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December 2000
Volume 64 |
Number 12
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VENTILATIONS
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| A Tale of Three
Men or Has Your GQ * Subscription Expired? |
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Mark J. Lema, M.D., Ph.D. Editor
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At 6:30 a.m. on Monday, three late-model
cars pull into the hospital parking ramp at Community General
Hospital in Anywhere, USA. Three men step out of their respective
cars. The first man is wearing a baseball cap (backwards), denim
jeans, sneakers and a sweatshirt with a football team's logo (OK,
it's a Bills logo!). The second man is dressed in a long-sleeved
knit shirt, corduroy slacks and loafers. The third man is attired
with a tie, sports jacket, dress slacks and shoes. The three men
enter the hospital and step onto the elevator along with a surgical
patient's family and a senior hospital executive. All three men
exit on the floor where the surgical suites are located.
From the information provided, can you tell me who is the surgeon,
who is the anesthesiologist and who is the nurse anesthetist?
Statistically, and intuitively, the man dressed in a tie and sports
jacket would be the surgeon. However, it is anybody's guess as
to which of the remaining two men is the anesthesiologist and
which one is the nurse.
In the September 1998 NEWSLETTER,1
I wrote an editorial that produced an unending string of letters
and comments to me on the topic of appropriate professional dress.
In the past two years, many U.S. businesses have changed to business
casual attire (open-collared shirt). It is interesting that our
European and Japanese counterparts have not adopted these relaxed
dress codes for the workplace. However, if businesses are now
adopting a more casual dress policy, why am I reopening old wounds
by raising the question of appropriate dress for anesthesiologists?
Three new developments have necessitated readdressing this topic.
First, at the recent ASA Annual Meeting in San Francisco, California,
over a dozen physicians approached me and specifically mentioned
the Emperor's New Clothes editorial. Each physician copied the
article to educate residents with respect to appropriate hospital
attire. It appears the recent Accreditation Council for Graduate
Medical Education anesthesiology residency program requirements
specify that emphasis be placed on interpersonal skills, effective
communication and professionalism and that graduating residents
demonstrate a commitment to...business practices... 2
Evidently it has stimulated a renewed interest in the dress for
success homily.
Second, a recent USA Today article titled Dress for Success?
Casual Bucks Trend, is representative of several magazine articles
reassessing business' dress-down policy. 3
Mark Gerson, co-CEO of a New York publishing company, explains
how the rapid appearance of Internet companies run by 27-year-old
billionaires accustomed to working in dorm rooms reshaped corporate
dress. However, he also questions whether dressing down is advantageous.
Men are still conforming by wearing button-down shirts and khakis
while women are left without any rules or guides to follow. Moreover,
it does not represent creativity because, as he states, "The
current technological boom is the second greatest explosion of
creative genius in U.S. history." The first occurred in Philadelphia
in 1787 on a hot July day when our founding fathers, in full formal
dress, crafted the American governmental system.
Gerson argues that these historic visionaries were not "uptight
prisoners of an anachronistic era," but rather that they
had sound reasons. As cited in the article, appropriate dress
can be an effective business tool. George Washington, offering
advice to his nephew, wrote 34 of 49 lines about the importance
of clothes and the remaining 15 lines on friendship, education,
morality and thrift. Gerson ends with a paragraph that, for me,
resolves this controversy:
There is a lot that Internet entrepreneurs know that Washington
didn't. There are some things that Washington knew that today's
entrepreneurs have forgotten: One is that proper attire reflects
a well-ordered mind. Another is that there is grace in life's
separations and purpose in variety: There's a difference between
a business lunch and a country picnic, between Tuesday and Saturday.
It's healthy to reflect those differences in our outward presentation
as well as in our activities and mind-sets.
The third reason deals with health care. As it continues to transform,
consolidate and intensely compete, more physicians are becoming
aware that external appearances can quickly identify them with
the medical profession. They have found that professional dress
improves negotiations with administrators, payers and colleagues
in addition to facilitating interactions with patients and families,
especially when difficult news must be imparted.
I often hear the argument that anesthesiologists immediately
change into scrubs or wear lab coats, and that identifies them
as medical professionals. While this attire is often suitable,
it is also the outfit worn by operating room nurses, physicians'
assistants and nurse anesthetists. One must ensure that scrubs
and shoes are not blood-soaked. Lab coats must be clean, unwrinkled
and appropriately sized to convey the image of a physician. Nonetheless,
the Mayo Clinic, located in a largely rural Midwest area, requires
that all physicians act as consultants and change out of scrubs
into business attire when interacting with patients (including
preoperative visits). The Mayo Clinic ranks as one of the best
health care facilities in the United States, is still under physician
oversight administratively and disciplines its staff for not conforming
to hospital dress codes. These three points are not, in my opinion,
coincidental but representative of a successful business formula.
Thus the message is clear: All physicians in a given hospital
environment should adopt dress standards that identify them as
a professional regardless of the length of time spent wearing
that attire. If a physician consistently wears sneakers and jeans,
it is unlikely that physician would feel comfortable attending
a hospital committee meeting, reception or dedication in the late
afternoon. Nonparticipation in hospital committee activities by
anesthesiologists is often a nidus for alienating them from the
rest of the medical community. Active participation conversely
keeps anesthesiologists in touch with health care changes such
as health maintenance organization price packaging, deep sedation
policies and resource allocations. Looking the look is as important
as talking the talk and walking the walk in these interactions.
In closing, which of the remaining two men is the physician and
which is the nurse? In many hospitals, one cannot separate the
doctor from the nurse by dress alone; and that is not because
nurses wear ties to the hospital! Think back to the elevator ride
and what thoughts might have been pondered by the family members
and executive if the identities of all three men were known. If
the anesthesiologist was dressed in the sweatshirt and jeans standing
next to his surgeon colleague, would these observers have the
same level of comfort and respect for both physicians? Is it really
logical to think that professional respect is gained solely by
what one knows and not also on how one looks?
As a quick rule for assessing hospital dress, ponder this scenario.
You are 1,500 miles from home, severely injured, requiring life-saving
surgery. The anesthesiologist arrives dressed in street clothes
looking like you usually dress for work. Would your initial visual
impression of that physician comfort or concern you? How much
time would that physician need to spend with you to gain your
confidence?
Please do not think that your knowledge and skills are readily
apparent to the frightened, concerned patient. Do yourself a favor
and look the look. You may need less time talking the talk.
– M.J.L
References:
1. Lema MJ. The emperor's new clothes. ASA Newsl. 1998; 62(9):1.
2. Accreditation Council for Graduate Medical Education. Program
requirements for residency education in anesthesiology. Available
at Effective January 1, 2001. Accessed November 6, 2000.
3. Gerson M. Dress for success? Casual bucks trend. USA Today.
March 8, 2000.
*GQ (Gentlemen’s Quarterly) is a men's fashion magazine. Men
were used because they both tend to dress down to a greater degree
than women and have more easily defined rules for proper attire.
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