Compassion and medical fashion

My patients sometimes comment on the idea that doctors’ education ignores nutrition research. But while they’re quick to point out this gap, they rarely mention the less-noticed issue of fashion!

Growing up with a mother and two sisters who often dressed to make a statement, it’s hard to imagine anyone less fashion-conscious than me. My distant memories include dreaded shopping trips with my mom and her picking out a ridiculous outfit and declaring, “I’m wearing it.” My response, as best I could tell, was, “Who are ‘them’ and why should I care?” It was. Then and now, my typical fashion statement might be given a “no statement at this time” by a political spokesperson.

Despite my fashion allergies, patients occasionally make nice comments about my clothes, especially a tie that matches a shirt. I usually respond by asking if their eye care is up to date. When I’m really cornered, I open with something like, “Sometimes a guy hits the ball with his eyes closed, even while swinging.”

Given this perspective, I recently found myself commenting publicly on physicians and fashion. My medical team asked us to provide lessons learned from thousands of patient care experiences spanning three decades. In charity, they have allocated twenty minutes.

Not surprisingly, there are studies showing that patients prefer doctors to wear somewhat formal clothes and white coats. But the pandemic, whose impact penetrates all corners, has changed that dynamic. Doctors doing video visits can wear whatever they want, at least from the waist down. I’m used to this too, and on video tour days, I wear a long-sleeved shirt and jeans with a tie. When informality spreads like a virus, we see doctors dressed as they are in the office or at home, or wearing surgical gowns.

How hard is it, I asked my friends, to take a few extra minutes to reassure those who care? That is compassion, not fashion.

I can tell you that the house dressing of my less formal colleagues doesn’t offend long-term patients whose confidence has been proven. But new patients are judged based on the first visit. For male physicians, wearing a tie indicates that patients feel more comfortable with someone who is “watching their game.” Especially for seniors, this typically translates to wearing a tie. How hard is it, I asked my friends, to take a few extra minutes to reassure those who care? That is compassion, not fashion.

Of course, women are off the hook when it comes to ties. But professional attire is still important for anyone in healthcare.

Clean up? There are three reasons to wear them. In the operating room, casual clothes generate air pollutants, so cleaners are needed. In the emergency room, clothes can become contaminated during the procedure. But neither case addresses outpatient primary care. I’m sure primary care doctors will find patients comfortable wearing pajamas to work. While it makes dressing easier, scrubs also add urgency and time constraints that are ideal for the emergency room. Outpatient care should be more about consultation. We may not need a pipe and tweed coat, but a long-sleeved shirt and tie, or the female equivalent, makes sense.

As a testament, I only wear white coats for photo ops or special occasions. The almighty turned my thermostat up a bit and I warmed up faster with the extra layer. I recently helped out at a clinic that provides Evusheld, which protects immunosuppressed patients against covid. Because the patients didn’t recognize me, and with the added benefit of “cooling off time,” I wore a white coat, even though it looked like a Marcus Welby Halloween costume.

A week after speaking to my colleagues, I noticed no difference in their dressing habits. Perhaps they change ingrained personal habits only because of the threat of death or compensation. And maybe not so. But that’s okay. After three decades, I’m used to people not taking my advice. Both patients’ and mine are occupational hazards. I will continue to act like a little formal medical dinosaur and plan to hang up my stethoscope, tie and bullhorn at the same time.

Daniel Stone He is the regional medical director of the Cedars-Sinai Valley Network and an internist and geriatrician practicing with Cedars-Sinai Medical Group. The views expressed in this column do not necessarily reflect the views of Cedar-Sinai.