The fashion doctor

" Who'd want to be a surgeon? Study for years and years, only to have to wear pyjamas to work every day!” my flatmate commented. And she's right: despite their portrayal in TV hospital dramas as outfits for seduction, scrubs are not attractive clothes. Monochrome and sack-like, scrubs are a triumph of function over form. This got me thinking: what should doctors wear? Does it matter?

Ask the infection control department of your teaching hospital what doctors should wear, and they are likely to emphasise cleanliness. Ask hospital administration and the word “cheap” will soon enter the conversation. Scrubs represent the marriage of these practical considerations: they're clean, cheap and two sizes fit most (if you pull hard enough on the drawstrings). Certainly, I don't think anyone could justify spending public health dollars on designer scrubs. Hence my surprise on discovering TC's Uniforms, a US company that markets a variety of fashion scrubs.¹

But doctors don't spend all their time wandering around in scrubs. And in many of the hospitals in which I've trained, medical staff are distinguished by the fact that they don't have a uniform. With this privilege comes the timeless fashion quandary, “What should I wear?”

Dressing like a grown-up

This is a quandary doctors initially encounter as university students. On starting clinical attachments, medical students must abandon their comfortable jeans and learn to dress like a grown-up. And not just any old grown-up: a grown up with a decent salary (a doctor). Such confusion. How to dress like a well paid adult while subsisting on a student loan, part time job, or the Bank of Mum & Dad? In an attempt to avert sartorial disaster, many medical schools provide guidelines on appropriate ward-wear. For example, the University of Glasgow medical school advises that:

“It is important… that students are groomed and dressed appropriately, in a way which will not cause offence or distress to patients…

• Dress must be tidy and presentable. This is not necessarily the same as fashionable. For example, torn or shredded jeans may be in fashion at a particular time, but they are not acceptable dress for seeing patients.
• For both female and male students, bare midriffs are not acceptable. ²
  ”
  

So much for the HipFlip. In all seriousness though, I support these guidelines. Sexually suggestive clothing is clearly inappropriate in the hospital setting, as is dirty or scruffy clothing. I've often noticed patients, particularly older folk, wearing their “Sunday best” to their outpatient appointments. Doctors should at least reciprocate this respect by wearing tidy, modest clothing.

Why not style?

But if my outfit is sufficiently neat and modest, is there any good reason why it can't be stylish? When getting dressed in the mornings, I often find myself thinking, “No one will take me seriously in this skirt. Even though it is damn cool. And appropriately below the knee.”

When faced with a well dressed doctor, I think that patients are at best surprised, and at worst, suspicious. Doctors are expected to be daggy, as if their medical knowledge should have displaced any aesthetic sense. This expectation derives from the schoolyard stereotype of the geeky smart kid. Trousers hiked up way over his shirt, he's more interested in his telescope, microscope, or history book than the colour of his shoes. And all doctors were once geeky smart kids, right? The stereotype has existed for millennia: those who use their mind for a living can be distinguished by their plain clothing, whereas those who follow fashion must be preoccupied with superficialities.³

But style does not preclude substance. Dressing well does not mean that I'm shallow. Moreover, the belief that “smart” people dress plainly and stylish people are superficial airheads smacks of precisely the type of mind-body dualism that Western medicine is trying so hard to overcome. To argue that doctors should dress plainly, lest they become distracted from their higher cerebral tasks, is to reduce doctors to disembodied minds and thus widens the chasm between patient/bodies and doctor/minds. In medical school we are taught to appreciate the “whole patient,” respecting the mind and spirit attached to the ailing body. An appreciation for fashion could help to recognise the whole doctor, with a body attached to his or her mind and examining hands. As doctors, we shouldn't have to be mind or body, rational or creative. We can be both.

Express yourself

And fashion is not only about the body: my outfit is an expression of my personality. In this way, my quandary, “What should I wear to the hospital today?” is inextricably linked to the question, “How much of my personality should be allowed into the consulting room?” This is a difficult area, as some outfits could certainly undermine the rapport between doctor and patient (imagine a cardiologist in punk leathers provoking further ischaemic events in his elderly patients, or a dermatologist in a red spotted blouse). But fashion can also add a human element to the medical consultation. An outfit that expresses my personality is an ever present reminder that I am a person working with other people, not a surgeon working with hips or a cardiologist treating murmurs.

This is art

There is a growing body of evidence that the arts, including visual arts, promote patient healing, staff morale and job satisfaction.⁴ In response to these findings, hospitals around the world are investing in paintings and introducing music therapy programmes. Surely encouraging staff to wear vibrant clothing could be a simple way of achieving the same ends? Clothing is more than a means to overcoming nakedness; it is an aesthetic experience for those around us. At best, a well assembled outfit can be a work of art. A somewhat fleeting art form, to be admired by those encountered before it's time to change back into pyjamas, but an art form nonetheless. As Freud argued, it's absurd to think that “the transience of beauty should interfere with our joy in it.”⁵I'm convinced that doctors should dress well for the same reason that there should be music played in theatre and flowers by patients' beds. Like the paintings at Peter Mac Cancer Centre in Australia that brighten my day as I walk down to radiology, a great shirt or a funky skirt adds colour to lives of patients and healthcare workers.

A dedicated follower of fashion?

Certainly, there are some worthy objections to fashion on the wards. A great outfit is often an expensive outfit, and overt displays of wealth can only further exacerbate the power imbalance inherent to the interaction between doctor and patient. Similarly, an eye catching outfit draws attention to the body beneath and therefore could accentuate the health differential between doctor and patient. Probably the most important objection is the fickle and subjective nature of fashion. After all, who's to say whether my outfit is great or not? And I'm no fashion fascist: I'm not objecting to particular labels, colour combinations, or hair styles. Rather, I'm objecting to the generic “drab doctor outfit” that many doctors wear, day in, day out. What does this achieve? A non-descript outfit does not necessarily obscure the health differential between doctor and patient. Rather, it shows that the doctor has the privilege of ignoring his or her body. Yes, the drab doctor outfit displays little personality and therefore may help foster a neutral atmosphere within the medical consultation. But it could also leave patients convinced that they're being treated by a cyborg trained to lead with open ended questions.

So should I put my favourite skirt back on its hanger? I don't think so. Perhaps my patients will wonder, “If she's putting that much thought into getting dressed in the morning, how much time is left for considering my medical treatment?” Such suspicions parallel Kaufman's one liner, “The kind of doctor I want is one who when he's not examining me is at home studying medicine.” Although I admire Kaufman's wit, I find his line of thinking disturbing. Doctors do not scurry home to study more medicine. Nor should they, or at least not every night. Doctors have a variety of interests outside of medicine, because doctors are humans. Humans with bodies as well as minds. Humans with personalities. And, for better or worse, my skirt is an expression of my personality.

1. TC's Uniforms. Products—medical. www.tcsuniforms.com/scrubs/ (accessed 25 May 2006).
2. University of Glasgow. MBChB Course Student Handbook 2004-05. www.medicine.gla.ac.uk/mbchb/MBChBHandbook2004-2005.pdf (accessed 25 May 2006).
3. Hanson K. Dressing down dressing up. From Hypatia, 5:2 (Summer 1990) (Indiana University Press, 1990) reprinted in: Korsmeyer C. Aesthetics: the big questions. Oxford: Blackwell, 1998:63.
4. Lelchuk Staricoff R. Arts in health: a review of the medical literature. Research Report 36. London: Arts Council England. 2004.
5. Freud, Sigmund. On transience. Translated by James Strachey. www.freuds-requiem.com/transience.html (accessed 25 May 2006).