I liked the first doc's comment. What does this have to do with medical care?
I moved from San Francisco where I did my residency and then worked in a county clinic for 10 years back home to PA in 1979. I wore a suit and tie every day, for a few years, then dressed down to a sport coat and tie for a bunch of years, then started to skip the tie, then finally ended up with a long white coat and no tie. It was all based on, in the beginning, the image I felt I had to present, social custom through the years and in the end my comfort and convenience.
I gave the same level of medical care throughout. I hardly ever got any comments about my appearance. I'm sure some may have had some opinions about it but after getting established I always had as many patients as I could handle.
Doctors wear their particular garb for different reasons. I tell my patients and family I went into emergency medicine so I could wear my pajamas to work. I have never been impressed by suits and ties. In fact, studies have shown that ties are a major vector of disease. But we should never put down a colleague who wants to show up in a suit. Who cares? I'm not impressed. I have never been criticized for wearing scrubs to work, treating over 130,000 emergency patients. "Doc! I dont thinks you should be treating me because you came to work in your pajamas"
wish i could comment. i would say that i am either a doctor's worst nightmare or someone that they very much look forward to seeing. I need to know things and if they ask, I will tell them anything they want to know about procedures I get from other specialists. I'm advocating and getting them to work together. It IS happening!
I believe it all comes down to respect, rightly so, wrongfully so, or indifferent. If we don't respect who we are, where we are, and what we want to accomplish, why should anyone else?
How hard is it to distance yourself in this new wave of disrespect? The 'people' who arrive in the ER with a gun and begin showering bullets everywhere. The 'people' who are in for a psych eval and get up pummeling an ED staff member causing lifelong debilities. What about healthcare workers who are so tired because of long shifts, no help, and innocently make a medication error to then bed stripped of their uniform, license, dreams, livelihood?
Fragile egos. I'm all that and a bag of chips. I'll just get my lawyer, HR, DOL, you'll see.
Mandatories: M&M, Peer Reviews, Quality Improvement, the organ recipient discussions, ....
How about - How to act in conflict situation? How to de escalate a violent person's rage? How to be a mirror for frustrated, angry, hurting patients? And so on....
Things have become homogeneous. All staff on each hospital floor wears navy blue. Who do I ask? Who do I listen to? Ok, the guy in scrubs must be a nurse. The gal with a scrub hat must be an anesthesiologist. The guy in a white coat is surely a doctor. Why are some why coats short, medium and long? Being here, sick as I am, I wish I had a game roster.
We, the healthcare workers who are in the trenches with a good bit of knowledge of what's happening in the world, the country, the city, the hospital can barely contain our frustrations and disappointments in healthcare. How in the world are we to expect patient 11085-9 female room 210, cholecystitis, patient 44239-0 male room 111, HIV & AIDS, cachectic and dying, and finally the 98 people in the ER waiting room because they have no insurance because they work 80 hours per week at minimum wage and have nowhere else to go for help understand the fragility of our healthcare system and the doctor in a Brioni $22,000 suit and the $12,000 Tom Ford Custom Oxfords and the $345 Jose Balli gilded pocket square?
For me, it was such a privilege to engage patients and parents (I was a pediatric specialist) for nearly 50 years. When I taught medical students how to take histories and physical exams, I tried to alert them to the mere fact that they were playing the role of a physician, an actual caregiver, patients and mothers on the in-patient service naturally exposed themselves willingly for the sake of their education. They sometimes shared nuggets of information and actual secrets that they had not told anyone else. Amazing! I wonder how many of them appreciated the awesome magic and privilege of the role that they were preparing to take full-time.
As a med student, part of my disillusionment with medicine is the disrespectful attitude to patients... They're not in bed for ward rounds? Discharge them... That cholecystitis can't be that bad if they've gone out for a smoke... And it's hard to see that I can have any impact as a junior given my senior's attitudes
I am a retired pediatric pulmonologist and my mother died of COPD. Thus, I naturally became a strong critic of the tobacco industry and tended to look down on smokers. However, Heather, you have much to learn. Tobacco addiction is a real medical disorder and requires understanding and sympathy as essential aspects of the treatment. I wish that I had a chance to share with you my sense of privilege for being a physician.
I am shocked by those comments. Wow. As humans, we all struggle with self awareness. But to see it so transparently like that... sometimes I am reminded of how so much progress has yet to be made with such existing attitudes.
Lisa Rosenbaum once wrote a piece that was powerful to me about tweets of gratitude.... Back in the Twitter days. She was reflecting on a tweet by an OHSU EM doctor, Esther Choo, who noted that a patient, whose life she saved, contacted her every year to thank her. Esther encouraged others to tweet gratitude, too and some beautiful tweets emerged.
We are supposed to be evidence based, right? There is strong evidence that how we dress influences how patients perceive us. That's why we wear white coats, hopefull CLEAN white coats. Also we should NOT wear ties as they have been shown to be an infection control risk. Like a contaminated stethoscope (which should disinfected after each use), a tie picks up the microbial flora from one patient and spreads it to the next. Finally, to all the idiots who were scrubs outside the hospital, STOP it. You are bringing all kinds of microbes in with you. No one is impressed at the airport or at Starbucks when they see someone with scrubs on that scream "i am a doctor". It should say, I am a FOMITE.
That truth, which was not yet in the medical literature, is one of the reasons that I wore a bowtie my entire career for decades after I abandoned my white coat. I was a pediatric pulmonologist. I wore an identifying badge and had a stethoscope somewhere on my person. I agree with you about the huge numbers of individuals who take hospital scrubs home and wear them on their return to work. Hospital leaders NEVER enforced their recommendations against this practice.
I certainly tried but Infection Control is like a bed pan. We are stuffed under the bed when you dont need us. But when you do its usually urgent. Nobody listens to Infection Control until every patient in med surg has C diff or apergillus is found in the transplant unit. Then we get called stat.
“I am a fomite!” Hilarious. I worked in a building on Hospital Row in Toronto. There was a Tim Hortons coffee shop on the first floor and one day I saw a group of 3 or 4 people in full surgical scrubs sitting at one of the tables. They did not look you enough to be learners. I thought, “I’m never sitting at one of these tables again.”
Was there any blood or body fluids on their scrubs or their clogs? As the former IG of the Pus Patrol and antibiotic police I would have immediately summoned reinforcements, all wearing PPE, to take down this colony of fomites on the spot, right there in the coffee shop, and culture them up! Nasal swabs, throat swabs, rectal swabs, urethral swabs, ripped off their scrubs and put them immediately into HAZMAT containers and drag them into a chlorhexadine shower.
How much would you bet that the doctor described in that comment said during his medical school and residency interviews that he was not pursuing medicine for financial reasons but to help humanity and do medical missions in the third world?
In my Kaiser GI clinic I wore a shirt and tie and jacket, assuming that that outfit projected respect more than did the scrubs that some of my colleagues wore. Better to treat the charwoman like a queen than the queen like a charwoman was my impetus. It did lead to an interest in ties and quite a collection (especially the Jerry Garcia ones!).
Thank you for sharing this - I wish you were my doctor! I so appreciate your views on what’s happening in the field of medicine & how it needs to improve from both doctors & patients.
God bless you in your efforts be the best doctor you can be!
Back in the day when I was raising my children, I was often in awe of and intimidated by physicians. They were mostly the age of my father or even grandfather. Everything they had was much nicer and "shinier"than anything I had.
Fast forward to now as an 81 year old healthy female who has seen classmates become doctors or children of those men / women go into the profession, I may have changed your diaper or tutored you in some subject you can bet I will bring it up when we meet. The fact that you wear a thousand dollar suit does not matter. I just want you to fix whatever is wrong, make eye contact when talking to me, and don't try to fool someone who knew you when. I don't want to be your friend, I want you to respect me as a patient and fix, or not, the problem.
It saddens me when the zero-sum, Foucauldian, everything-boils-down-to-power-dynamics worldview infiltrates, and dare I say, desecrates medicine and the intimacy of the doctor-patient relationship.
It reminds me of one of the saddest “educational” sessions I was subjected to during my residency. The whole thing was about “microaggressions” and “white/male etc privilege” - so far, so unsurprising. I was prepared to just let it wash over me, like so much else in this genre. But to my great dismay, the majority of the session and the the scenarios used as discussion prompts were about interactions between doctors and patients - and the patients were almost invariably cast as the “oppressors” or “aggressors”! I was appalled. I tried to push back: “everyone in this room… what’s our average income going to be? $300k? And that of our patients? $60-70k? And how much power do we hold in making literally life-or-death decisions with these people? Is it really right to focus on how we need to be afraid, protect ourselves from patients? Can we really see ourselves as victims in this scenario??”. As far as I know, it fell on deaf ears. It was profoundly disheartening. Almost more than any other experience I’ve had, this soured me on the “woke” worldview.
Thank you for all your thought-provoking posts, Dr. Cifu. Always appreciated. 🙏
I liked the first doc's comment. What does this have to do with medical care?
I moved from San Francisco where I did my residency and then worked in a county clinic for 10 years back home to PA in 1979. I wore a suit and tie every day, for a few years, then dressed down to a sport coat and tie for a bunch of years, then started to skip the tie, then finally ended up with a long white coat and no tie. It was all based on, in the beginning, the image I felt I had to present, social custom through the years and in the end my comfort and convenience.
I gave the same level of medical care throughout. I hardly ever got any comments about my appearance. I'm sure some may have had some opinions about it but after getting established I always had as many patients as I could handle.
Doctors wear their particular garb for different reasons. I tell my patients and family I went into emergency medicine so I could wear my pajamas to work. I have never been impressed by suits and ties. In fact, studies have shown that ties are a major vector of disease. But we should never put down a colleague who wants to show up in a suit. Who cares? I'm not impressed. I have never been criticized for wearing scrubs to work, treating over 130,000 emergency patients. "Doc! I dont thinks you should be treating me because you came to work in your pajamas"
wish i could comment. i would say that i am either a doctor's worst nightmare or someone that they very much look forward to seeing. I need to know things and if they ask, I will tell them anything they want to know about procedures I get from other specialists. I'm advocating and getting them to work together. It IS happening!
I believe it all comes down to respect, rightly so, wrongfully so, or indifferent. If we don't respect who we are, where we are, and what we want to accomplish, why should anyone else?
How hard is it to distance yourself in this new wave of disrespect? The 'people' who arrive in the ER with a gun and begin showering bullets everywhere. The 'people' who are in for a psych eval and get up pummeling an ED staff member causing lifelong debilities. What about healthcare workers who are so tired because of long shifts, no help, and innocently make a medication error to then bed stripped of their uniform, license, dreams, livelihood?
Fragile egos. I'm all that and a bag of chips. I'll just get my lawyer, HR, DOL, you'll see.
Mandatories: M&M, Peer Reviews, Quality Improvement, the organ recipient discussions, ....
How about - How to act in conflict situation? How to de escalate a violent person's rage? How to be a mirror for frustrated, angry, hurting patients? And so on....
Things have become homogeneous. All staff on each hospital floor wears navy blue. Who do I ask? Who do I listen to? Ok, the guy in scrubs must be a nurse. The gal with a scrub hat must be an anesthesiologist. The guy in a white coat is surely a doctor. Why are some why coats short, medium and long? Being here, sick as I am, I wish I had a game roster.
We, the healthcare workers who are in the trenches with a good bit of knowledge of what's happening in the world, the country, the city, the hospital can barely contain our frustrations and disappointments in healthcare. How in the world are we to expect patient 11085-9 female room 210, cholecystitis, patient 44239-0 male room 111, HIV & AIDS, cachectic and dying, and finally the 98 people in the ER waiting room because they have no insurance because they work 80 hours per week at minimum wage and have nowhere else to go for help understand the fragility of our healthcare system and the doctor in a Brioni $22,000 suit and the $12,000 Tom Ford Custom Oxfords and the $345 Jose Balli gilded pocket square?
For me, it was such a privilege to engage patients and parents (I was a pediatric specialist) for nearly 50 years. When I taught medical students how to take histories and physical exams, I tried to alert them to the mere fact that they were playing the role of a physician, an actual caregiver, patients and mothers on the in-patient service naturally exposed themselves willingly for the sake of their education. They sometimes shared nuggets of information and actual secrets that they had not told anyone else. Amazing! I wonder how many of them appreciated the awesome magic and privilege of the role that they were preparing to take full-time.
Interesting; the only thing I wondered was if the person was at Mayo, where that is a dress code (or used to be).
As a med student, part of my disillusionment with medicine is the disrespectful attitude to patients... They're not in bed for ward rounds? Discharge them... That cholecystitis can't be that bad if they've gone out for a smoke... And it's hard to see that I can have any impact as a junior given my senior's attitudes
I am a retired pediatric pulmonologist and my mother died of COPD. Thus, I naturally became a strong critic of the tobacco industry and tended to look down on smokers. However, Heather, you have much to learn. Tobacco addiction is a real medical disorder and requires understanding and sympathy as essential aspects of the treatment. I wish that I had a chance to share with you my sense of privilege for being a physician.
I am shocked by those comments. Wow. As humans, we all struggle with self awareness. But to see it so transparently like that... sometimes I am reminded of how so much progress has yet to be made with such existing attitudes.
Lisa Rosenbaum once wrote a piece that was powerful to me about tweets of gratitude.... Back in the Twitter days. She was reflecting on a tweet by an OHSU EM doctor, Esther Choo, who noted that a patient, whose life she saved, contacted her every year to thank her. Esther encouraged others to tweet gratitude, too and some beautiful tweets emerged.
We are supposed to be evidence based, right? There is strong evidence that how we dress influences how patients perceive us. That's why we wear white coats, hopefull CLEAN white coats. Also we should NOT wear ties as they have been shown to be an infection control risk. Like a contaminated stethoscope (which should disinfected after each use), a tie picks up the microbial flora from one patient and spreads it to the next. Finally, to all the idiots who were scrubs outside the hospital, STOP it. You are bringing all kinds of microbes in with you. No one is impressed at the airport or at Starbucks when they see someone with scrubs on that scream "i am a doctor". It should say, I am a FOMITE.
That truth, which was not yet in the medical literature, is one of the reasons that I wore a bowtie my entire career for decades after I abandoned my white coat. I was a pediatric pulmonologist. I wore an identifying badge and had a stethoscope somewhere on my person. I agree with you about the huge numbers of individuals who take hospital scrubs home and wear them on their return to work. Hospital leaders NEVER enforced their recommendations against this practice.
I certainly tried but Infection Control is like a bed pan. We are stuffed under the bed when you dont need us. But when you do its usually urgent. Nobody listens to Infection Control until every patient in med surg has C diff or apergillus is found in the transplant unit. Then we get called stat.
“I am a fomite!” Hilarious. I worked in a building on Hospital Row in Toronto. There was a Tim Hortons coffee shop on the first floor and one day I saw a group of 3 or 4 people in full surgical scrubs sitting at one of the tables. They did not look you enough to be learners. I thought, “I’m never sitting at one of these tables again.”
Was there any blood or body fluids on their scrubs or their clogs? As the former IG of the Pus Patrol and antibiotic police I would have immediately summoned reinforcements, all wearing PPE, to take down this colony of fomites on the spot, right there in the coffee shop, and culture them up! Nasal swabs, throat swabs, rectal swabs, urethral swabs, ripped off their scrubs and put them immediately into HAZMAT containers and drag them into a chlorhexadine shower.
Pus Patrol to the rescue.
Oh, that would have been beautiful! I didn't want to get close enough to look!
I've got one coming on the whole white coat and tie infection issue. It's a good one...
How much would you bet that the doctor described in that comment said during his medical school and residency interviews that he was not pursuing medicine for financial reasons but to help humanity and do medical missions in the third world?
In my Kaiser GI clinic I wore a shirt and tie and jacket, assuming that that outfit projected respect more than did the scrubs that some of my colleagues wore. Better to treat the charwoman like a queen than the queen like a charwoman was my impetus. It did lead to an interest in ties and quite a collection (especially the Jerry Garcia ones!).
Thank you for sharing this - I wish you were my doctor! I so appreciate your views on what’s happening in the field of medicine & how it needs to improve from both doctors & patients.
God bless you in your efforts be the best doctor you can be!
Back in the day when I was raising my children, I was often in awe of and intimidated by physicians. They were mostly the age of my father or even grandfather. Everything they had was much nicer and "shinier"than anything I had.
Fast forward to now as an 81 year old healthy female who has seen classmates become doctors or children of those men / women go into the profession, I may have changed your diaper or tutored you in some subject you can bet I will bring it up when we meet. The fact that you wear a thousand dollar suit does not matter. I just want you to fix whatever is wrong, make eye contact when talking to me, and don't try to fool someone who knew you when. I don't want to be your friend, I want you to respect me as a patient and fix, or not, the problem.
This piece was excellent.
It saddens me when the zero-sum, Foucauldian, everything-boils-down-to-power-dynamics worldview infiltrates, and dare I say, desecrates medicine and the intimacy of the doctor-patient relationship.
It reminds me of one of the saddest “educational” sessions I was subjected to during my residency. The whole thing was about “microaggressions” and “white/male etc privilege” - so far, so unsurprising. I was prepared to just let it wash over me, like so much else in this genre. But to my great dismay, the majority of the session and the the scenarios used as discussion prompts were about interactions between doctors and patients - and the patients were almost invariably cast as the “oppressors” or “aggressors”! I was appalled. I tried to push back: “everyone in this room… what’s our average income going to be? $300k? And that of our patients? $60-70k? And how much power do we hold in making literally life-or-death decisions with these people? Is it really right to focus on how we need to be afraid, protect ourselves from patients? Can we really see ourselves as victims in this scenario??”. As far as I know, it fell on deaf ears. It was profoundly disheartening. Almost more than any other experience I’ve had, this soured me on the “woke” worldview.
Sounds like a deeply strange session.