The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, December 13, 2006

The Clothes Make the Clinician

While stopping at a nearby Tim Horton's on the way to work, I saw a resident that I recognized. I smiled politely and waved while I struggled to remember her name-- or, at least, where I'd encountered her before. I studied her from my spot in line. It was 7:45am, so I knew she wasn't in surgery-- she would have been at the hospital long before now. She was nicely dressed, so she wasn't likely to be in anaesthesia. Anesthesiologists would either be wearing scrubs to work or dressed casually, intended to change once they got there. Couldn't be emergency medicine, or I'd know her. Family medicine and pediatrics were unlikely, as she was wearing a slim skirt and stylish sweater. Family and peds residents tend to dress more casually, as a general rule. Must be internal medicine. But wait... as she stepped away from the counter, I noticed her feet. Black heels that must have been 3 inches high. No way would an internist, or anyone in ward medicine for that matter, suffer through a 12-hour day in impractical shoes. Not to mention that running for codes would be next to impossible. By the time she greeted me I had it-- psychiatry. Stylish outfit, impractical shoes, lack of white coat (not that she'd be wearing it outside of the hospital, I'd hope)... it all added up.

It's amazing how much you can tell about someone by the way they dress. It's probably something that's true everywhere, and not just within the confines of the hospital. What we wear to work has been a topic of conversation since we started medical school. My medical school, as I've mentioned before, is a little on the traditional side. A little stuffy, a little old school. Initially, the only guidance we were given pertaining to dress code was: Men should be attired in dress pants, a dress shirt and tie. Women should aim to match this level of dress. Whatever the hell that means. Soon after trading in our classroom uniforms of jeans and t-shirts for the 'business casual attire' appropriate for patient encounters, it became clear that we needed more guidance than that. One of my classmates was reprimanded in third year for dyeing her hair pink. Another for wearing a midriff-bearing top (seriously... who thinks that is appropriate?). I can only imagine what other transgressions were unearthed as the year went on, since we seemed to get regular 'warnings' regarding our attire throughout clerkship.

There will always be those who just don't give a shit. One of my classmates, upon deciding that he wasn't going to go through the match but would rather travel the world and save it from a grassroots level, stopped 'playing the game'. He started coming to clinics and rounds unshaven, dressed in jeans (if it was a 'dressier' day) or some variation of workout clothing. He was reprimanded on more than one occasion and couldn't care less. When they have nothing to hold over your head, there's not much the 'powers that be' can do to make you dress better. Now he is a community medicine resident working on his Master's of Public Health and I have no doubt he WILL save the world someday... and he'll probably still be dressed like a bum.

This has become an issue discussed in the media as well... a recent American Journal of Medicine article actually tested the effect of a doctor's attire on the doctor-patient relationship. Not too surprisingly, when doctors were dressed casually their patients had less confidence in their clinical abilities and were less likely to share important medical information with them. What did surprise me a bit was the fact that the white coat won out over regular professional dress. The results are discussed in this article: When Young Doctors Strut Too Much of Their Stuff

This has been on my mind recently as well. When I switched into family medicine I soon adopted the uniform of khakis/cords on the bottom, sweater on the top. Comfortable, not TOO casual, and fairly effortless. Soon, however, I found myself reverting back to the slightly more formal dress pants, shirts with collars (although sometimes under sweaters), blazers and jackets... just generally more professional. I don't necessarily feel like I'm conforming to the mold, I just feel that professionalism comes more naturally when I'm dressed the part. It's like my 'uniform'. Part of it might be because I have so much working against me-- I'm female, and I look much younger than my age. Being female doesn't seem to matter much to anyone but the odd elderly male patient, but many of my patients have remarked that I 'don't look old enough to be a doctor'. I usually reply with a polite smile that I'm older than I look and leave it at that. But when I'm dressed more professionally, I don't seem to get the comments nearly as often. I know the piercing in my nose (a small, tasteful stud) doesn't help. So I do what I can.

Hey, in an ideal world we'd be judged based on only our clinical skills and ability to relate to our patients. But if my patients have more confidence in me when I'm wearing pants that are Dry Clean Only, it's a small price to pay.

Besides, in the emerg it's all scrubs, all the time. Heh.



Anonymous A girl said...

Friend of mine was approached by her attending during surgery rotation with the following complaint: One of the surgeons on the service (older male btw) has problems with my friend's shoes. Namely, her shoes being pink turned out to be a major problem for this guy. Not the hills' hight (they were flats), not even a style, but the fact they were pink that bothered him. I guess it was too girly for this tough guy to handle. She was pissed, but never worn them again.
I, on the other hand, bougth a pair of nice comfortable pumas for the long OR times. When I had to pick between dark blue and pink, I picked pink. Unfortunately, I am doing my rotation in a different hospital than my friend.

2:03 AM

Anonymous Anonymous said...

haha, what an a**hole. hopefully he's a rare one...

It's nice to finally find a Canadian blog. I get sick of reading about the economics, lawsuits and premiums, and skewed outsider views on our health system etc..

2:39 PM

Blogger doctor T said...

Hmm, my psych resident friend wears jeans and a sweater to work pretty much every day, along with a nose ring. She's just 28, and looks fairly young, but I don't think she's bothered by what is perceived as typically doctor-ish. I think I've seen her in a skirt once, and NEVER in heels (but she is 6' tall). I believe she wears a white coat sometimes. She said some doctors have commented on her dress, but never a patient.

6:12 PM

Blogger Joy said...

De-lurking to say the only thing that bothers me about a doctor's apparel is the wearing of a tie. I have a child who is a frequent flier at our local pediatric hospital and urgent care center, and nothing bothers me more than a guy's tie dangling into my child's face. How many other children's faces did that tie contact?

10:10 PM

Blogger Couz said...

An interesting study came out while I was still in medical school that actually tested how many viruses and bacteria were stuck to a physician's tie. After that, many of my classmates stopped wearing them. I'm often surprised that anyone in medicine still does.

11:09 AM

Blogger Dex said...

The whole tie-as-infection-vector really fired me up when it came out. I brought it up with my dad, an oncologist (think neutropenia). He said yeah, sure, ties got lots of bugs on them, but so do stethoscopes, cuffs, hands, breath, BP cuffs, etc., etc. Just wash your hands, people.

Incidentally, inspired by some other blog I frequent; what is the 0.01 percent of bugs that Purell doesn't kill? MRSA? C.Diff? P. aeruginosa? Acenitobacter?

I know fashion is difficult for female doctors. I've seen power suits, miniskirts, tank tops, high heels. What seems to blend the best is a not-prim, not-racy blouse over slacks or skirts, "sensible" shoes, and an in-your-face white coat, with ID badge or embroidered name with M.D or D.O. prominently portrayed. The business attire really sets you apart from nurses, and the obvious long white coat establishes your cred from the get-go. No cutesy shit, either--all business, all the way. It's an uphill battle, but competence this way will be recognized.

11:41 PM

Blogger DrWes said...

What about a few other questions at Christmastime? You've been tagged!

11:00 PM

Blogger Calavera said...

Besides, in the emerg it's all scrubs, all the time.

Yet another reason to contemplate emergency medicine as a possible career choice...

12:11 PM


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