My patients sometimes comment on the notion that physician education neglects the study of nutrition. But while they are quick to point out this gap, they rarely mention an issue that receives far less attention: fashion!
Despite growing up with a mother and two sisters who often dressed to make a statement, it’s hard to imagine anyone less fashion-forward than me. My distant memories include terrifying shopping expeditions with my mother, who would pick out an absurd outfit and declare it “just what they’re wearing”. My retort, probably as soon as I could speak, was, “who are ‘they’ and why should I care?” Then and now, my usual fashion statement could be issued by a political mouthpiece: “no statement at this time.”
Despite my fashion allergy, patients occasionally comment favorably on my attire, usually a tie that complements a shirt. I usually respond by asking if their ophthalmology care is up to date. When I’m really in the corner, I’ll give something like, “Sometimes someone hits the ball even when they’re swinging with their eyes closed.”
Given this attitude, I was recently surprised to find myself speaking out publicly about doctors and fashion. My medical group had asked those of us with three decades of tenure to offer lessons gleaned from thousands of hours of patient care. Charitably, they shared twenty minutes.
Not surprisingly, there has been research showing that patients prefer doctors to dress somewhat formally and wear a white coat. But the pandemic, whose impact permeates every corner, changed that dynamic. Doctors doing video visits could now dress however they wanted, at least from the waist down. I have also taken advantage of this and on video visit days, I will wear jeans with a long sleeve shirt and tie. As informality spreads like a virus, we now see doctors in the office either dressing like at home or wearing surgical scrubs.
How hard is it, I asked my colleagues, to take a few extra minutes to reassure those who might care? This is not fashion, this is compassion.
I would concede to my less formal colleagues that house dressing would not offend long-term patients whose trust has long been established. But new patients make judgments based on the first visit. For male doctors, wearing a tie reflects an understanding that patients feel more at ease with someone who looks “on their game.” Especially for seniors, this traditionally translates to wearing a tie. How hard is it, I asked my colleagues, to take a few extra minutes to reassure those who might care? This is not fashion, this is compassion.
Of course, women are not interested in the tie issue. But professional attire still matters to anyone in healthcare.
Scrubs? There are three reasons to wear them. In the operating room, common dressings generate pollutants in the air, so cleaning is required. In an emergency department, clothes can be stained by procedures. But neither issue applies to primary ambulatory care. I doubt patients understand that primary care physicians wear scrubs because it’s more comfortable to work in pajamas. Although they make dressing easier, scrubs also contribute to an atmosphere of urgency and time constraints appropriate to an emergency department. Outpatient care should be more about discussion. We may not need a trench coat and tweed, but a long-sleeved shirt and tie, or the feminine equivalent, makes sense.
As a confession, I only wear white coats for photos or special occasions. The Almighty has set my thermostat a little high and with the extra layer I overheat quickly. I recently helped out at a clinic that administers Evusheld, an injectable medication that protects immunosuppressed patients from COVID. Since the patients didn’t know me and with the benefit of some extra ‘cooling off time’, I wore a white coat even though it looked like a Marcus Welby Halloween costume.
A week after talking to my colleagues, I did not notice any noticeable change in their dressing habits. They would probably change entrenched personal habits only at the risk of mortality or a threat of compensation. And maybe not in that order. But that’s okay. After more than three decades, I’m used to people not taking my advice. It is an occupational hazard, both for patients and myself. I’ll keep walking along like a slightly formal medical dinosaur and plan to hang up my stethoscope, tie and horn at the same time.
Daniel Stone is the Regional Medical Director of the Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.
