Patient’s Perception Regarding the Choice of Their Orthodontist: A Questionnaire Study

INTRODUCTION

Over the last few decades, health care professionals have become more familiar with the concept of patients’ preferences, views, and that it must be a central part of our care delivering system. The general theme of providing value treatment thus far has focused on cost reduction through maximizing efficiency. However, where most of us tend to concentrate on the results, a more fruitful approach is to look at the basic components of the concept, i.e., expectation and experiences.^1–4

The appearance and attire of medical professionals have long been considered important; for instance. The white coat itself has been a powerful symbol of authority and healing worn by medical practitioners for %3E;100 years. The appropriate appearance and attire for physicians has been debated over time and evaluated extensively, but there are few studies published in the dental literature and none specific to the specialty of orthodontics regarding this issue.^3,4

The initial appointment between a dental professional and a patient is an important contributor to the professional relationship that develops during dental treatment. A dental professional’s appearance is relevant with regard to a good first impression and the promotion of a better and more successful relationship.^5,6

Therefore, age, sex, and attire may contribute to a patient’s selection, e.g., a dentist who wears appropriate attire may give a professional impression, whereas inappropriate attire might suggest negligence and disorganization. However, the patient’s perception of attire may also be influenced by his or her age, as well as the location, setting, and context of care.^2,3,6,7

In an increasingly competitive market, orthodontists should consider all factors that may influence a parent’s choice of provider. In a recent survey, the most highly ranked factor in choosing an orthodontist was that the “orthodontist appears competent, knowledgeable and confident”. Thus, an orthodontist’s appearance and attire are likely to be highly important.^1,2,8,9 The objective of this study was to evaluate parents’ preferences regarding the appearance and attire of orthodontists. The findings may encourage orthodontists to alter those factors within their control to conform to styles that are most preferred by the public.⁵

MATERIALS AND METHODS

The present cross-sectional descriptive study was conducted using survey methodology on new patients attending the outpatient department of the Institute (Faculty of Orthodontics, Mahatma Gandhi Dental College and Hospital). A self-completion bilingual (Hindi and English) questionnaire was developed to know the patients’ views on dental clinical attire, appearance, hairdo, and several other relatable factors. A pilot run for the study was done on 30 patients to validate the questionnaire. The sample included 100 new patients (56 males and 64 females) between the age group of 20 and 35 years. The questionnaires were distributed to the patients by non-clinical reception staff in the waiting area before an initial consultation appointment and written informed consent was taken. The survey was conducted for over 4 weeks between January 2019 and December 2019. The questionnaire included the patients’ demographic information (age, sex, and education) and the questions (along with relevant photographs attached to the back of the question) framed to gain information on patients’ preferences in the following areas: attire, appearance, cross-infection measures, and attributes to be present in the clinician.

The first question (Question 1) was asked to choose the gender of the orthodontist.

The second question (Question 2) was related to patients’ preference for the age group of the clinician.

The third question (Question 3) was related to patients’ preference for different clinical attire (Fig. 1), the photographs displayed male and female models wearing white coats, formals, casuals, and dental scrubs. The background, hairdo, models were the same in all the attires and only the clinical attire was different to remove bias. The photographs displayed male and female models wearing white coats, formals, casuals, and dental scrubs.

The fourth question (Question 4) was related to their preferences for the appearance and ambience of the clinic.

The fifth question (Question 5) was framed to find out whether the showcase of previously treated case records are helpful or not.

The sixth question (Question 6) was framed to anticipate the patient’s preference over the time spent by the orthodontist in the initial appointment and its effect on their decision of seeking the treatment.⁶

The next question (Question 7) related to their priority between the costs and skills of the treatment provided to them, i.e., whether they would prefer a general dentist and get the same treatment done at low cost when compared to the specialized one at a higher rate (Fig. 2).

The eighth question (Question 8) asked to know whether the overall smile and occlusion of the orthodontist himself/herself as an important criterion.

The ninth question (Question 9) asked about their preference in terms of the appearance and skills of the operator.

Specifically, the survey asked the patient to “Select the one photograph that depicts the orthodontist that you are MOST LIKELY to choose as a care provider”. The same four photographs were presented again and the prompt changed to “Select the one photograph that depicts the orthodontist that you are LEAST LIKELY to choose as a care provider”.

The data were explored descriptively and are presented as absolute (numbers) and relative (percentages) frequencies. The Chi-square test was used to investigate the participants’ preferences for the orthodontists (considering age and sex) and types of attire. To evaluate statistically significant differences, a statistical test of multiple comparisons for proportions was applied. A significance level of 5% (p %3C; 0.05) was implemented.

RESULTS

Patient preferences for their choice of orthodontist showed significant differences according to the provider’s sex, age, dress, and hair. The most preferred age group was the middle-aged woman wearing formal attire. Results are separated into those factors that cannot be altered by the provider (age and sex) and those that can be altered (dress, hair control, and nametag). There was an overall preference for female providers. While combining results for the male and female providers, there was an overall preference for older orthodontists. Patient preferences for the alterable provider characteristics (dress, hair) are shown in Figure 1. Casual dress was the least preferred; formal attire and scrubs were both preferred styles. The evaluators did not indicate a preference one way or the other regarding the use of a white coat.

For hair, there was a positive preference for controlled hair (pulled back for women) and a negative response associated with uncontrolled hair (loose hair for women). Each orthodontist’s appearance included the combination of all two factors: dress and hair. Therefore, each of these combinations could be ranked from most preferred to least preferred. The most highly preferred styles were providers who had controlled hair; were dressed in formal attire, a white coat, or scrubs. All of the photographs that depicted providers with casual dress had consistently negative ratings. Analysis of the patient evaluators’ characteristics (parents’ sex, age, race, ethnicity, education, and income) showed that they did not influence the choice of an orthodontist (p %3E; 0.05).

Summarized data are presented below:

1. Who would you prefer as your dentist?
   1. male (32%)
   2. female (54%)
   3. doesn’t matter (14%)

   (p value = 0.052)

2. Which of the age group of doctors do you prefer?
   1. <35 (42.7%)
   2. 35–45 (12.7%)
   3. > 45 (44.7%)

   (p value = 0.035)

3. What do you prefer as you doctors dress?
   1. Scrubs (30.2%)
   2. White coat (63.1%)
   3. Casuals (2.7%)
   4. Formals (4%)

   (p value = 0.733)

4. How important is the overall appearance of the clinic to you?
   1. yes (57%)
   2. no (14%)
   3. doesn’t matter (29%)

   (p value = 0.069)

5. Does showing pictures of previously treated alike cases to you is helpful?
   1. yes (84%)
   2. no (3%)
   3. doesn’t matter (13%)

   (p value = 0.557)

6. Does the time spent in the initial appointments makes a difference?
   1. <2 minutes (12.7%)
   2. 5–10 minutes (42.7%)
   3. >10 minutes (44.7%)

   (p value 0.035)

7. Choose one of the following.
   1. General dentist with low t/t cost (42.7%)
   2. Specialist with higher skills and cost for the same (57.3%)

   (p value = 0.069)

8. Do you consider your orthodontist’s smile/appearance of their teeth is important?
   1. yes (88%)
   2. no (2.7%)
   3. doesn’t matter (9.3%)

   (p value = 0.071)

9. Which of the following qualities is important according to you?
   1. appearance (28%)
   2. skills (58%)
   3. both (14%)

   (p value = 0.069)

Most of the patients gave importance to the overall appearance/ambience of the clinic.

At the same time, documenting and showing previously treated cases to the patients helps them in better understanding of the treatment procedure and results, also motivates them for the same.

Most of the patients preferred a time range of 5–10 minutes or greater than that which is spent on the initial appointments by the orthodontist.

Smile and occlusion of the orthodontist himself/herself creates an impact or came out to be an important factor from the patients’ point of view.

Also, most of the patients preferred a skilled and specialized person compared to the same treatment provided by the general clinician at a less price which came out as a positive response regarding the awareness or the treatment needs.

DISCUSSION

Despite investing in marketing tools with the intent of reaching new patients as well as maintaining good relationships with patients already undergoing treatment, orthodontists must remain aware of patients’ opinions.^10,11 As noted above, orthodontists have gradually changed their attire from casual to more contemporary outfits. In the current survey, we proposed an important and scientific approach to justifying the changes observed in the attire of dentists, especially orthodontists, and additionally investigated whether these changes meet patients’ expectations. Using standard photographs with the same background and facial expression, hairstyle, our investigation showed an overall preference for the female orthodontist, whereas the age group preferred by the patients was above 45 years. This finding corroborates the outcomes of a study by Souza-Constantino et al.,¹² who noted that females professionals were most preferred by patients whereas contradicted the age preference which is middle age in our study as compared to young professionals in the former one. Similar to the investigation of Swami et al.¹³, the participants in our study preferred female dentists (64%) to male dentists (32%). A small proportion of the participants (8%) justified their choice for a female orthodontist based on the statements that “women are more trustworthy”, “women are more careful and gentle”, “women make me feel more comfortable”, and “women have more patience and dedicate more attention”. However, sex did not play a significant part in the study by Asokan et al.¹⁴

The present study was conducted in young adults; however, the results could be different in various age groups and people of different anxiety levels as white coat anxiety is a well-known phenomenon. Also, future studies can be done comparing urban and rural viewpoints and how the questions are perceived across India where different cultural and religious believes exist.

CONCLUSION

This study has relevance for all specialties of dentistry and especially in today’s world where services have become patient-centric.¹⁵ Though students and clinicians have become casual in their dressing, patients continue to prefer a professionally dressed clinician.^16,17 This understanding of patient preferences should enable individuals and organizations both in government and corporate setup to frame standards for professionalism for clinicians in the dental profession.¹⁸ The results of this study are also important for dental students who should understand the values of professionalism which will help them in making stronger bonds with patients in their future careers.

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