TORONTO - Appearances count, it seems, even when a loved one's life may be hanging in the balance.

A new study shows that family members of people in hospital intensive care units place more trust in doctors who are well groomed, in a white coat or scrubs and wearing an easy-to-read name tag.

First author Dr. Selena Au said evidence suggests the public's expectations of what doctors should wear — how doctors should look — differs depending on where in the hospital they work.

In pediatrics, say, a white coat is a no-no. And in the emergency department, people don't seem to care what doctors are wearing; they just want to be helped.

But in the ICU, where patients are critically ill and families are often faced with heart-stopping news and gut-wrenching decisions, it appears people want to deal with professionals who look like the quintessential doctors portrayed on TV.

"I think more than anyone in the hospital, that we are having very intense discussions where we're talking about end-of-life care, where we may be talking about treatment options where decisions have to be made quickly," said Au, who is with the University of Calgary's department of critical care medicine.

"And so family members have to make some quick judgments as to whether or not they trust us.... So things that are part of non-verbal communications come into play quickly."

Au did the work with two colleagues from the University of Calgary and Alberta Health Services, Calgary zone. The research was supported by a grant from Alberta Innovates and is published in this week's issue of the journal JAMA Internal Medicine.

The team surveyed 337 people visiting family members in three Calgary-area ICUs between Nov. 1, 2010 and Oct. 31, 2011.

They asked people to rate in importance 10 factors related to the outward appearance of doctors in general, not specific physicians. Those factors were things like age, race, gender, dress, the presence or absence of a name tag, tattoos or visible piercings and overall first impression.

Respondents were then asked to select, from panels of pictures of models posing as doctors, which appeared most knowledgeable, most caring, most honest, most competent and best overall.

The panels of photos portrayed doctors in white coats, scrubs, business suits and casual clothing, such as jeans.

Those wearing stereotypical doctors' garb were judged to be most knowledgeable and most honest.

"Traditional attire was associated with perceptions of knowledge, honesty and providing best overall care," the authors wrote.

"Physicians wearing (surgical) scrubs were a second choice among participants and were perceived as being caring and competent to perform a lifesaving procedure."

The study found that even when respondents said they didn't care whether a doctor was wearing a white coat, most strongly favoured the models wearing white coats.

"These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs," the authors noted.

Interestingly, doctors in business suits were not terribly well received, and didn't fare much better than doctors in casual clothing.

Respondents explained the aversion to doctors in suits by describing them as less approachable, and looking as if they would not get their hands dirty to help save a patient, Au said.

The authors suggested physicians' appearances in ICU settings may be especially crucial. Patients and their families do not have pre-existing relationships with these doctors, but circumstances may demand that families work through tough decisions very quickly with these physicians.

"Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence," the authors wrote.

How often should you see health experts? Here are 10 appointments you should make for a healthier you:

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  • Family Doctor

    <strong>HOW OFTEN TO GO:</strong> If you're not sick, once a year for annual check-ups and flu shots, or <a href="">several times a year</a> if you're suffering from illnesses, need immunity shots or are pregnant <strong>THE DETAILS:</strong> Doctors are often the first people you visit as soon as something goes wrong. Coughs, runny noses, back pains and the flu shot — you doctor can both treat these ailments or refer you to a specialist who can help. Annual check-ups are also <a href="">recommended once a year</a> to update your family doctor with your weight, height and any changes in your blood, for example. <b>DO I NEED A REFERRAL?</b>: No, but you need to find a family doctor. If word-of-mouth doesn't work, the <a href="">College of Physicians and Surgeons</a> has an organization based in each province with a list of doctors accepting new patients.

  • Dermatologist

    <strong>HOW OFTEN TO GO:</strong> Once a year, and in warmer months if you're seeking advice on skin protection from the sun <strong>THE DETAILS:</strong> According to skin expert Dr. Jim Baral, how often you see a dermatologist depends on the purpose of your visit. If you're curious about the condition of your <a href="">skin overall or have general inquires, once a year is sufficient</a>. But if you're worried about skin spots or acne, make an appointment right away, he said in an article on <em></em>. <b>DO I NEED A REFERRAL?</b>: Yes for medical procedures (like acne and moles), no for cosmetic procedures (like wrinkles or sunspots).

  • Gynecologist

    <strong>HOW OFTEN TO GO:</strong> Once a year or every three years (depending on your situation) — for many women, their general practitioner (GP) is sufficient <strong>THE DETAILS:</strong> Women over the age of 18 (both sexually active and not) should see a gynecologist (or someone with whom to discuss reproductive concerns) at least once a year, according to <a href=""><em>Everyday Health</em></a>. If you're pregnant, for example, you're more likely to see the gyno more often. <b>DO I NEED A REFERRAL?</b>: Yes — if you have specific concerns or are pregnant, your GP can refer you to a gynecologist

  • Dentist

    <strong>HOW OFTEN TO GO:</strong> Six months for a cleaning, once a year for X-rays <strong>THE DETAILS:</strong> Depending on your health, your visits to the dentist <a href="">can vary</a>, according to the Canadian Dental Association. Do you smoke? Floss every day? Eat well? The organization says these are questions you should ask yourself before you see a dentist — and it will determine how often you have to sit in a dentist's chair. <b>DO I NEED A REFERRAL?</b>: No.

  • Optometrist

    <strong>HOW OFTEN TO GO:</strong> Age dependent, but roughly, once every two to three years <strong>THE DETAILS:</strong> School-aged children (under the age of 19) <a href="">should receive eye examinations annually</a>, according to the Canadian Association of Optometrists. Adults between the ages of 20 and 39, especially if they wear glasses or contacts, should see an optometrist once every two to three years to keep their prescriptions updated. Anyone over the age of <a href="">40 should have eye exams once every two years.</a> <b>DO I NEED A REFERRAL?</b>: No.

  • Occupational Therapist

    <strong>HOW OFTEN TO GO:</strong> Depending on the treatment, visits can vary from once a month to once every few years <strong>THE DETAILS:</strong> Occupational therapists cover everything from <a href="">stress management to exercises to build strength</a> after an injury, according to The Cleveland Clinic. Depending on your <a href="">mood, injury and age</a>, some clients visit OTs regularly to receive therapy. <b>DO I NEED A REFERRAL?</b>: No.

  • Colonoscopy/Proctologists

    <strong>HOW OFTEN TO GO:</strong> Every 10 years (for people with average or low risks of colon-related illnesses) <strong>THE DETAILS:</strong> For most people, colorectal cancer screenings begin at the age of 50, according to <em></em>. Screenings should depend on your age, your risk factor and the type of screening you want. For example, <a href="">fecal occult blood tests (fecal samples) should happen once a year</a>, while double-contrast barium enema (an X-ray for the entire colon) should happen every five years after 50. <b>DO I NEED A REFERRAL?</b>: Yes, by your family doctor.

  • Allergist/Allergy Shots

    <strong>HOW OFTEN TO GO:</strong> For those who have allergic reactions, depending on the type of test, it could vary from every two to four weeks for the first five months and later, once a month for the next three to five years <strong>THE DETAILS:</strong> <a href="">Allergy shots help your body get used to allergens</a> — they actually don't cure you from having allergic reactions, according to WebMD. If you suffer from any allergic reactions during spring or summer months, and medicine doesn't seem to do the trick, these <a href="">shots are designed to lower your risk of symptoms</a>. <b>DO I NEED A REFERRAL?</b>: Yes, initially by your family doctor.

  • ENT Specialists

    <strong>HOW OFTEN TO GO:</strong> Ask your family doctor if an ENT specialist is needed — course of treatment is on a case-by-case basis. Depending on the severity of your condition, you may have to see an ENT specialist as much as once a week to heal. <strong>THE DETAILS:</strong> An ENT (ear, nose, and throat) doctor or an otolaryngologist, is trained to treat <a href="">everything from injuries to nerve damage in the ear, nose or throat area</a>. ENT specialists can also provide treatments for cosmetic surgeries, sinus pain and head and neck cancer, according to the Canadian Society of Otolaryngology. <b>DO I NEED A REFERRAL?</b>: Yes, by your family doctor

  • Chiropractor

    <strong>HOW OFTEN TO GO:</strong> At least 10 to 20 visits after your first visit — at least once a week in the beginning <strong>THE DETAILS:</strong> Most people tend to seek chiropractors because of <a href="">body pains and strains</a>, according to the Canadian Chiropractic Association (CCA). San Francisco based chiropractor Dr. Eben Davis adds that people with fast-paced jobs or ones who perform a lot of physical activity, are more likely to see a <a href="">chiropractor a few times a month.</a> <b>DO I NEED A REFERRAL?</b>: You can ask your doctor to refer you to a specialist, but you can also <a href="">find a list of chiropractors in your area</a> through the CCA.

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