Thursday, September 11, 2008

Professional Attire

Last month, our colleague Jason wrote a post on the White Coat Syndrome, discussing the drawbacks of dress on patient care. With the potential of stress that it may cause, seems like it would be advantageous to do away with the white coat. However, since first impressions and appearance plays such a huge role in interpersonal relationships, it's hard to discard such a recognizable article of distinction. One of the arguments for wearing a white coat is that it gives patients a sense of comfort and professionalism: a practitioner who takes the time to polish her/his appearance must be someone well-equipped to help them with their concerns.

Beyond the white coat, what does the "professional look" actually entail?

The general formula for a male doctor would be dress shoes, dress pants, long-sleeved button-up shirt, tie, and white lab coat. For a female doctor the rules are generally the same, though the tie is not necessary, and it's sometimes acceptable to get away with capri pants or a skirt on occasion.

As an acupuncture intern, I've found that the long sleeves of a white lab coat are sort of dangerous. Getting caught on a needle, for instance, is a threat that I'd rather not take the chance on; it can either cause my patient undue pain, or a needle-stick to myself. Brushing on patients' clothing and bodies when reaching over them is also a possibility, which is not good if a patient has anything that I can carry on myself and on to the next patient. Washing my hands all day long after touching patients puts me at a higher likelihood of getting my sleeves wet as well. It is a known fact that damp and moist environments are playgrounds for germs, fungus, and bacteria. My solution to this has been to roll up the sleeves of both my button-up shirt and my lab coat, which deals with the sleeve issue, but at times restricts my movement making it difficult to maneuver into certain positions for needling.

I leave the bottom buttons of my coat unbuttoned for the same reasons, otherwise it's almost impossible to squat or bend at the waist. Although it would be more comfortable for me, leaving my coat completely unbuttoned makes it more likely for me to drag or snag on the chairs and table, as well as brush up on patients. I imagine that if I had to wear a necktie, I would feel even more restricted. I don't wear ties in the clinic because I don't have to, but I don't understand why anyone would considering they are known vectors for bacteria.

I won't even start with dress shoes and how impractical they are for long periods of standing and treating patients.

I actually enjoy looking professional and put-together, but I wonder why that can't be done without the restrictive clothing and the long sleeves. What if we created a new-era uniform for medical professionals? Not as surgical as scrubs, but not as impractical as a business suit.

Apparently, the National Health Institute in England is thinking about the same thing. In the interest of public health and safety, they've instituted a new dress code banning ties and urging doctors to wear short sleeves. That sounds great to me, but I guess it makes a lot of people uncomfortable. There are studies that show patients do care greatly about what their doctors are wearing. But what if we just change the expectations? It seems impractical and negligent to continue a practice as superficial as focusing on attire when it jeopardizes the health and safety of both practitioner and patient.

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