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.