Dr. Bacon’s Wardrobe Opinions Wearing on Reader

I was most disappointed in Dr. Bacon’s diatribe on the ills of dressing comfortably and the responsibilities of physicians to dress in a specified way (October 2004 “From the Crow's Nest”).

He is absolutely correct, however, when he reports with dismay the report that “three separate anesthesia providers failed to identify themselves or assess the patient prior to anesthetic.” This is indeed horrific. What I fail to understand is the leap from this to his apparently equal horror that a “brilliant and extremely hardworking resident” wore scrubs to a preoperative clinic. Brilliant and hard-working physicians are rare and precious and, personally, I do not think they should be discouraged with petty details that do not affect patient care. The stresses of residency are hard enough without having to worry about wardrobe issues.

And I am singularly unimpressed with the study that “patients preferred physicians who wore the traditional shirt and tie for men and a blouse and skirt for women.” Really! These patients get their ideas from television shows and movies that have actors and wardrobe consultants. Dr. Bacon is, I am sure, not aware of how difficult it is to wear a skirt and pumps all day. Try reaching down to start an I.V. in a skirt! Try staying pleasant all day in the footwear necessary for a skirt!

It is sad that, given the terrible problems in medicine today, so much attention was devoted to clothing. The best parallel one can think of would be someone on the Titanic complaining about the décor while totally ignoring the scarcity of lifeboats.

Tamar F. Singer, M.D.
Los Angeles, California


Editor’s Note:I am deeply saddened by Dr. Singer’s lack of understanding of patients’ needs in this area. When the patient expects a physician to act or dress in a certain way, and those expectations are not met, there begins a breakdown in the physician-patient relationship. When we fail to communicate properly with our patients both verbally and nonverbally, we lose. The resident in question is brilliant, but not the best in the class. All the others were able to show up in the preoperative clinic dressed to our, and the patient’s, expectations. All our residents work hard, and if we fail to teach proper behavior both by our words and our actions, we have failed our residents. As anesthesiologists we cannot afford to cavalierly dismiss how our patients perceive us. There are many challenges before us in medicine today; the teaching of professionalism in manner, dress and action is so important that the Accreditation Council for Graduate Medical Education has mandated that all residencies develop programs and assess professionalism in their residents. I maintain that if we acted and dressed like the professionals we wish people to assume we are, many of the problems in medicine would lessen. Can we afford NOT to take this issue seriously?

— D.R.B.

A FAER and Balanced Way of Ensuring Our Future

Your editorial in the October 2004 ASA NEWSLETTER was excellent. Measuring and valuing the dedication of educators in anesthesiology has challenged chairs and deans for many years.

The Foundation for Anesthesia Education and Research (FAER) shares your views and wishes to take this opportunity to increase your readers’ awareness of FAER’s efforts in and focus on education and research. As reported in the November 2004 issue of your NEWSLETTER, FAER created four research councils to better align the research goals of industry, investigators and donors. The Foundation believes that there are additional and more effective ways to elevate anesthesiology education in FAER.

Over the past 18 months, FAER has held two strategic planning retreats that involved stakeholders from across the anesthesiology community. We have created and begun to implement a strategic plan that will further develop funded research in basic and clinical science and education. In 2004, FAER’s Mentoring Committee, chaired by John P. Kampine, M.D., Ph.D., established the Academy of Anesthesia Mentors. This new organization, with start-up funding from FAER, recognizes the active contribution of highly successful anesthesiology mentors and, where possible, helps implement strategies and programs to improve and recognize mentoring in clinical research and education. Also in 2004, FAER approved a two-year Research in Education Grant available to anesthesiology faculty at all levels of appointment to study anesthesiology education. The award for this grant is $50,000 per year with mentoring through outside expertise (e.g., schools of education) as necessary. This increase in the award stipend has resulted in a dramatic change in both quality and quantity of submissions. FAER acknowledges that impediments to the growth of scholarly activity in anesthesiology departments include expanding clinical time requirements and diminishing institutional support from leadership that views anesthesiology solely as a service specialty. (The grants we have approved are listed on page 40 of this newsletter.)

I assure you that we value the educators who create the environment of intellectual curiosity from which our future leaders are born.

Joanne M. Conroy, M.D., Chair
FAER Board of Directors

Judge AMGs/IMGs by Performance, Not Appearance

In response to the letter published in the November 2004 issue titled “AMG/IMG Controversy Continues,” I respectfully disagree with the author’s conclusion. While I totally agree with some of the serious concerns raised in that letter, they are not unique to international medical graduates (IMGs).

I am, and clearly everybody else ought to be, concerned about the quality of any graduating physician, as he or she may harm patients and the general perception of the specialty. However, drawing a line between IMGs versus American medical graduates (AMGs) based on the school’s location is simply not logical. This fact alone should not limit the candidate’s eligibility to be in a residency program, provided that other concerns are dismissed.

Not all physicians are educated equally. The educational systems of various foreign medical schools are far away from the norm of American medical schools. This may make the IMGs inferior in their learning curve and still be competitive with AMGs. The IMGs’ obstacles (i.e., differences in language, terminology, culture, ethics) and how they were overcome may even be a “positive” in regard to this selection.

I hope all residency coordinators would have the same concerns for all candidates — not only for IMGs. The fact is that not all AMGs are acceptable and not all IMGs are unacceptable. It is wrong to state that “it is a mistake to continue taking IMGs in a quest to fill every possible spot” but rather to emphasize and encourage fair and positive selection guidelines detailing the dangers otherwise, as the author expressed. That statement defeats the very concept of a “selection process” — it is not supposed to be an “acceptance process.”

If a program selects and teaches well, what is the difference between IMGs and AMGs?

A. Cüneyt Özaktay, M.D.
Bloomfield Hills, Michigan

Naming the Missing Element in AMG/IMG Debate

In the November 2004 issue of the ASA NEWSLETTER, you published a letter titled “AMG/IMG Controversy Continues.”

My problem with this letter is that it is not signed. What possible justification is there for accepting anonymous contributions to an ASA publication?

The author has every right to raise these issues; what he or she says may be true, and perhaps something should be done, although he or she does not seem to offer any helpful solutions.

In any case, I think the editorial board should make a clear policy that you do not accept unsigned letters or articles.

If you do not agree, could you share your reasons with the readers?

Kenneth W. Green, M.D.
Waterville, Maine

Reflections of a ‘Foreigner’

It was with amazement and profound regret that I read the letter in the November ASA NEWSLETTER, which was written by an unnamed writer concerning American medical graduates (AMGs) and international medical graduates (IMGs).

Although I have lived most of my life in the United States, I would be classified as an IMG. (I am long retired and do not take risks by publishing my name.) In my wife’s family are four anesthesiologists, all IMGs and my brother, who has since passed on, was also an IMG. My wife’s family even produced a UCLA professor.

My brother was a graduate of Trinity College, Dublin, of which some of the finest English writers were graduates. He was two weeks in the United States when someone asked him where he learned to speak English so well!

He was one of the finest anesthesiologists I have known, having taken his Canadian and U.S. boards, his academic fellowship and U.S. fellowship, all by examination. In my lifetime, I have met both good and bad physicians, and quite a few of the bad ones were American graduates.
I perceive the letter to which I refer was nothing more than blatant bigotry; a letter written by one who perceives American medicine as being superior to any other. Why then has so much of our progress been due to research, both in the past and present, by graduates of medical schools in foreign countries?

The writer has placed us in a category which I hope we may never achieve, that of “ignorance and bias,” a place the writer himself may already have achieved.

It is my opinion that the letter explains the writer’s personal feelings, and it is my opinion that he belongs in a category of his own, which is best described by these simple words: Look in the glass. Look in the mirror and try to answer the question: Am I any better?

Or perhaps the writer failed to recognize that the author of Through the Looking Glass was not from the United States.

Name withheld by request