Our Lives

Elizabeth Dreesen says MDs-in-training should pass patients’ visual exams

September 14, 2013 

My husband, a psychiatrist, says M.D. stands for “makes decisions.” He’s right, I think.

That’s what we do, we doctors. He decides whether to commit people, to hold them against their will in order to keep them safe. I decide whether to operate, whether the benefits outweigh the risks.

Sometimes these are difficult decisions. Always they come with consequences. Still, this is what we’ve trained to do, and what we’ve done for many years. We’re accustomed to the weight of decision making. So I was surprised recently as I’ve struggled over what to do about what my students were wearing to work.

A male med student arrived on rounds with his hair pulled into a ponytail. His hair wasn’t quite long enough for the rubber band to snag it all, so the straggly strands fell into his face as he bent over his patient.

A female student entered the intensive care unit in black suede heels and tight green capri pants. A man came to clinic wearing rubber shoes with 10 black toes. I raised my eyebrows and he told me that they were good for his feet.

I had a visceral response to each of these fashion choices. The hair looked unkempt; the pants/heels combo was for a nightclub. And the shoes looked like they came off the set of a “Planet of the Apes” movie. You can’t wear this stuff to work, I thought.

I didn’t send them home, though. Instead, I started wondering whether I was wrong. Maybe I’ve become a conservative old surgeon lady. Maybe the patients are fine with this, and I’m just stuck in some previous century with some vintage view of things. So instead of pulling rank and ordering outfit changes, I started talking to doctor friends about how to dress for the serious work we do.

Everybody I polled agreed that the patients shouldn’t be subjected to belly button rings or mohawks. Cleavage and skinny jeans were out, as were flip-flops and tennis shoes. The general consensus reassured me that I wasn’t off-track, but a couple of anecdotes really sharpened my thinking about what doctors and students should look like.

One friend had a student who had also worn the shoes with toes. “No way,” she’d thought at the sight of them, but then like me, she’d begun to wonder. Was the problem the shoes or was it her? She wouldn’t have let her son wear the shoes to work, but the student wasn’t her son. Was his taste in shoes her business or was she overinvolved and meddling?

At the time she’d asked his patients what they thought of the shoes. The patients, it turned out, thought he had some sort of foot disease, that his freaky footwear was the prescription for some dreadful podiatric illness. One of them even thought that he’d had his regular feet amputated, that the toe shoes were a temporary prosthesis until he could get more permanent artificial legs. Several patients had actually worried about the young student with a difficult disease.

When I asked my husband to weigh in, he told me a story I hadn’t heard in our 20 years together. As an earnest young medical student, he’d put on a tie and a white coat, and he’d gone to examine a hospitalized patient, someone who had generously volunteered to be examined by a student. When he was done with his exam, he’d thanked her and solicited feedback.

“What could I do better?” he asked.

“You could tie your shoes,” she answered without hesitation, and he looked down to see that one of his wingtips was untied.

So here’s what I took home from my research and reflection. Patients examine us, just as we examine them. We look for signs of illness, but what they’re looking for, I think, are hints of who we are as people.

Are we attentive to the details of our appearance? Maybe that will translate into attentiveness to the patients themselves. Are our clothes subdued and respectful or startling and eye-catching? And if they’re catching too many eyes, then there may be no eyes left to look after the patient.

We live in a world of brief encounters. Even medicine has shift workers, and more and more people get their primary care in the emergency room. In circumstances like these, we need to manufacture trust, to create it out of thin air, during an ever-so-brief encounter at the bedside of some sick person. Our clothes are part of how we do it. They’re more than fashion statements. They’re one of our tools. Their simplicity and predictable plainness ensures that the focus is on the patient and not on us.

So I was right to cringe at the green pants, the straggly hair, the weird shoes. And I’m decisive now about outfits, as I am about surgery.

Dreesen: elizabethdreesen@gmail.com

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