Douglas R. Bacon, M.D., Editor

T-Shirts, Jeans, Sandals & Professionalism

s I write these words, the first days of school are upon my children. My wife and I have had the usual arguments about what is appropriate school dress for our teenage sons.* The “Hastings Hockey” T-shirt, well-worn with a few stains no longer able to be removed by the usual washing process and a small hole from some now forgotten summer adventure, seemed the wrong thing to wear to make a good first impression upon a new set of teachers. My 13-year-old eighth-grader saw things differently. Peter is a reasonable child, though, and he changed his shirt.

Peter failed to see the importance of the first impression on his new teachers. In anesthesiology we often fail to appreciate that each time we approach a patient, we are making a first impression. How we appear is very important, for we only have a few moments to secure our patient’s trust. The Anesthesia Patient Safety Foundation Newsletter has one of the most disconcerting letters to the editor I have read about recent anesthesiology practice and professionalism.¹ In essence three anesthesia providers failed to identify themselves or assess the patient prior to his anesthetic. The fact that this occurred in a recognized major medical center is even more disturbing.

Several days ago, the residents within my academic practice switched rotations. I happened to be one of the attendings in the preoperative assessment clinic on the first day of the new rotation. In our institution, attendings and residents wear business attire when assessing and interviewing patients in the office setting. Our resident, brilliant and extremely hard-working, arrived in scrubs and a white coat. One of the respiratory therapists who works with us daily in the preoperative assessment clinic commented to me that I needed to speak to the resident “about the dress code.”

The incident with the resident was both positive and negative. On the positive side, the respiratory therapist, as well as other members of the staff, recognized that there were standards for proper attire regarding a physician seeing patients. Secondly, and perhaps more importantly, they wanted to uphold this standard. The culture within the preoperative assessment clinic was clearly on the side of appropriate dress for patient care. The negative side was that our resident clearly misunderstood the culture not only of the preoperative assessment clinic but also of the institution as a whole.

Almost a year ago, a very interesting article appeared in the Southern Medical Journal describing patient preferences in physician appearance.² To quickly summarize the article, patients preferred physicians who wore the traditional shirt and tie for men and a blouse and skirt for women, with their stethoscope prominently displayed. While the study looked at family practitioners — and no comparable study has been done for anesthesiologists — appearing like a physician is important, patients said. On the average day, if it were not for scrubs, many anesthesiologists would see patients in T-shirts and jeans; at least this is the impression I get from seeing what they wear into the locker room!

Recently an orthopedic surgical colleague of mine described how he had learned a lesson from anesthesiologists. No longer wearing business attire on days when he was assigned to his laboratory, he now wore a polo shirt without a tie. Thus he could not be asked to see patients and could spend uninterrupted time in his laboratory. What I find distressing about this conversation is not the need for uninterrupted time for research; rather I find it disturbing that he “learned” this lesson from “anesthesiologists.” What does this say about our reputation among our fellow physicians?

Many years ago, while taking a medical ethics class as an undergraduate, I became engaged in a discussion with the philosophy professor who taught the class. The professor insisted that physicians were “different” from other people. I argued that they were not. Yet, over time, I have come to see the wisdom in the professor’s argument. To be a successful physician, one needs intelligence and industriousness. By experience most physicians have witnessed human nature at its best and worst. Because of this, society has a different set of behavioral expectations for physicians.

Society requires much of those it entrusts with the care of the sick, among the most vulnerable members of the group. Society’s expectations extend to how we conduct our lives, our manner of speech and even to our dress. As physicians, we may protest against this; yet in doing so, we begin to break the “social contract” between those of the healing profession and society at large. By both experience and expectation, physicians are different from ordinary members of society.
Like my son Peter, we may not often understand why society expects us to act and dress differently, but we need to be ready to acquiesce. Lacking insight and understanding of what society needs us to be and failure to acknowledge and attempt to meet those requirements will only further erode the professional standing of physicians and perhaps void our social contract with our society.

Should that happen, our clothing may be more comfortable, but our jobs will be far less secure, and most importantly of all, the practice of medicine will suffer. Is the lack of a knotted piece of silk around the neck, the beginnings of an outsider’s view of medical professionalism, really worth it? Only you can decide.

— D.R.B.

* My wife and I have not been blessed with a daughter; we have four wonderful sons.

References:

1. Surgeon suffers poor quality of care—advocates for professionalism. APSF Newsletter. 2004; 19(2):17, 28.

2. Keenum AJ, Wallace LS, Barger AR. Patients’ attitudes regarding physical characteristics of family practice physicians. Southern Med J. 2003; 96(12):1190-1194.

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