Abstract
Jerome L. Gelb, Noosa Heads, Queensland, Australia:
The recent article on mental health professionals' attire [1] confirms my clinical impression that patients either don't care what their psychiatrists wear or prefer a more casual look. I have struggled with this issue since my medical student days, when my friends and I would carry our short white coats over our shoulders on hot days, rather than swelter. On more than a few occasions, we were hauled over the coals by the more old-fashioned consultants and told that we had to look ‘professional’, despite the discomfort.
When I started my internship at a university teaching hospital, all the residents wore ties, which constantly got in the way, flopping in patients' faces or dangling perilously close to open wounds. I went through a period of wearing bow ties to try to avoid this problem, but I gave that up when a girlfriend told me I looked like a ‘dork’!
From that time on, I threw away the tie and came to work in smart casual attire with an open-necked shirt. I'll never forget the ridiculous situation where a senior consultant castigated me for not wearing my tie, in front of my registrar, who was dressed in worn cords, desert boots and one of those horrible, thin woollen ties. The consultant himself delighted in wearing ill-fitting, crumpled and rather cheap suits. I realised then that the issue of ‘professional attire’ was going to be a thorny one for me.
When I qualified as a psychiatrist and began my private practice, I started out wearing the obligatory dark suit and tie but quickly found that spending 10–12 h a day in such a costume was awful. I gave up my pretence of being ‘formal’ and returned to the much more comfortable smart casual attire that I preferred. My patients immediately noticed and without exception, commented on how they felt more comfortable and relaxed to see a specialist dressed ‘normally’. I was intrigued by this and asked a number of them what it was that made them feel more comfortable about my casual attire, and some suggested that it indicated to them that I wasn't trying to ‘put myself above them’. Many of my patients were disadvantaged and saw the suit and tie as a mark of wealth and privilege to which they could never aspire.
A number of my colleagues in Melbourne would make snide comments about my failure to wear a suit when they saw me attending my patients in hospital, with one actually asking me if I was ‘on holidays', despite knowing full well that I was seeing patients. It didn't seem to make much difference that I wore good quality and well put together casual clothing, my lack of a jacket and tie branded me as ‘unconventional’ or, heaven forbid, ‘unprofessional’.
When I moved to country Queensland 2 years ago, I was able to swap my casual trousers for the regulation shorts and open-necked shirt worn by many of my subtropical colleagues. Up here, I don't get the ‘tut-tutting’ comments of disapproval for my attire and patients seem relaxed and happy to come and see a doctor whose attire suits the climate and the culture. I am now in the process of splitting my clinical time between Melbourne and Noosa and find it amusing that I will have to have a separate wardrobe for each practice; maybe psychiatrists need a summer and winter uniform, like school kids? Oh! No! I can hear someone suggesting a suit!!
I often wonder whether some doctors need to create an artificial distinction between themselves and their patients by dressing formally and whether they actually come to believe in their superiority as a result. I guess it's also easier to hide behind the formality of a suit and tie, and I wonder how some of my more formal colleagues would actually cope if they dressed casually and their patients felt more equal. Perhaps it's time to recognise that ‘clothes don't maketh the shrink’.