Casual Fridays don’t have a place in medicine

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A disclaimer before I even get started on this post.

Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further.

I am simply writing something that has been kicking around in my head for a long time. Feelings that I have about a concept.

A concept called casual Friday.

It is fairly common nowadays in companies and facilities and services of all sizes and types to allow employees to wear more casual clothing to work on Fridays. The thinking is, of course, that it’s close to the weekend, things are winding down, people are starting to loosen up a bit, and that consumers and customers and patients won’t really care one way or the other.

I disagree.

Why?

There are several reasons.

One is that one of my major male role models in life growing up, my father, was a manager for a large textile company for most of his working life. I remember Dad wearing pressed, short-sleeved white shirts, a tie, dress slacks, and business-dressy belt, socks and shoes every time he would go to work. Including Fridays. Sometimes on Saturdays. Maybe Sundays after church if something needed checking on. My memory may have dimmed through the years (Mom, maybe if you read this you can provide a reality check for me on this point), but I never remember him going to the plant in a polo shirt or jeans or anything less than his professional “uniform.”

My dad impressed me, and impressed his work ethic upon me, because he always cared very much about how he presented himself, how he interacted with his people on the floors of the plant, and how he was a role model for the kind of dedication and hard work he expected from all his subordinate employees.

As I grew and went to school and eventually found myself in a medical school environment, it was impressed upon my very early on that one should present oneself as a doctor at all times, not just when on duty, but at the grocery store, in church, and at the football game on Friday night. Part of this was, of course, how one dressed. Somehow, and I’ve written about this before, people can tell that you’re a doctor without your saying a word. I’m still not sure exactly how that happens, but I know that clothing, in certain situations, quietly proclaims professionalism, or not. It’s part of the package, the persona, the training, the projection of who the professional is. It’s the way doctors of my generation were trained.

Also, we were trained very explicitly to observe every little thing about the patient we were bringing back to our consulting room, including their hygiene, gait, clothing, makeup, hairstyle, arm swing, and level of alertness. Would it not be very naive indeed to think that patients would not be checking us out as well? First impressions are huge, especially when you are entering into a relationship with someone who is going to be asked to tell you about everything from their drinking to their sexual abuse history to their suicide attempts.

Now, fast forward to the present. I see patients every day of the week, including Fridays in the clinics and now via telepsychiatry on some Saturdays and Sundays. Again, it may just be the way I was brought up, but I feel that every patient, no matter which day they are scheduled or how late in the day or the week it is, deserves the same attention to detail, professionalism and interaction that every other patient gets. I had fourteen patients scheduled in the clinic today, a Friday. Are they any less important to me just because I see them just before I am getting off for a weekend out of town? Of course not. Do they deserve the same presentation and professionalism from me that the Monday, Tuesday and Wednesday patients get? In my opinion, yes.

That being said, I do not feel comfortable wearing jeans or polo shirts or flannel to see these folks just because it’s Friday. Sure, I would be more relaxed and probably be more easy going, but is that the way I’m supposed to be on Friday visits with a suicidal sixteen year old or a defiant five year old and his distraught parent?

i have noticed over these last few years that when I dress professionally for the day, just as when I now wear a close-cropped beard that is more white than it used to be, that I get a lot more “yes, sirs” and “no, sirs” than I used to. A function of age and seniority? Sure. Clothing? Probably? Demeanor and confidence? Absolutely. It’s a package deal, remember?

When one does a telepsychiatry consult, all the folks on the other end of the camera see is you from the waist up, or more if you pull the camera angle back some. You could certainly were jeans or even shorts and flip flops for all that matters. Do I do that? No. Why?

Because the other part of all this for me is that when I am dressed for work, I am thinking work-related thoughts. When I am dressed in casual clothing, I’m ready to head for the beach or the football game or dinner with my relatives. It just goes together for me. Again, I think this is due to upbringing, role models, intensive training, and personal choice as my career has evolved. I have a standard uniform now, I’m comfortable in it, and when I have it on I know it’s time to see patients or run meetings or do supervision or write prescriptions or type progress notes. Anything less and I just don’t feel like the doctor is in.

So, casual Friday will most likely still be around for some time in some fashion in many of the places that we frequent.

Just don’t expect that if you come see me on Friday that I will look much different than I would look if you came to see me on Tuesday.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

Image credit: Shutterstock.com

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