It’s July 1st, a time of year when third year American medical students take the step from auditorium to clinic. It’s a time of sorting out. Every medical school deals with their share of students appearing on clinical clerkships showcasing their unique brand of personal expression. Meetings ensue. The argument is always the same: ‘I can be a good doctor with purple hair.’
Of course you can. But this isn’t about you.
Among patients the measure of your ability is no longer limited to how smart you are or how hard you studied, but includes how you’re perceived. We’re one-half of an important relationship and the confidence we inspire sets the stage for the success of that relationship. While there may be patients not preoccupied with a surgeon’s eyebrow-to-lip chain, there are likely those who are.
Ultimately the work of a physician requires that we surrender a small piece of our independence. A career built on the privileged relationships shared with patients requires consideration of what will make them most comfortable.
July is the month when senior medical students face the reality that it’s no longer just about them.
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I totally agree. I live in a small town where even the pediatric neurologist who walks around with his messenger bag slung over his metrosexual ensemble while texting on his hot pink cell phone is viewed as a bit over the top. I don’t know how the rest of the country views things, but in the rural south, dressing and looking professional will always be in order.
So much of how we’re perceived is culturally based. The norm in a major metropolitan city may be quite out of place in a small southern community. And, of course, in many cultures outside of the U.S., body jewelry is the norm.
My cell phone has an orange bumper. For what it’s worth.
I have asked the same question about nose piercings, which is a much more trendy fad. It seems to be becoming a much more acceptable aspect of daily lives, but still it must be appreciated that many patients want their patients to maintain a very conservative, traditional appearance. Ultimately, who is really to say which is right? I’m not sure.
Nice post Bryan.
Yes. And in the land of the nose-ringed, the absence of piercing comes as a distinct disadvantage for the clinician. The pickle with the ‘which is right’ question is that educational programs have to provide some basis for appearance and behavior. Still gets into tricky territory, for sure. Rights of physicians v. standards of behavior/appearance.
I couldn’t agree with you more! Although, I’m not sure “grown up doctors” know it’s “not about them” any longer. How many of our colleagues cross the line these days with their dress codes, hair cuts, piercings and body art? In the big picture of life, if they can dress the part and act the part, I’m ok with purple hair and I suspect the patients will be, too, since most of them have green hair and tattoos…in all communities.
My sister Dr. Miriam Kaufman has done just fine with purple hair. She’s an adolescent medicine specialist at the Hospital for Sick Children and tenured faculty at the University of Toronto Medical School. It’s her trademark, if you will; she gets recognized all over the city; I’ve been with her in restaurants, on the street, in stores … So be careful about “never” and “always” statements.
(She says her patients tell her the most important things are a) she listens and b) she always washes her hands.)
It’s interesting that @DrSnit noted this afternoon that she removed her lip ring when she began her clinical teaching. I followed back that her lip piercing would probably confer and advantage in peds/adolescent medicine. Our populations need to be considered in how we present ourselves.
As I concur in the second paragraph, hair color has nothing to do with one’s qualifications or capacity. Again, it’s what’s acceptable to a given patient population in a given cultural setting. As we saw with the first comment, what’s acceptable in SoHo may not fly in a small Southern community….and visa versa. One population of patients isn’t ‘right.’
If open ended acceptance of diversity is the goal, should there then be no boundaries or limits on how a medical student presents herself on rounds? And if we agree that there should be some limits, what are those limits?
To an extent, this *is* about you. Doctors do exist to serve others, but the world is increasingly coming to acknowledge that physicians are people, too. People needing more family time, more sleep, more guidance, more peer support, and perhaps even more of a chance to be themselves. As a 20-something, I wouldn’t bat an eye at a physician with a nose ring. Purple hair? All depends on the person’s overall presentation, but I can think of a few people with crazy hair colors who I would fully trust with my life.
There may be groups for whom nose rings and crazy colors fly in the face of professionalism, but there also segments of society who would sooner continue suffering than be managed by a doctor of a certain race, gender, or sexuality.
I know a physician who, after showing amazing skills, knowledge and attitude during her orthopedic surgery rotation was given a top 2% reference but told never to apply in that field – they just wouldn’t accept a woman. This was in the early 90s.
I do realize that hair color and piercings are choices, and are different from things like gender, but the end result is similar: people judging you based on inferences from your appearance rather than your skill and merit. The field of medicine has long been far too traditional, far too willing to pander to the somewhat stuck-up, conservative archetype of what a doctor should be. For this reason I embrace physicians who are ‘different;’ after all, many patients are different and could benefit from shaking their view of medicine as an intimidating world of white coats, gray slacks, and black shoes. If you’ve passed all the same tests and paid all the same dues as your colleagues, I don’t think it’s fair to demand that you fall in line and all look the same too. Is there even any evidence that professional appearance correlates to professional behavior in the medical field?
That said, there is a point that’s too far, and for this reason it is probably best for medical students to hold back so they can focus on becoming a great doctor rather than finding exactly where that point is (and dealing with the inevitable headaches and criticisms involved in that process). Consider it a part of paying your dues. Once you’re done, out, and licensed though- be yourself. Some won’t like it, but some will truly appreciate that there’s a practitioner who isn’t afraid to tip their hat to the outcast in all of us. You don’t have to look bland to engender trust, be compassionate, and build strong therapeutic relationships.
For the record, I have no tattoos or piercings and have never dyed my hair. Just believe in diversity
Yes. You raise the point that doctors are 50% of the relationship and certainly we have to be comfortable in our own skin. Honestly it all involves balanced respect.
Ultimately it is every physician’s choice to dress, speak, Tweet and act as they wish in their own clinical environment – of course at their own risk. I’m with you on residents/trainees ‘holding back’ until they’re further along with the confidence of their peers and superiors.
Excellent, thoughtful comment. Thank you, Sam.
With the supply:demand ratio being what it is these days (in most locales, anyway), I don’t think doctors express themselves “at their own risk.” Most patients don’t have the luxury of being too choosey. I’m a conformist. Hell, I’m a Navy doctor, you can’t get any more conformist than that! Yet, I applaud the expression of individualism within our profession. I don’t think we owe our patients any more than clinical competence and respect. Professionalism, sure? When it comes to behavior/demeanor. But not appearance. We shouldn’t have to sacrifice our individuality and conform to whatever society dictates a doctor should *look* like (see: medical stock photography). My two cents.
It is interesting that the necktie on a clinician is a more concerning fomite for carrying nosocomial infections from patient to patient than the nose piercing. Nasal piercings can harbor staph aureus just as frequently as the non-pierced clinician nose. A study showed patients have less confidence in the nose-pierced clinician than the neck-tied clinician. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490068/
That said, the dress code for employees in my clinic allows for piercings in ears only, no other facial piercings while at work, and that’s in a college health setting where the patients are multiply pierced and tattooed. A neck tie, a rare sight anywhere on a west coast college campus, is unnecessary window dressing in our setting, and very possibly a hazard.
Excellent point about the fomites. And just one reason I haven’t worn a tie in a couple of years.
(note to self: change profile picture in necktie)
I have a good friend and colleague who is tatted and pierced. He has better patient rapport than the suited and tied doctors. I think patients can trust him because he seems like someone they would know outside the hospital. We have enough to worry about to instill professionalism in our trainees. What color they choose to dye their hair is the least of mine.
Like everything else the choice one makes regarding personal appearance has consequences. One chooses a look, and knowingly or otherwise one has chosen a reaction. Purple hair? Nose ring? For that matter, white coat? Bow tie? We are free to choose what it is we present to our patients (and our attendings as residents), but we do not have control over their reactions and responses. Nor should we expect that. We are free to choose our presentation, but we must accept the consequences of our choice. Fewer (or more) patients, a particular patient population, a persistent rating from attendings, all result from our choices.
I have no quarrel with those who would choose a look different from mine, only with those who would seek to impose restrictions on how others perceive them BECAUSE of that look. TANSTAAFL.
A physician may have exactly what a patient needs in a given circumstance; both patient and physician need to have the opportunity to discover that. Who has the greater responsibility to remove barriers to arriving at that discovery?
Oh, by the way, Miriam doesn’t have any piercings (except conservative earrings) and no tattoos. She dresses pretty straightforwardly – flats, white coat. And the purple hair is dark-ish purple, not neon. If that makes a difference.
But as I said, the difference is that she’s a damn good doctor.
While there are certain things that should definitely be avoided, for infection control purposes, I always find myself chuckling slightly at the forced prudeness the medical community are faced with.
Professionalism is definitely a must, but hair color really shouldn’t define who is or is not a professional.
I get it, I really do. But I wish we would have the acceptance for harmless forms of self-expression that can elicit great confidence in the person.
Alas, people will always be judged for their appearances, and that goes deeper than piercings and hair color, and not for their minds.
As long as he or she is a good Provider, they can dress like Lady Gaga.
Loved the way you highlighted the idea that it’s not about you (me/us). It’s such a huge lesson, and it’s not in the textbooks. I humbly believe you captured a ton in a such a brief post- thanks!
-Aaron
It is sad to say, but appearance makes a big difference. Especially with older people in different generations, crazy hair colors, tattoos and piercings are not normal or acceptable. It is important for patients to feel comfortable and confident with medical staff, and if that means sacrificing a little freedom and personal expression I think that is okay. Most hospitals have rules and regulations on piercings and what shows too.
Liz-CoolProducts
Interesting ideas in all of these replies … Time for my own small contribution.
I think there was a time when piercings (or other body art) were so uncommon in society that a physician with a particular very visible type of ‘art’ was automatically classified as ‘crazy’, or at least ‘not mainstream’ or ‘very unconformal’ or ‘lower class’ or whatever. And that was indeed not the image the physician wanted to give, so (s)he was often asked to remove the art or rapidly came to the same conclusion him/herself.
But things are changing, and some types of body art are getting so mainstream that you are no longer a complete outsider if you have one. This includes doctors. In fact physicians reflect society, and what society likes. There are still plenty of people who would be a little puzzled when seeing a physician with some visible body art, but probably as many people would find it courageous or nice or refreshing. Once the physician gets to work, patients will appreciate who (s)he really is and what (s)he can do for the patient, and will rapidly forget about physical appearance. Within certain limits, I agree.
I’m a board certified physician myself, male, aged around 40. I have a larger septum piercing (in the nose septum) but I do not wear any jewelry in there during working hours. I also have a tongue piercing, which is not very visible. During contact with patients they will probably NOT notice my piercings. But if they do, they don’t mind (and neither do I). It did take me some time to get the courage to stop ‘hiding’ my personal interests all the time. But I haven’t regretted doing so. I work in an academic hospital and I’m quite high up the rank. There are at present NO rules or regulations in my institution. I’m definitely not the only physician with body art, but my colleagues seem to have more ‘hidden’ art (like tattoos on usually covered skin, non facial piercings, …). I’ll not get more visible art, but since things are fine at the moment I’m also not planning to do away with my art. Just for your information, I have had both piercings since the end of medical school, now 15 years ago.