Does a patient’s appearance at a doctor’s appointment impact the way their health care provider treats them? It’s a worry some people have, and as it turns out, there’s some merit to it.
A recent patient survey reveals that people of different races and ethnic minority groups are concerned that the way they dress determines the type of care they receive from their physician. KFF, a nonprofit organization focused on health policy, polled nearly 6,300 adults who had met with a doctor over the last three years and asked about their experiences. While white participants in the study reported having more positive interactions with their health care team compared to people of color, a substantial amount of the volunteers from every demographic believe their appearance plays a critical role during their appointments.
Here are the numbers: About 55% of Black adults feel they need to be very careful about their appearance to be treated fairly by a medical professional. Roughly half of American I ndian, Alaska Native and Hispanic patients feel similarly, along with 4 out of 10 Asian patients. And almost 30% of white patients surveyed said they worried about their appearance before appointments. The survey also found that 60% of Black adults, more than half of American Indian and Alaska Native and Hispanic adults, and more than 40% of Asian adults say they “prepare for possible insults from providers or staff,” compared to 33% of white adults.
For example, one individual — a 30-year-old Hispanic male college professor — explained that he purposely wears an item of clothing that displays the logo of the university where he works since this prestigious label tends to encourage the doctors to listen to him more intently, as well as involve him in more treatment decisions.
Does appearance influence how some patients are treated by physicians? And if so, what implications could this have on their care? Two experts weigh in.
Are doctors judging their patients?
Dr. John Whyte, chief medical officer of WebMD and a former director at the U.S. Food and Drug Administration, tells Yahoo Life these findings are not shocking. “As health care professionals, we're trained to be objective, but we're also human,” he says. “We bring our own unconscious biases to the examination room. It's disheartening that some patients, particularly people of color, feel the need to present themselves in certain ways to receive fair treatment.”
Dr. Andy Luttrell, associate professor of psychological science at Ball State University and host of the Opinion Science podcast, agrees, telling Yahoo Life: “People everywhere exhibit these kinds of social biases, so it's not surprising that health care professionals exhibit them too. In fact, social scientists have been tracking a variety of ‘implicit’ biases for years, and it seems that medical professionals are not immune to them.”
Luttrell refers to a 2016 review published in the journal Group Processes & Intergroup Relations, which stated that several health care organizations developed training in implicit bias for their providers since evidence suggests that it is one possible cause of disparities in health outcomes for stigmatized groups.
“Brains make assumptions — and in a lot of ways, that's essential to their ability to do what we need them to do,” he says. “We don't have the capacity to start from zero and carefully assess a situation from scratch every time.” Luttrell explains that we tend to slip into autopilot mode while trying to apply what we've learned in the past to new situations.
“The problem, of course, is that these assumptions are imperfect, especially when we're making sweeping generalizations about what a person's clothing or skin color means about who they are.”
However, it’s worth noting that the latest KFF survey focuses on the participants' concerns that they need to dress a certain way, adds Luttrell. “It’s possible that a doctor’s conduct is biased, at least somewhat, by a patient's clothing. But as far as I can tell, we don't actually have evidence that this is happening.”
How can unconscious bias impact a patient’s care?
“If a doctor equates informal clothing with ‘unintelligent,’ they might talk down to the patient,” says Luttrell. “If they equate informal clothing with ‘doesn't take care of themselves,’ they might avoid suggesting effective treatment options because they already assume the person won't care to comply.”
However, a patient’s preoccupation about how they look when meeting with a medical professional can also play a role in their care. “A meta-analysis of 134 studies found a clear connection between how much a person perceives that they face discrimination and their health outcomes,” says Luttrell. “The more someone believes that they face discrimination, the worse their mental and physical health. Worrying about how others are unfairly treating you is associated with stress and anxiety — neither of which do your health any favors.”
And chances are when a patient feels anxious or uncomfortable in a health care environment, they may shut down. “I haven't seen specific data detailing worse outcomes, but here's the important issue: If a patient believes they're being judged on their appearance, it can create a communication barrier,” explains Whyte. “They might be less forthcoming with symptoms or concerns, fearing further judgment. This can lead to misdiagnosis or delayed treatment.”
Should people dress up for a doctor’s appointment?
Not necessarily. “I'm not super comfortable putting the onus on patients to answer other people's unfair biases,” says Luttrell. “In principle, dressing better for a doctor's visit could improve your care, but bias can be slippery.”
After all, assumptions could be made if a patient walks into the exam room wearing designer clothes from luxury brands “particularly when it seems that clothing standards might be applied to marginalized groups more than to white patients,” says Luttrell. “It doesn't seem right for the solution to be that Black patients dress up for the doctor while white patients carry on.”
Luttrell, who teaches courses on persuasion psychology and the psychology of diversity and unconscious bias, is hoping to see “more institutional changes that help doctors uphold their responsibility to protect people's health, no matter their clothing.”
Experts say the focus should be on the patient’s physical and emotional well-being, not fashion. “We all want health care to be equitable and non-judgmental,” says Whyte. “If you ever feel judged or uncomfortable, it's important to communicate this to your doctor or seek a health care provider where you feel respected and heard.”