Medical Fashion

I heard on the news that New York City’s fashion week just came to a close.  I was in the Big Apple just a couple of months ago and came away with the impression that fashion in our nation’s largest city consists mainly of different ways to accessorize the color black—to me it looked like everyone had just returned from attending a funeral.  I don’t keep up with the world of fashion but it did prompt me to think about how this subject relates to the medical world.  So, here it is, the definitive summary of medical fashion from someone who is no expert in fashion and barely an expert in medicine.

When I started in medical school in the late 1980s we were given no formal guidelines or instruction on appropriate physician attire, which, in retrospect, now strikes me as odd since the prevailing fashion trends at the time were pretty frightening.  When I started doing hospital rotations I was simply told to dress nice, which I took to mean slacks, a nice shirt and a tie.

Things are different now.  The young medical students of this century are provided explicit instructions on what to wear and what to avoid.  My own alma mater, the University of Utah School of Medicine, now has a dress code for work in the hospital and will likely soon enact a set of rules governing attire for the first two years of study (largely classroom only).  This document proscribes unwanted attire such as open-toed shoes, soiled white coats, and jeans, and specifically singles out halter-tops, midriffs, and shorts (although why someone would show up dressed like Daisy Duke is beyond me).  Similarly, facial piercings and tattoos are frowned upon.  Oddest of all is the heading of “Hygiene”: Daily hygiene must include clean teeth, hair, clothes, and body, including use of deodorant. I’m sorry, but if we have to spell out the need for bathing and daily toothbrush use to our medical students I fear for the future of medicine.

I’ve heard more than once from friends that doctors, on the whole, are poor dressers.  I don’t really take offense at this since I openly admit I have poor sartorial sense.  What I do have, though, is the ability to read scholarly journals (and by that I don’t mean Vogue or Glamour).  There have been several studies addressing the issue of patients’ perception of physician attire and suggest that people prefer their doctors to wear professional clothing rather than casual clothing.  In general the term “professional clothing” is defined as shirt with tie, business suit, or white lab coat, while “casual attire” refers to everything from Seattle grunge to any clothing that appears on the show Dirty Jobs.  While I respect the desire to reach such conclusions through the application of scientific rigor I kind of think that common sense is more than adequate to determine that patients have greater respect for someone who looks more like Marcus Welby than Larry the Cable Guy.

The degree of formality of physician dress may be somewhat regional.  I’ve heard that white shirt, tie and business suit are more common among physicians from the east coast.  Out west, particularly in the mountain states and Pacific Northwest, the implicit dress code is considerably looser and many doctors I know dress as if they plan to head up Pike’s Peak as soon as clinic hours are over.  I imagine that patient expectations eventually conform to whatever the prevailing trend is.

The white coat is always a plus, especially if it is starched and well-pressed.  I have previously written about my misgivings for this fashion accessory but still admit that it can make you look pretty snappy.  A stained, wrinkled coat, on the other hand, can look pretty frightening, especially if you’re the kind of patient who likes to avoid things like MRSA and C. difficil colitis.

The issue of surgical scrubs is a mixed bag.  In one study of obstetrical residents, patients reported that they felt quite comfortable being seen by a doctor clad in green scrubs.  I suspect these particular patients like the idea of their doctors being dressed and ready at a moment’s notice to race them into the delivery suite without the delay of swinging through the locker room (every second counts after you’ve put up with bloating and insensitive husbands for 9 months).  Conversely, walking around in pajamas is not terribly flattering especially when they seem to be designed for people who are 5’4” and 250 pounds.

Footwear is easy: the more comfortable, the better.  Medical students and residents will spend half their lives standing around hallways waiting for crusty old doctors to simply stop talking, and for that you need good arch support.  The Dansko clogs seem to be quite popular especially with anyone who spends much time in the operating room, with their main drawback being incurable unattractiveness.  The tall heels will provide an inch or two to your height (especially helpful in the OR for those of challenged stature) but this increased altitude on a relatively narrow platform can also pose a substantial risk to your health, to which I can attest with a personal anecdote.  I once stumbled in my Danskos while walking down the back stairs at Clarkson Hospital and came to a rest only after a couple of Cirque du Soleil summersaults down the cement steps.  Anyone wanting a first-hand account of this can speak to another of Alegent’s doctors (and bloggers) Ryan Isherwood, M.D., who was a resident with me at the time and provided much-needed first aid.

I’m no fan of neck ties.  Sure, they look great in the board room and strung around the necks of politicians, lawyers, and businessmen, but doctors have more practical issues to consider.  If you were to design an article of clothing for the sole purpose of dangling onto the beds of hospitalized patients during your exam, the neck tie would be the perfect accessory.  You could then successfully collect a specimen of every germ in the hospital and drag it around to each of your patients.  If you think I’m going overboard with this, think again.  In 2004 the New Scientist reported on a bacteriological survey of hospital doctors’ neckties with the alarming byline “Half of doctors' neckties contained dangerous bacteria, new study.”  Hospitals in the United Kingdom have gone so far as to ban them from rounding doctors.  Bowties solve the problem of infection risk but tend to suffer from unforgivable nerdiness.

My final observation relates to wristwatches.  For those of you under the age of 30 who rely on your cell phone to let you know if you’re running late for your morning Venti Latte, a wristwatch is a small device, kind of like an iPod, that straps to your wrist and tells time.  It can’t surf the web, play music, or provide you with hours of entertainment with Angry Birds.  It just tells time.  Being somewhat older than Justin Bieber I find a watch an indispensable accessory.  If you’re looking to invest in one of these for the first time try to get one with a second hand so that you can accurately measure your patient’s pulse (although even that function is not mandatory since there’s probably an iPod app that will do it for you).

There you have it—I have officially exhausted my entire acumen of fashion knowledge.  Now, if you’ll excuse me, I’ve got to go take a shower and brush my teeth—it’s that time of the week again.