I would make myself head of the style police

and we would fight fiercely 

against sloppiness.

Karl Lagerfield 

It was rare for me at any time during my career to be scruffily dressed or unkempt in my appearance.

My father was on a dialysis program. He had been unwell overnight. I could not refuse to sit next to him to provide comfort. At some point I had fallen asleep. I awoke with a bang. That was when I realised that I would be late for work. I was on call for the intensive care unit. Before I left my parents house, I had contacted the ICU to explain my predicament.

There was a fifty mile commute for me. I had not had time for a shower or change my clothes to my usual standard. I arrived in the ICU wearing scruffy jeans, a tee-shirt, trainers, unkempt hair and unshaven. The consultant took one look at me and suggested that I go home and return when I was suitably attired. I could attach no blame to him. There was a sense of painful shame rattling inside me. He was spot on. I did not have the appearance of an increasingly senior doctor. I looked like a bag man.

That was first and last time I ever appeared at work dressed like that.

There were only two aftershaves I ever used. They were admired by patients. On occasions I was told how pleasant they were. I adhered closely to two of the principles set out by the father of modern medicine, Hippocrates;

A physician must have a clean appearance,

and wear good clothes, 

using a sweet smelling ungent,

which should be a totally unsuspicious perfume.

This is pleasant when visiting the sick.

Hippocrates continued about the physical well-being of doctors.

The position of a doctor must make him careful

to keep his complexion and weight 

at their correct natural standard.

Furthermore;

For most people think that those who 

fail to take care of their own physical condition 

are not really fit to take care 

of that of others  

Hippocrates

All Quotes

A survey in the United States revealed that sixty-five percent of medics were overweight. I don’t think Hippocrates would approve of their blubber considering their position in medicine.  

Since that day I have considered frequently the attire of present day doctors, in particular trainees.

Would anyone have faith in a solicitor who looked like a chimney sweep as the picture at the top of this post. Would anyone trust an accountant who looked an escapee from a steel mill?
The answer to both of those questions is a resounding no.

Why do hospitals want their staff casually dressed and sometimes poorly so. To the discerning eye it appears unprofessional. Furthermore, elderly patients are accustomed to seeing their doctors smartly dressed in a suit and tie. It cannot be good for their psychological welfare when they are confronted by someone who does not fit their image of a medicine man.

When a present day doctor turns up in the hospital cafeteria he could be anybody, even a visitor. When a manager goes for food in the cafeteria, people will assume he is a senior doctor by virtue of his smart attire. Perhaps managers want to be considered as hospital bigwigs (they do) whilst demeaning the medical staff. It often seems that the desk jockey “bigwigs” consider themselves to be more important than the frontline staff who make the real difference to people.

It takes considerable knowledge 

just to realise the extent of your own ignorance.

Thomas Sowell

White has long since been recognised as the colour of purity and innocence. In the time of Hippocrates physicians often wore white robes. Black was adopted by those carrying out human dissection. This was to show respect for the dead.

In the early nineteenth century the white coat became the standard physician’s apparel. At that time scientists wore white coats. Medicine adopted the white coat so practitioners would appear to have a scientific background which added to their hocus pocus. Until relatively recently the white coat distinguished medical staff from all others. All doctors including surgeons wore the doctors’s hallmark.

Wear the white coat dignity and pride –

it is an honour and privilege to get to 

serve the public as a physician.

Bill H. Warren 

In 2007 British hospitals shed the white coat. This was followed by a government report with a revised dress code. No white coats. No long sleeved shirts. No ties. No watches. Essentially be naked below the elbows. These ideas were based on reports that wearing any of the items above resulted in an increased of cross infection. Subsequent reports have concluded  that the change in dress code makes no difference to infection rates. From the change in dress code emerged a new empire. The department of infection control.

The empires of the future 

are empires of the mind.

Winston Churchill

One day I was I a side room in the ICU. I was wearing a bow tie, sleeves rolled up, wearing no watch. There was a plastic apron wrapped around my neck and gloves on my hands. Who should walk in? The rather large infection control nurse who had challenged me for wearing a suit and tie as a hospital employee. You may recall “Dirty Harriet” from an earlier post, overweight, huffing and puffing with perspiration down to her waist and smelly. She was accompanied by a senior “bugs” doctor. He was in a suit, tie, with cufflinks and a watch. To make matters worse he was also wearing a white coat. I momentarily looked at the nurse and saw her acute embarrassment. That was some level of hypocrisy!

Because hypocrisy stinks in the nostrils 

one is likely to rate it as a more powerful 

agent for destruction than it is.

Rebecca West

There was once alcoholic based hand wash plastic cartons outside every ward. Unfortunately the patients, alcoholics and junkies made a habit of drinking it. The handwash then had to be moved inside the ward environment.

The bugs doctor was busy rubbing his hands with the hand wash when the partner of the patient piped up, “Oh! You’ve replaced the hand bottle outside. That’s great news. I hope it is the same as the one that was there last night. That was a fine vintage, it was”

What happens if a relative walks onto a ward suited and booted? Will he be asked to remove his garments? Was the white coat dismissed as the doctor’s uniform because hospitals no longer have laundry facilities? The white coat allowed us to carry our drug prescribing bible in one pocket and the Oxford Textbook of Medicine and stethoscope in the other. The Oxford Textbook of Medicine was carried by virtually every junior doctor in the country. Now in a group of hospitals under one wing there are protocols that vary from place to place. This detracts from the learning experience and consistency. Trainees need to improve their skills. Medicine was not and should not be about sitting at a desk looking for protocols endlessly. Inevitably these doctors will have pressure sores by the time they are consultants.

One of the questions that has bothered me for several years. Every doctor comes from home wearing his own clothes. Are these not likely to become bug infested at the start of the day and worse by the end of a hard shift? The doctor may have young children, what is being passed onto them? On the way home the doctor may go to a shop, takeaway or restaurant. Is the doctor in the most hygienic state to visit any of these places?

Personally, I think to get cross infection to zero is for doctors to wander the wards naked around the wards and have a carbolic soap shower after touching each patient. What other method would or could deliver the best results?

Has it occurred to anyone to consider implementing what the patients might prefer? Most would prefer to have their doctor smartly dressed and looking professional. It provides people with confidence that they will be cared for well.

Why ask the patients, after all they pay for it from their gross income. If it was not for them the health system would not even exist.

I do believe that it was decided to remove the doctor’s uniform for reasons of subterfuge. No one knows who is and is not a doctor anymore. Of course there is the identity badge often hanging around the neck on a lanyard. Word on the street is that moves are afoot to ditch that too. The badge can then be stapled to a blouse or a shirt. Surely with time there will be enough damage caused for a hole to develop through which a boob or moob might fall through.

What flummoxed me most was that doctors have less direct contact with patients than nurses. Their uniform remains intact. albeit it has changed from clean white dresses to hideous trouser like things, sometimes known as pantaloons! Perhaps they should wander the wards in a bra and suspenders. Maybe not if Dirty Harriet arrived in such gear. She would be an individual who caused more heart attacks than recoveries. Whilst nubile young female staff might have the same effect, at least the guys would float to heaven with a smile on their face. 

Excepting doctors, I do not recollect any other healthcare professionals losing their uniform. Not nurses. Not physiotherapists. Not occupational therapists. Not radiographers. Not even infection control nurses. Not even the dear ladies in the volunteer shops!! No one!!!

I have wasted much time contemplating these matters. 

What do you think? Time for your roll of the dice!! 

Sometimes I inspire my patients;

More often they inspire me.

Unknown

Sleeping with the Gasman 

amazon.co.uk/dp/1398415278

Thank for reading this post.

Kindest regards

Jazz Pal-Kerr