Throughout my time in medical school, residency, and now as a practicing physician, I have noticed physicians’ changing face. When applying for medical school, I remember choosing a medium-grey pantsuit to match my medium-brown hair to wear for my interview, paired with a simple necklace and conservative makeup. Nothing too flashy, as even choosing grey instead of black and a pantsuit instead of a skirt would stand out and be somewhat “daring.” Throughout medical school, I remained focused on a conservatively “professional” appearance in all ways, and my ERAS photo for residency application again only took calculated daring risks: a navy jacket and burnt orange blouse. When I began my residency in internal medicine, I remained focused on being professional, both in behavior and practice as well as in physical appearance. The definition I used for “professional appearance” is now quite antiquated.
Professionalism is difficult to define, and for a physician, encompasses many domains, including our commitment to patients, to ever-expanding our knowledge and application to clinical scenarios, advocacy for patients, and managing relationships between the members of a health care team. And somehow, physical appearance was also considered part of professionalism. But to define “professional” dress/appearance is difficult. Classic and arbitrary standards would say conservative business dress, no visible tattoos or piercings, no unnatural hair colors. But why? The American population has increasingly more piercings, tattoos, and colored hair. Recent studies from IPOS and Statista suggest 30 to 40 percent of Americans have at least one tattoo, and younger generations have higher rates of tattooed people. While historically, tattoos carried with them a stigma of being associated with groups of peoples often considered “deviant,” the explosion of tattoo popularity has wildly changed that.
During my residency, I began to express myself in ways I’d always wanted. For four years, I had bright purple hair and now sport white hair. I pierced my nose and my septum and started working on tattoo sleeves on my arms. I got my first tattoo at age 18, but I always thought they’d need to be covered as a physician. But as my tattoos crept down my arms, my coworkers and leadership embraced the evolution. The policies changed, and visible tattoos are now permitted. And nothing about who I am and how I practice as a physician and now faculty member for our residency program has changed. The idea that hair color or tattoos implies that someone is unprofessional is shortsighted, as I think physicians should be free to express themselves and feel comfortable in their appearance. As I have embraced my non-traditional appearance, I’ve felt more confident and comfortable in my own skin. And, for the significant population of patients who are similarly “non-traditional,” I believe it makes them see me as more relatable.
I have had visible tattoos for nearly two years at this point, and I’ve found it’s allowed me to be more genuine at the bedside. I have yet to have a patient behave negatively to my tattoos or ask not to see me because of them, yet I’ve had countless conversations with patients about my tattoos or theirs and see them relax because of it. I have had a number of patients or their families say, “I feel like I can talk to you because you have tattoos. “ I distinctly remember a middle-aged male patient who had been very difficult with nurses, often angry and impulsive and emotionally flat. When I walked in, I noticed he had a full sleeve with beautiful black and gray tattoo art. I pushed up my sleeves when I sat down as I usually do, and his eyes tracked down from my face to my arms. I’m used to the scanning eyes; this happens whenever I meet someone new. But in him, his gruff and scared exterior quickly melted away. He and I had a great conversation. To see himself represented in a health care provider, especially a doctor, made him feel comfortable and more at ease for his hospitalization duration.
As younger generations increasingly make up the population of physicians, more of us will be inked. And I think the previously arbitrary designations of “professional appearance” are changing for the better. I look forward to seeing the faces of physicians in another decade. Professionalism to me, is about our behaviors and our practice, and I think by expressing ourselves and being true to who we are, we can only become more professional. And I am looking forward to seeing this change and evolve!
Katherine Palmisano is an internal medicine physician.
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