What Doctors Wear Matters: Insights From Visitors at Riyadh's Primary Healthcare Centers

Background: How a physician dresses has been known, since the time of Hippocrates, to shape the way patients see and relate to their doctor. In a country like Saudi Arabia, where cultural norms, religious values, and medical professionalism intersect in distinctive ways, the question of what physicians ought to wear is more than a trivial matter of aesthetics. Despite a growing literature on this subject, relatively little research has focused specifically on primary healthcare settings within the Gulf region, where the majority of routine patient-physician encounters take place. Objectives: This study set out to examine how patients attending primary healthcare centers (PHCs) affiliated with the Riyadh Second Health Cluster perceive and rate different physician attire options, to gauge the overall importance they place on appearance, and to explore how attire-related perceptions translate into attitudes toward the doctor-patient relationship. Methods: A cross-sectional survey was conducted from the 1st of April to the 31st of May, 2026. A self-administered bilingual (Arabic/English) questionnaire, adapted from validated tools in the literature and reviewed by two family medicine consultants, was completed by 1,176 adult PHC visitors aged 14 years and above. Participants rated male and female physician attire items and 11 relationship/perception outcomes on a five-point Likert scale. Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis tests were applied where appropriate, with statistical significance set at p < 0.05. Results: Participants had a mean age of 33.3 ± 9.8 years; 597 (50.8%) were male. Eight in 10 participants (950; 80.8%; 95% CI: 78.5-83.0%) considered physician appearance important, a finding that held across all demographic subgroups. The white medical lab coat topped the preference list for both male (1005; 85.5%; 95% CI: 83.4-87.5%) and female (922; 78.4%; 95% CI: 76.0-80.8%) physicians. Jeans and expensive/fashionable clothing were broadly disapproved. For female physicians, the niqab/veil (756; 64.3%) and skirt (732; 62.2%) ranked highly alongside modest professional dress. Niqab preference varied significantly by age group (Kruskal-Wallis H = 14.93, p = 0.002), and female participants were more approving of the male national costume than their male counterparts (p = 0.01). Preferred physician attire was associated, across the board, with higher perceived respect (892; 75.9%), greater satisfaction (880; 74.8%), stronger follow-up intention (863; 73.4%), and better anticipated treatment compliance (773; 65.7%). Conclusion: The white coat stands as the clearest, most cross-demographically consistent preference in this PHC population. Cultural modesty norms meaningfully shape how patients envision their female doctors' dress. Perhaps most importantly, how a physician looks appears to touch the very foundation of the therapeutic relationship, affecting willingness to return, comply with treatment, and engage openly. Dress code policies for PHCs in Riyadh should take these preferences seriously.