(Reuters Health) - Patients don’t see a difference in competence, professionalism or trustworthiness when doctors sport tattoos or piercings, a small U.S. study suggests.

Perceptions have likely changed over time as societal norms regarding tattoos and piercings have changed, too, the researchers write in Emergency Medicine Journal.

“Tattoos are more prevalent now than they were 10 years ago, professionals included,” said coauthor Dr. Holly Stankewicz of St. Luke’s University Health Network in Bethlehem, Pennsylvania.

“The stigmas are falling away, and we think that’s a good thing,” she said in a phone interview. “Patients know it doesn’t affect how professional or qualified you are.”

Stankewicz and colleagues surveyed patients in a Level I community trauma center in the third largest urban area of Pennsylvania. Seven doctors - four men and three women - wore standard navy blue scrubs during the study and rotated between four conditions: being “clean” (without tattoos or piercings), “pierced” (a hoop earring for men or a fake nasal stud for women), “tattooed” (a temporary black tribal tattoo around the upper arm), or both tattooed and pierced.

At the end of each patient visit, a nurse gave a survey to the patient, saying it was intended to measure courteous and competent medical care during the stay. The nurse referred to the doctor by name and description (such as “the tall red-haired male doctor”) to make sure the patient identified the doctor.

The survey asked about the doctor’s characteristics, such as caring, confidence, reliability, attentiveness, cooperativeness, professionalism, efficiency and approachability. The survey didn’t specifically ask about body art or whether the patients themselves had tattoos or non-traditional piercings.

During the nine-month study, the nurses surveyed more than 900 patients. Overall, there were no differences in patients’ perceptions of professionalism, approachability, competence or comfort when the doctors had piercings, tattoos or no body art at all. Answers were similar regardless of whether doctors were male or female, or the patient’s age and education level.

“We expected younger patients not to care, but it didn’t affect the older patients either,” Stankewicz said. “I was surprised when I walked into the room of a 73-year-old patient and she said she liked my tattoo.”

Stankewicz doesn’t expect she would see a difference outside of the urban environment, but she would like to do a follow-up study regarding nurses’ body art since they often see patients more frequently than emergency department doctors do.

“We are beginning to learn that patients often form instantaneous impressions about their providers the moment they enter the door,” said Dr. Vineet Chopra of the University of Michigan Medical School in Ann Arbor, who published a study in May that found patients did care about doctors’ clothing and it influenced their satisfaction with the care they received.

“It’s interesting, though, that all physicians (in the new study) wore scrubs, and we know that this has a ‘professional’ connotation in the ER,” Chopra told Reuters Health by email. “So it’s possible that the scrubs overpowered any body art.”

He suspects that if the body art study were repeated in a larger academic setting, or a non-urban community, results might be different.

Most dress codes and institutional policies still prohibit medical professionals from having visible body art, the authors note. Future research that directly surveys patients’ opinions about body art could better determine whether policies should shift with societal norms.

“I’m not sure if written policies will change, but the enforcement might change with time,” Stankewicz said. “Appearances shouldn’t affect professionalism, and across the board, we believe that’s beginning to be accepted.”

SOURCE: bit.ly/2LDXn6V Emergency Medicine Journal, online July 2, 2018.