from New York Times Online
MIAMI, Nov. 20 — When I was a new faculty physician, I worked with a resident doctor who was smart and energetic and took excellent care of her patients.
There was just one problem. As she delivered her thoughtful patient presentations to me and the other attending doctors, it was hard not to notice her low-cut dress.
“You two have to say something to her,” one of my male colleagues said to me and another female doctor one afternoon. But while none of us would have hesitated to intervene had she prescribed the wrong drug for a patient, we felt weird saying something to her about her clothes. So we didn’t.
Nearly a decade later, my impression is that more young physicians and students are dressing like that resident. Every day, it seems, I see a bit of midriff here, a plunging neckline there. Open-toed sandals, displaying brightly manicured toes, seem ubiquitous.
My observations may partly reflect the city in which I work, Miami, a subtropical place known for its racy clothes. But colleagues who practice elsewhere report that they, too, have seen medical students and young doctors show up for clinical work in less-than-professional attire.
“Poor choice is not regional — I’ve seen it everywhere,” said Dr. Pamela A. Rowland, a behavioral scientist and director of the office of professional development at Dartmouth Medical School, who has studied the impact of physician clothing on patient confidence. “It always surprises me when there are dress codes for staff but not for physicians.”
Among older and middle-aged physicians (like myself), tales of salacious and sloppy trainee attire abound. One colleague commented that a particularly statuesque student “must have thought all her male patients were having strokes” when she walked in their exam room wearing a low-cut top and a miniskirt. Another complained about a male student who came to class unshaven, even though he hadn’t been on call the night before. One Midwestern medical school dean reported that her school instituted a formal dress policy after administrators noticed students revealing too much flesh while sunbathing on a small patch of grass outside the school building, directly below patients’ hospital room windows.
Patients and colleagues may dismiss a young doctor’s skills and knowledge or feel their concerns aren’t being taken seriously when the doctor is dressed in a manner more suitable for the gym or a night on the town. There are also hygiene considerations: open-toed shoes don’t protect against the spills that commonly occur in patient care, and long, flowing hair can potentially carry harmful bacteria.
“Patients don’t have your c.v. in front of them, and appearance is all they have to go by,” Dr. Rowland said. “If you don’t meet their expectations, their anxiety level increases.”
In a study published last year in The American Journal of Medicine, patients surveyed in one outpatient clinic overwhelmingly preferred doctors photographed in formal attire with a white coat to photos of doctors in scrubs, business suits and informal clothes — jeans and a T-shirt for men, an above-the-knee skirt for women. The patients also said they were more likely to divulge their social, sexual and psychological worries to the clinicians in the white coats than to the other doctors.
Plaintiffs’ attorneys sometimes ask about a doctor’s attire in malpractice depositions, Dr. Rowland said. Her research has also found that physician clothing can influence scores on board certification oral exams, in which a senior doctor assesses a younger doctor’s medical knowledge.
“You don’t want to look too attractive to be serious,” she said, adding that “a certain amount of the nerd factor” can help a doctor’s performance.
Historically, doctors have dressed differently from the rest of the population, and the doctor’s uniform in the Western world continues to evolve. Hippocrates advised doctors to be “clean in person” and “well dressed” but also recommended that they be “plump” and anoint themselves with “sweet-smelling unguents.” The white coat itself became a staple for Western doctors in the early 20th century. More recently, the British Medical Association recommended that doctors on hospital wards not wear ties, because they are seldom washed and can carry antibiotic-resistant bacteria.
Many medical schools have dress codes (my employer, the University of Miami, specifies that students have hair “of a natural human color,” among other things). But enforcement is often left up to faculty members and thus can be haphazard.
Last year, I sent home an otherwise excellent student because her feet were clad in shoes that looked like flip-flops (though she claimed they were expensive leather sandals). I felt guilty about it at the time, since it meant she missed an afternoon of clinic. But I doubt she’ll ever wear them in front of patients again.
And I wonder about that resident with whom I worked many years ago. Do patients and colleagues underestimate her abilities? Ultimately, we didn’t do her a favor by pretending to ignore her clothes.