
Barbosa CD, Balp MM, Kulich K, Germain N, Rofail D. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence 2012;6:39-48.  Back to cited text no. 8
    
9.
Chung H, Lee H, Chang DS, Kim HS, Lee H, Park HJ, et al. Doctor’s attire influences perceived empathy in the patient-doctor relationship. Patient Educ Couns 2012;89:387-91.  Back to cited text no. 9
    
10.
Bianchi MT. Desiderata or dogma: What the evidence reveals about physician attire. J Gen Intern Med 2008;23:641-3.  Back to cited text no. 10
    
11.
Petrilli CM, Mack M, Petrilli JJ, Hickner A, Saint S, Chopra V. Understanding the role of physician attire on patient perceptions: A systematic review of the literature – Targeting attire to improve likelihood of rapport (TAILOR) investigators. BMJ Open 2015;5:e006578.  Back to cited text no. 11
    
12.
Mahmud A. Doctor-patient relationship. Pulse 2009;3:12-4.  Back to cited text no. 12
    
13.
Brandt LJ. On the value of an old dress code in the new millennium. Arch Intern Med 2003;163:1277-81.  Back to cited text no. 13
    
14.
Yonekura CL, Certain L, Karen SK, Alcântara GA, Ribeiro LG, Rodrigues-Júnior AL, et al. Perceptions of patients, physicians, and medical students on physicians’ appearance. Rev Assoc Med Bras 2013;59:452-9.  Back to cited text no. 14
    
15.
Reddy R. Slippers and a white coat? (Hawai’i physician attire study). Hawaii Med J 2009;68:284-5.  Back to cited text no. 15
    
16.
Johnson SC, Doi ML, Yamamoto LG. Adverse Effects of Tattoos and Piercing on Parent/Patient Confidence in Health Care Providers. Clin Pediatr (Phila). 2016;55:915-20. doi: 10.1177/0009922815616889. Epub 2015 Nov 24. PMID: 26603585.  Back to cited text no. 16
    
17.
de Groot H. Doctors’ dress code. S Afr Med J 2008;98:658.  Back to cited text no. 17
    
18.
Collins AM, Connaughton J, Ridgway PF. Bare below the elbows: A comparative study of a tertiary and district general hospital. Ir Med J 2013;106:272-5.  Back to cited text no. 18
    
19.
Hueston WJ, Carek SM. Patients’ preference for physician attire: A survey of patients in family medicine training practices. Fam Med 2011;43:643-7.  Back to cited text no. 19
    
20.
Dancer SG, Duerden BI. Changes to clinician attire have done more harm than good. J R Coll Physicians Edinb 2014;44:293-8.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Patients and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed314    
    Printed0    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal