Letters

RESEARCH LETTER Likert-type scales and presented participants with 4 images

each of a male and female clinician in different colored scrubs:
Association Between Patient Perception of Surgeons light blue, navy blue, green, and black (Figure 1). Participants
and Color of Scrub Attire were asked to identify the male and female they most strongly
Research suggests there is an association between a physi- identified with the profession of a surgeon, and then to rank
cian’s attire and patient confidence in them, as well as pa- the most and least knowledgeable, skilled, trustworthy, and
tients’ ability to perceive clinician trustworthiness, intelli- caring male and female clinicians (Figure 1). Responses from
gence, and empathy, with scrubs garnering favor.1-5 Despite 113 participants were included in the final analysis. Summary
this, to our knowledge, no data exist on scrub color and phy- statistics (frequencies, percentages) were used to character-
sician perception. We examined whether scrub color is asso- ize the distribution of responses among the full sample and
ciated with the ability to be perceived as a surgeon and the per- stratified by age level. Additionally, Fisher exact tests were used
ception of selected clinician character traits. to identify associations between responses related to each
character trait and age level (SAS, version 9.4; SAS Institute,
Methods | An electronic survey was administered from June to Inc). Statistical tests were 2-sided and P < .05 denoted
July 2019 to patients and visitors aged 18 years or older at the significance.
University of North Carolina Medical Center in Chapel Hill. The
University of North Carolina institutional review board clas- Results | Age was the only demographic factor collected (18-30
sified the study as exempt from approval and informed con- years; 24 participants, 31-60 years; 60 participants, >61 years;
sent due to deidentified data. The survey items were 29 participants). Green was most frequently chosen for sur-

Figure 1. Identification of Surgeon and Skill Based on Scrub Color

A Identification of surgeon

Of the photographs below, please select the physician you identify most strongly as a surgeon:

B Identification of skill

Of the clinicians below, which do you think is the MOST skilled:

Identifying a surgeon (A) and the

most skilled individual (B) based on
scrub color.

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Figure 2. Distribution of Trait Identification

A Male clinician and negative traits B Female clinician and negative traits
60 60
Black Blue Green Navy
50 50
Proportion of respondents, %

Proportion of respondents, %
40 40

30 30

20 20

10 10

0 0
Least Least Least Least Least Least Least Least
knowledgeable skilled trustworthy caring knowledgeable skilled trustworthy caring

Negative character trait identification (least knowledgeable, skilled, trustworthy, and caring) based on scrub color worn by male (A) and female (B) clinicians.

geons, followed by blue, for both sexes of clinicians (male, As this was a novel topic, the aim was to explore the po-
green: 51 selections [45.1%]; female, green: 47 [41.6%]). Black tential association between scrub color and perception that
scrubs were most commonly identified with each negative might exist to then garner more rigorous follow-up study. Fu-
characteristic (ranked least of a specific trait) for both male and ture efforts would be best suited addressing our limitations,
female models (Figure 2), including being the least knowl- including using a wider variety of physician models, collect-
edgeable (male, 44.3%; female, 40.7%), skilled (male, 40.7%; ing additional demographic information, and employing more
female, 45.1%), trustworthy (male, 44.3%; female, 54.9%), and rigorous sampling and survey question design.
caring (male, 55.8%; female, 58.4%). However, we observed
an association between selections of least trustworthy mod- Casey A. Hribar, BS
els and age group for male models, with green (10 [41.7%]) and Avinash Chandran, PhD, MS
blue (7 [29.2%]) most often identified as least trustworthy Martin Piazza, MD
among respondents aged 18 to 30 years and a similar trend for Carolyn S. Quinsey, MD
least caring.
The male and female clinicians in blue scrubs were most Author Affiliations: School of Medicine, University of North Carolina at Chapel
commonly identified as the most caring (male, blue: 64 selec- Hill (Hribar, Piazza, Quinsey); Datalys Center for Sports Injury, Research and
Prevention Inc, Indianapolis, Indiana (Chandran); Department of Neurosurgery,
tions [56.6%]; female, blue: 55 [48.7%]) across all age groups.
University of North Carolina at Chapel Hill (Piazza, Quinsey).
A differential distribution was noted for least caring female
Accepted for Publication: August 27, 2022.
models by age group with green (10 [41.7%]) most often iden-
Published Online: January 11, 2023. doi:10.1001/jamasurg.2022.5837
tified as least caring in the youngest population. The female
Corresponding Author: Casey A. Hribar, BS, School of Medicine, University of
clinician in blue was also most commonly identified as most North Carolina at Chapel Hill, 170 Manning Dr, Campus Box 7060, Chapel Hill,
trustworthy (44 [38.9%]). Of note, 5 participants verbalized NC 27599 (casey_hribar@med.unc.edu).
they perceived the green scrubs to be janitorial, and 5 respon- Author Contributions: Ms Hribar had full access to all of the data in the study
dents asserted that the black scrubs looked deathlike or like a and takes responsibility for the integrity of the data and the accuracy of the data
analysis.
mortician’s uniform.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Hribar, Chandran, Quinsey.
Discussion | Given the increasing use of scrubs and the magni- Drafting of the manuscript: All authors.
tude of expenditures dedicated to them, color choices should Critical revision of the manuscript for important intellectual content: Hribar,
Piazza, Quinsey.
be purposeful and data based. In our study, participants most
Statistical analysis: Chandran.
strongly recognized the clinicians in green scrubs as sur- Administrative, technical, or material support: Hribar, Piazza, Quinsey.
geons, indicating scrub color as a potentially valuable identi- Supervision: Chandran, Piazza, Quinsey.
fication tool. Additionally, across all participants, black scrubs Conflict of Interest Disclosures: Dr Chandran reported funding from the
were most commonly chosen for negative character traits while National Collegiate Athletic Association as the Director of the National
Collegiate Athletic Association Injury Surveillance Program outside the
blue scrubs were most commonly chosen for positive traits. submitted work. No other disclosures were reported.
Although rapport depends on both tangible and intangible fac-
Funding/Support: Part of Ms Hribar’s participation in this research was funded
tors, scrub color is an easily modifiable feature that may be a by the Carolina Medical Alumni scholarship fund.
factor in the clinician-patient relationship, and thus, clinical Role of the Funder/Sponsor: The funder had no role in the design and conduct
outcomes.6 of the study; collection, management, analysis, and interpretation of the data;

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preparation, review, or approval of the manuscript; and decision to submit the 3. Jennings JD, Ciaravino SG, Ramsey FV, Haydel C. Physicians’ attire influences
manuscript for publication. patients’ perceptions in the urban outpatient orthopaedic surgery setting. Clin
Meeting Presentations: This paper was presented at the Annual Student Orthop Relat Res. 2016;474(9):1908-1918. doi:10.1007/s11999-016-4855-7
Research Day; October 19, 2019; Chapel Hill, North Carolina; and at 4. Clark M, Shuja A, Thomas A, et al. Patients’ perceptions of gastroenterolo-
Neurosurgery Grand Rounds; September 14, 2022; virtual. gists’ attire in the clinic and endoscopy suite. Ann Gastroenterol. 2018;31(2):237-
Additional Contributions: We thank the models that participated as the 240. doi:10.20524/aog.2017.0223
physician and clinician in Figure 1 for granting permission to publish this 5. Au S, Khandwala F, Stelfox HT. Physician attire in the intensive care unit and
information. patient family perceptions of physician professional characteristics. JAMA Intern
1. Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? effect Med. 2013;173(6):465-467. doi:10.1001/jamainternmed.2013.2732
of doctor’s attire on the trust and confidence of patients. Am J Med. 2005;118 6. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links
(11):1279-1286. doi:10.1016/j.amjmed.2005.04.026 between patient experience and clinical safety and effectiveness. BMJ Open.
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021239

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