The Patient Was…

“All the world’s a stage, and all the men and women merely players,” said Shakespeare.

“Clothes make the man,” according to several others.

And the Academy Awards do give an Oscar for costume design.

If all this be so, then clearly how we dress, how we present ourselves, how we appear to others, must have an important impact on the various roles we play in our lives.

My wife, who is one of the most gracefully elegant women I have known, would say I probably have a greater-then-average interest in fashion. (I confess to faithfully reading Vanessa Friedman’s New York Times column every week.) Perhaps it’s because I have dined, stayed, and traveled with people in the fashion industry.

The fact is that how we dress affects the way people see us. It influences the trust they place in us, their confidence in our abilities, their perception of our value and worth. It sends a message, whether intended or not.

Some years ago, when I was Medical Director at a large, multinational company, I was on the train platform in Newark, New Jersey, awaiting an Amtrak train to Washington, D.C., for meetings to be held the next day. I saw the President of our company on the platform and went to greet him. I was dressed in pressed slacks, a dress shirt and tie, and a blazer; he was in an unpressed pair of pants and shirt.

“Where are you off to,” he asked. “You’re so dressed up. Is something going on today?”

“Nothing special today,” I said, “just traveling.”

“Why are you dressed so nice, then?” he said.

“Well,” I answered, “you never know whom you might meet and under what circumstances. And I feel that no matter where I am I represent the company.”

The train came, we parted, and never referenced the conversation again. But the next time I saw him on the train platform, he was dressed as I had been.

On another occasion, I was in Charles De Gaulle Airport in Paris with the Vice-President who ran the medical – marketing group I was in. We had finished meetings sooner than planned and were hoping to get an earlier flight back to the U. S. I was dressed in slacks, pressed shirt, and a blazer, while he was in shorts, a tee shirt, and sandals. We were on the waitlist for the flight home and were called to the desk. The agent said they had one seat open in the last row in coach; my colleague said, “I’m the boss, I’m taking it.”

We returned to the waiting area where I decided to stay until the flight left, hoping another seat might open up. Just before boarding I was summoned to the desk, where the agent said they had a first-class seat available and asked if I would take it: No extra charge because I was a frequent flyer. Of course I accepted.

When I went back to join my colleague, he smugly said, “No luck, eh?”

“Oh, no” I replied, “they had one seat.”

“Then we’ll be together, right,” he said.

“Not exactly,” I said, “but you’ll see me in first class when you board with the coach group.”

“Why did you get the first-class seat instead of me?” he bellowed.

“Look at me, the way I’m dressed,” I said. “And look at you.”

Of course, I had totally made up that reason for the seat assignments, but he took it to heart. Whenever we traveled after that, he always dressed well.

Early in my career, I served as the Medical Director of a large pharmaceutical advertising agency. Now, everybody knows that advertising agencies can be rather casual places, where language, dress, and manner can be pretty informal. Fridays are often more casual than usual; the term grungy Friday is not entirely off base. Our agency used to meet with the advertising division of one of our corporate clients on Fridays; I always wore a tie and jacket and was the butt of endless jokes and comments about being too formal. One Friday, I arrived early and changed into a full formal outfit: tuxedo, dress shirt, studs, cummerbund, patent leather shoes. When I entered the meeting room there was momentary silence, then hilarity. And they never again teased me about not being informal enough for our meetings.

So, what does this have to do with medicine and health care?

Well, if how we dress sends a message, affects how we are perceived, influences how people regard us, and impacts their views on our competence, our focus, and our intent, then we, as health care professionals, should give that some consideration.

At this stage of my life, I have a few physicians involved in my medical care. I like and trust them all. I know their qualifications, their experience, their abilities, because I have worked with them or at least in similar situations. So how they dress has only a minimal effect on my views of them. But there are still subtle differences. If I were a typical patient and not their colleague, and not personally aware of all of .their qualifications, these might have a bigger imkpact on my reactions.

One of my doctors dresses impeccably: bow tie, jacket when not in his office, starched white coat when seeing patients. He is always on time, organized, aware of everything in my medical record. He is totally focused on me when I am in his examining room. Everything seems precise and orderly.

Another of my physicians is almost always late for our appointments; an assistant makes some excuse and handles some of the preliminary parts of the visit which the doctor will sometimes check but sometimes not. When he appears, he is dressed very casually; no white coat or even the “obligatory” stethoscope draped around his neck. He addresses issues in a casual manner, and I always wonder if he has considered all available information, so I am pressed to ask specific questions to assure myself that he has. At the end  I’m always satisfied, but it takes more effort on my part to be so.

A third physician is primarily a surgeon, so she is always in scrubs and that seems quite appropriate. She graciously sees me for nonsurgical evaluations and she is totally focused on the issues I have raised. Her dress and role and manner are entirely in synch and it is effortless to feel confident about her care.

It may not be fair to say that casual dress means casual thinking, as an executive I knew did as she fired an assistant whose outfit was not “business-like.” But there is a kernel of truth in it, especially in the message it conveys.

If you are a patient, in particular, and you have a medical concern, and someone whom you do not really know well presents themselves as your physician, you will likely react to everything about them. Their words, their voice, their manner, and yes, their appearance. If it is not “professional”  —  whatever that actually means  —   there is an obstacle, however minor in some cases, thrown into the mix. In a situation requiring absolute confidence, belief, and trust, there may be some niggling doubt. And that is counter-productive in a medical setting.

Some years ago, when I was still admitting and actively caring for patients in the hospital, I raised the issue of inappropriate dressing with the hospital executive responsible for administrative management of in-patient care. My concern was that the clerks, who were the first people whom visitors encountered when they came to see hospitalized patients, almost uniformly looked slovenly and unprofessional on weekends. During the workweek, when administrators were around, everything seemed alright. On weekends, when visiting was busiest, but executives were not on duty, the clerks often wore sloppy, more beach-appropriate than work-appropriate outfits. To me, it immediately conveyed a casual and unprofessional atmosphere, not what one wanted in a hospital dedicated to serious, professional care.

The executive I spoke with said she had not encountered what I described. I told her it happened on weekends when she wasn’t around. I invited her to come in one weekend and meet me and we would go around the hospital together to see what I was describing. Her response: Come in on a weekend, when I’m off? No way! The situation didn’t change.

I am not advocating going back to the days depicted in old black and white movies where doctors wore starched collars and formal jackets, and nurses wore starched white uniforms with caps perched on carefully coiffed heads. But I am advocating for recognition that dress conveys meaning and message, and they in turn are important to patients whose trust and confidence we need to do our best for them.

There is something called the White Coat Ceremony, introduced some years ago at my alma mater (Columbia University) and now practiced at most medical schools. It is a formal ceremony in which medical students are “cloaked” with a white coat placed upon their shoulders, the coat representing their commitment to professionalism, trust, and ethical standards in their service to others. It is not just an article of clothing: It is a symbol of dedication to the principles of the Hippocratic Oath.

If clothes do indeed make the man (and woman, of course), and dress sends a message and conveys meaning, however subtly, then physicians and other health care professionals should, in my view, recognize this and act accordingly. It isn’t fashion or false front; it’s symbolic of purpose and commitment.