Medical

Put Your Patients First When Choosing Clinical Attire

Dress like an intern, not a hipster, not an executive
When I was in first-year medicine I had my ears pierced and grew my hair out. I went to attend a surgery and showed up with my piercings in and my little ringlets popping out from beneath the surgical head mask. The consultant gave me a look of consternation, the same look you’d expect from your curmudgeon next-door neighbor who’s disgruntled at kids skateboarding outside his house. He said to me, “Those piercings you have there; that hair of yours; you don’t look like a med student. I’ll tell you what. If you go back to the locker room, take out those piercings, and tuck that hair into your cap, you can observe this surgery.” I acquiesced. But I hadn’t learned the lesson yet.
In second-year med, I showed up to PBL/CBL discussion with the same appearance and my skateboard. This was a casual classroom setting. Our desultory conversation at one stage became about the class photo of our school’s first med school cohort back in the 1930s – roughly 30-40 students who all wore gray suits. The consultant looked at me and said, “Yeah, that’s how things still should be. None of this skateboard, baseball cap, nonsense.” I had a good working relationship with that consultant, and he said it in good humor. But he still said it.
My sentiment during the first two years of med school was essentially, “I can be a competent and confident doctor no matter what I look like. People shouldn’t judge me superficially. If they’re going to judge me based on my appearance without knowing me, that’s their issue, not mine.” But I came to realize that the reason there’s a baseline, conservative dress code in medicine isn’t because people are uptight; it’s to prevent your patients from being uncomfortable around you because of your appearance.
If even a small percentage of your patients are uncomfortable because you don’t have the standard, professional dress, you need to take responsibility for that. You have to ask yourself: What’s more important, that I get to express my individuality the way I want even if 5% of my patients might be uncomfortable and won’t say anything, or that I present myself in accord with the profession and more of my patients are comfortable.
Medicine is a profession where we unequivocally put our patients first. It’s not about you. It’s not about me. Maybe individuality is important to me. But my patients are more important. And the feeling that I want to express myself outwardly a certain way should never take precedence over the comfort of my patients.
As a career, medicine really is conservative. Not because it’s been framed by previous generations, but because patient comfort requires it. You might be extremely competent and affable, and you might have a tiny stud in your ear. Guaranteed there’s a percentage of your patients rubbed the wrong way by it who won’t ever say anything. And it’s not just the patients. It’s also the staff. People need to work together in the healthcare setting. If another staff member sees your piercing and feels you haven’t learned basic conscientiousness yet, he or she might view you as questionable.
Having any type of appearance that deviates from the conservative propriety of the profession not only rubs a percentage of patients and staff the wrong way, it also lowers the threshold for negative judgment against you if one of your decisions isn’t stellar. There is not a single healthcare professional who isn’t going to make a less-than-stellar clinical decision at some stage. Don’t let others’ subjectivity cloud what’s objective. Don’t give other people a reason to question their trust in you. If you’ve got a tattoo on your forearm and a labret, a bad decision suddenly becomes a catastrophic one from the patient or team perspective. It’s just the nature of things. Maybe people shouldn’t base their first impressions in part off of appearances. But they do. There’s an extremely low threshold in medicine for any type of conduct or expression that presents itself as self-focused.
I knew a guy who started med school with a clean-cut appearance. By fourth-year he had dreadlocks. I heard through the grapevine that a consultant pulled him aside and said, “Mate, if you actually want people to trust you, you have to be kidding about the hair.” In medicine, an alternative appearance communicates that your expression of individuality takes precedence over the comfort of 100% of your patients (and staff). If you’re a guy, keep your hair above the ears and lose all piercings. If you’re a girl, one earring on each lobe is acceptable. If you have tattoos, cover them up.
Yes, there is also such thing as dressing too well
If the residents and registrar on your team are wearing slacks and a button-up shirt with no tie, and you rock up wearing a three-piece suit, you’ll come off self-focused and lacking conscientiousness. I learned this lesson in third-year medicine. By this time I lost the piercings and cut my hair, but I showed up every day to hospital sporting my collection of 800-dollar bespoke suits and silk ties. I received compliments on occasion, but I also raised some eyebrows. I was doing a geriatrics rotation at the end of third-year working under an intern whom I had a good working relationship with. He wore slacks and a button-up shirt with no tie. His sleeves were rolled up above his elbows, as per hospital health standards.
Toward the end of the rotation, the intern and I had a more personal conversation. He said to me, “Look, do you see our registrar? He wears a tie, which isn’t atypical for a reg. He almost never wears a jacket, and if he does, it’s because he’s got a special meeting of some kind. And have you ever seen a resident wear a tie? At our intern orientation the beginning of this year, there was a guy who showed up wearing a tie and jacket, and the impression was, ‘what’s the deal?’”
I said, “Wait, so are you saying the suit and tie rub people the wrong way?” [He scrunched his face and nodded] “Wait, seriously, so it rubs people the wrong way?” [He scrunched his face and nodded] I basically open-palmed my forehead thinking, “How could I have been so oblivious this whole time?”
Essentially I have no idea how I went through third-year medicine unaware that I was dressing too nice. It seemed ridiculous. Dress too sloppy and you’re unprofessional. Dress too nice and you rub people the wrong way. So I started dressing like interns do. Slacks. No tie. Sleeves rolled up to the elbows. This wasn’t a matter of dressing down to appease those above me, as though they have insecurities, since that would be the immature perspective. It simply required not making it about me. This yet again falls within the spectrum of dressing in accord with the profession, and working within a team means not one-upping anyone or making people question whether you’re conscientious. The rule of thumb is to dress like the intern. The ideal dress for a med student is, therefore, smart-casual.
Bear in mind this article represents my mere opinion on clinical attire and does not serve as an overarching generalization for clinical dress code. If you have any specific questions about appropriate clinical clerkship attire, the best person to discuss this with is your medical school’s rotation coordinator.

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Dr. Michael D Mehlman lives in Osaka, Japan and is an Australian medical graduate. During medical school, he was an author and editor for First Aid for the USMLE Step 1, USMLE Rx Step 1 Qmax, and First Aid Express. He is director of USMLE services at Residents Medical Group. His current passions are... Dr. Michael D Mehlman lives in Osaka, Japan and is an Australian medical graduate. During medical school, he was an author and editor for First Aid fo...