Do hospitals need a formal appearance policy?

One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, suitable for asphyxia if your face gets too close, where they have languished on a wire hanger for months following their last encounter with laundry detergent.

There is some legitimately divided opinion on whether doctors should wear neckties that serve as fomites, but mine typically have an inoffensive paisley or striped pattern that either coordinates visually with everything or with nothing. I have not seen an employee sporting a tattoo with a swastika or something offensive to the Prophet Muhammad so if they exist here at all, the skin artist complied with instructions to place them in normally clothed areas.

Now the medical center could have determined that my professional image as a representative of the hospital would be enhanced if I were taller. Our city’s world famous art museum has a medieval section which most likely has a room with instruments of torture. Their rack can be borrowed to enhance height. The hospital’s quality image might also be better if I carried a more impressive pen than the Bic Crystal obtained as a 10-pack at last summer’s back to school clearance. I think I still have a Levitra pen somewhere from the days when pharmaceutical representative generosity with company assets had less restraint than now. Push the button, release the spring, and the folded over pen goes boing, releasing the business end that is gripped for writing. Probably not the image that our medical center wants to convey, though probably not expressly prohibited either. Keep that tchotchke in storage a while longer until the antique road show comes to town, maybe.

So do we and other medical institutions really need a formal policy, one composed by a representative committee, the memo said, to assure that we appear professional and competent to our patients? When John C. Molloy’s Dress for Success reached the New York Times Bestseller list in the mid-1970’s he included a chapter on optimal appearance for medical professionals, revised a little for the women’s edition that followed, and repeated verbatim in the revised edition ten or so years later.

Based on his research, restricted mostly to wardrobe, medical professionals conveyed maximum authority with a white coat and otherwise standard business attire. Remember at the time, my fellow medical students and residents included hippies and yippies. There was more of a gender divide with older men as physicians and older women as nurses while that dimorphism was rapidly disappearing among the younger physicians. He presented this sartorial advice for the purpose of economic benefit.   Peace loving but eccentric appearing flower children later gave way to more menacing appearing iconoclasts in the form of bikers with tattoos and visible weapons who seemed perfectly OK as trauma patients but as an employee, it projects an appearance that would make some patients paranoid even if assigned someplace other than the psychiatric unit.

The formality of work attire and expectations of visitors who view us has changed considerably since Dress for Success moved from the bookstores to more obscure library shelves. High-tech millionaires come to their work campuses in T-shirts, casual Friday has relaxed formality in many traditional offices, doctors wear V-neck scrub tops daily, and running shoes have become part of the standard nursing uniform. But it fails to answer the question of whether we really need an appearance code, let alone a considerable investment on the part of the hospital which had to pay employee salaries while some of them met in committee to assess and articulate the final policy.

In the years that I have been at my hospital, not a lot but enough, I cannot say I’ve encountered any staff member who struck me as memorably offensive in their appearance, though perhaps offensive in their political views and demeanor. As any school teacher can attest, the day the photographer visits to take class pictures, the number of student fights in the hall goes down. If you look dignified, you are likely to act dignified. You can still be a crook like Bernie Madoff who always presented himself as polished while swindling but the façade of a competent professional remains what people see. And in a pageant as large as the medical center with its doctors, nurses, clerks, phlebotomists,  the relative handful of people that our patients meet really does imprint their experience. So while individuals who detract from this are probably too few for me to have noticed, the head nurses in all likelihood have a more significant number of lapses of appearance and demeanor brought to their attention.

So not having a real big problem to correct but a small one to tweak, the guidelines are rather modest. If your function has an identifying uniform like navy blue scrubs for nurses, wear that. Don’t smoke in front of the hospital while you wear one of the hospital uniforms. Go easy on the cosmetics. It’s OK to look like one of the Hasidim if you are one of the Hasidim but otherwise, a beard is intended to accent a face rather than replace it. And enough people find tattoos objectionable that they should stay covered irrespective of whether the image is a pretty flower or a Rubenesque voluptuous nude. And make sure people can read your name badge or ID tag.

Clothes make the man sometimes, but usually not the doctor, who tends to be more dependent on the caliber of medical assessment and its perception of credibility. Thoroughness, undivided attention during each patient encounter and pleasantness probably matter a lot more than presence or absence of a white coat or tie, though people probably will notice mismatched socks and link it negatively to attention to detail. There are also the components of a doctor that are hidden from sight but not from awareness, things like promptness in returning phone calls, willingness to answer questions, explaining lab results in way that makes them understood. No formal policies forthcoming on those items.

Richard M. Plotzker is an endocrinologist.

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