Recently, researchers found that half of all patients surveyed prefer their doctors to wear traditional attire, such as a white coat, and this influenced an increasingly important measure: patient satisfaction. Many hospitals try to control another aspect of a caregiver’s visual presentation: visible body art or piercings. However, a new study published in the Emergency Medicine Journal suggests that whether a doctor has visible tattoos or piercings doesn’t seem to matter much to the patients they’re treating.
“We were inspired to conduct this study because hospitals have many rules around what constitutes 'professionalism,' and some of these rules are excessively stringent and outdated when compared to the general public,” Dr. Holly Stankewicz, associate program director of the Allopathic Emergency Medicine residency at St.Luke’s University Health Network in Bethlehem, Pennsylvania, and co-author on the study, told ABC News. “We set out to see in this case whether patients actually cared about whether their doctor had a tattoo or a piercing, specifically if it affected how they experienced their care, and whether it negatively affected how they perceived their doctor.”
In this study, seven emergency room doctors chose each day to wear one of three options: (artificial) non-traditional piercings, stick-on tattoos, neither, or both for nine months while seeing patients.
One physician had real “full sleeve” tattoos on both arms, so on days he chose to have "no art or piercings," he wore a white coat to cover them. The doctors wore standard blue scrubs throughout the study period. The patients -- all of whom were over the age of 18 -- were then surveyed about their satisfaction with care, and specifically rated the doctors’ competence, professionalism, empathy, approachability, trustworthiness, and reliability. The patients were not aware of the purpose of the study.
Two of the doctors didn’t enroll enough patients in the study, and another doctor dropped out due to discomfort with wearing visible body art. Only five doctors’ data made it into the study -- males, females, residents and attending physicians. A total of 924 patients were surveyed.
For all five physicians, there was no difference in how the patients perceived their competence, comfort, professionalism, or approachability, whether they had a tattoo or piercing or not. They were rated positively on all surveyed qualities 75 percent of the time, and this showed no statistically significant difference between days they wore a tattoo or piercing compared to days where they did not.
As well, the researchers found that the ratings didn’t change if the patients were over or under the age of 50, or between men and women. Of note, the patients in the study were not asked whether they had body art themselves, or if they disapproved of it.
“It was surprising to see that age wasn’t a big factor. Some of the older patients didn’t even notice the tattoo or piercing, and if they did they would say things like, 'I like your tattoo,'" Stankewicz told ABC News.
Stankewicz believes the study will help change views around body art.
“At our center, I think it was helpful to change perceptions in both the administration and physicians and staff in general,” Stankewicz explained.
Dr. Myles Spar is an internal medicine doctor at the University of California, Los Angeles (UCLA) School of Medicine who runs a busy practice in Venice, California, where many patients themselves may have tattoos and piercings.
“This is an interesting study given the breakdown of survey results by age of the patient. In my experience, I’ve noticed that much older patients may have more traditional expectations about what their doctor should look like, whereas the younger ones do not,” Spar told ABC News. “It might also be helpful to know if the patients themselves had body art or not.”
There were some other limitations. For instance, it’s unclear if the physicians behaved differently on days they wore tattoos or piercings. Known as the “Hawthorne effect,” it’s a common issue that happens in research when subjects are aware they are being observed.
As such, it’s entirely possible that on days where the doctor wore a tattoo or piercing, they may have behaved more positively towards their patients, who then evaluated them more favorably. As well, given that two doctors dropped out of the study, there may be some selection bias at play: The doctors that remained in the study may have been more confident around their patient communication skills compared to those that dropped out. Regardless, Spar sees the results of the study as encouraging.
“The good thing about this study is that it suggests perceptions are changing. Across the board, patients are looking to their provider as a coach and advisor to work with them and less as a traditional authority figure,” Spar told ABC News. “People recognize that there are excellent physicians of all genders and backgrounds. At my office, we recognize that and something as simple as having casual Fridays, where we wear jeans, makes us more accessible to patients and they are thus more likely to tell us what’s going on with them.”
Dr. Amitha Kalaichandran is a pediatrics resident doctor working in the ABC News Medical Unit in New York.