What clothing choice says about a patient

asco-logo The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was perfect, not a strand out of place. I felt positively under-dressed in my black pants and loose black jersey top—with flat shoes as always.

As we settled into our chairs in my office, I asked if she was going back to work after our appointment.

“Oh, no!” she explained with a smile on her face, “I’m off work for the rest of the year. I just like to dress up for all my appointments.”

She must have registered my facial expression as one of amazement, which it was.

“You dress like this for all your appointments?”

She went on to explain that when she was diagnosed with cancer and was facing many months of chemotherapy and radiation, she decided that she was going to “dress up” for all her appointments. She went on to tell me that she had made a conscious decision that she was not going to wear sweatpants or other “leisure” wear.

“When I was having chemo, I looked around the waiting room and saw how other patients were dressed,” she continued, “and this confirmed for me that I needed to take care of my appearance, no matter how bad I was feeling.”

I thought about how some of my patients dress for their appointments. For the most part, it is easy to tell the difference between those who are retired (jeans and sweatshirts) and those who have attended their appointment in the middle of a workday (suits for men and office attire for women). Most of the women I see who are having radiation therapy for anal or rectal cancer wear loose fitting clothing, and some have admitted that they are going “commando” under their skirt or dress because wearing underwear is just too painful. I have had discussions with these patients while both of us are standing in my office; it feels odd to be sitting when the patient is too uncomfortable to do so.

The well-dressed patient and I talked about this a bit more.  She never said as much, but there was some judgment, perhaps unintentional, in her views of those who attend appointments dressed in sweatpants. Some of my patients are less than “well dressed.” They wear clothes that could do with a trip through the washer or even some spot cleaning. Many have pet hairs clinging to their sleeves or food stains down the front of their clothes. Others have a strong body odor that precedes them into my office, and I have to admit that there are times that I wish I did not have to close the door for our encounter. As I’ve reflected before, our patients may have challenges in their personal life that impact how they come to us for care, and they deserve our compassion, not our judgment.

Some of the men that I see for counseling after treatment for prostate cancer are incontinent, and this poses a unique challenge. Do I mention this and if yes, how can I do it without shaming them? I mostly encounter this in men who do not have a partner. I would hope that a partner would say or do something if they noticed the odor, or perhaps help ensure that he washes his clothing on a regular basis. I am of course aware that not everyone has easy access to laundry facilities or the money to wash their clothing regularly. So I try not to judge … but I do ask them about their incontinence and refer them for pelvic floor physiotherapy.

After my meeting with the well-dressed woman, I thought about her attitude. Her statement about taking care of herself made an impression on me. What she was saying could be interpreted to mean that she did not want to play the “patient” role, that she wanted to be seen as someone who had not relinquished how she wanted to be perceived despite the challenges of treatment. She did not mention the word, but the concept of dignity certainly occurred to me as I thought about her. Her outward appearance was to me a manifestation of how she wanted to be perceived as a woman first and patient second. That is part of dignity and many patients tell us that treatment for cancer (or many other illnesses as well) robs them of their dignity. So much of what happens to patients in our care is undignified.

Perhaps this woman did not think of her clothing choice as related to dignity, but it certainly made an impression on me. I felt respected by her decision to look her very best for her appointment with me. I am pretty sure that this was not a conscious decision on her part, but it made a difference to my day.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

Image credit: Shutterstock.com

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