How We Dress Matters

Once upon a time, the Chairman of Medicine (also my mentor) practically blew a gasket when he saw one of his faculty members wearing blue jeans to work on the weekend. The doctor was rounding on the hospital wards, seeing patients on a Saturday morning.

I wasn't present to witness what occurred in the moment but there were all sorts of stories floating around. What I do remember like it was yesterday was what The Chief told us residents as we gathered for Morning Report in the conference room adjacent to his office shortly after this event. His words have stuck with me forever; they are so ingrained that conscious thought about the issue comes up only when I happen to see a colleague in jeans.. In the 30 years since The Chief imparted his wisdom on the subject,  I wouldn't dream of putting on a pair of jeans and heading into work, weekend or not.


"When you dress like that [jeans], the message you send to your patient is loud and clear; you'd rather be out on the golf course or anywhere else rather than where you are right now."

I think he was/is absolutely correct. Yesterday was Sunday and I was on call, rounding in the hospital. Standing in a patient's room with three attentive and concerned family members at the beside hungry for information and a sense that their loved one was in good hands, in walked a surgeon, dressed in blue jeans.. Was it just my impression or was every word out of his mouth colored by what he had chosen to wear?

I may be old school but, in my view, jeans of any kind have no place in a hospital except on visitors. The Chief said it best.

Bravery?

I finally learned what not to say to my patient who is battling a chronic illness whether it be cancer, recurrent strokes, kidney failure on dialysis, diabetes with endless complications or anything remotely similar.

Never (ever) say: "You're so brave." in response to their hardships, struggles, and the seeming courage they show making it through each day.

Guilty of this faux pas on an embarrassingly frequent number of occasions, a light bulb finally went off in my head. Uniformly I've received the same response from my patients to my perceived encouraging and complimentary statement. I've been told nicely by some and with exasperation by others something on the order of "Brave? I had no choice in the matter." In other words, trying to pin the word brave on someone fighting for their life is likely neither reassuring nor endearing. In fact, many who've heard these words come out of my mouth probably say to themselves, "Doc just doesn't get it.".

I suppose I'll never really know how annoying my comment, however innocent, feels since I don't walk in their shoes. What I learned was to hold back on this reflexive comment and instead, listen more deeply, respond with the squeeze of my hand on theirs and say less. For this, I'm grateful.

Intermission

I want (desperately) to post on this blog. Flooded with ideas, I'm struggling to focus. What I need to do is stop thinking so much and just write. Write.

In part I'm plagued by wanting what I say to stand up to a self imposed standard. "It's got to be good", I tell myself. An overwhelming need to produce at my peak, to write my best does nothing but push me into paralysis.

"I'll write later", the voice inside says. Procrastination is alive and well in my soul.

I find myself pondering a potential post and sinking into weariness considering all the seemingly important background facts or figures or data or proper recollection that need some research;  any one of number of other details which spoil the spirit of writing.

Here's my resolution: Begin again and ignore the background noise  that wants to disrupt what could be good stuff emanating from my screen.  Hit the publish post button. Just go with the sentences longing to be free.

What's in a Name? A Lot.

Between college graduation and my first day of medical school, I changed my name. Well, not exactly my given name: Catherine, or my last name but my "for short" or nickname. That sweet little name my parents bestowed upon me and which I accepted willingly fell into the deep hole called the past when I transitioned into a new phase of my life. I figured the time was ripe for change. I  had moved from upstate New York to Texas, starting out anew, turning over a new leaf, and maybe becoming someone different when I matriculated in medical school. I introduced myself as Kate to everyone I met.

My parents and all who ever knew me before I turned 22 know me as "Kitty". To my 94 year old Dad, I'm even more than "Kitty", I'm "Kitty Kat". Sigh. It's sweet and he'll never change, nor should he. But, the name "Kitty" didn't feel right to me, nor did it seem to fit me once I reached my twenties. My family still calls me Kitty from time to time before they catch themselves. I suspect when they talk of me (I won't say about me) out of my presence I'm probably "Kitty" all over again.

My birth name, Catherine felt stately and wise but too formal. Catherine also left the door open to others shortening it to Cathy which would never work for me. Kitty wasn't a name for the long haul of life. So, Kate she became; a name that fits my skin, a name I chose for myself instead of the other way around.

I don't think my parents ever really understood why I decided to do this. My siblings and their families indulged me my independence and choice.  My husband, his family, my children, and anyone who has ever met me after I started medical school know me by the name I preferred to be called. And all that is good.

Sometime my colleagues write my name as "Cate" because Catherine is spelled with a "C". Sometimes my patients call me "Katie" or Catherine if they're feeling formal. Whatever.  More on being addressed by my first name in a professional setting by a patient later. That's an interesting issue and has definitely changed over time.

There's no more worrying about my nickname from the past except around those who knew me back in the day. These folks have license as the only ones allowed to use that name in my presence. If I ever hear it slip out of the mouths of others, I cringe (curdle may be a better word) inside and if they keep it up, they eventually learn never to go there again.

Names are important.

The White Coat

Every medical student dreams of slipping on that first short, thigh high white coat and wearing it around the hospital wards. The pockets, weighted down with medical stuff like a shiny new stethoscope, penlight, and small medical books (known as "peripheral brains") made us feel like members of the profession despite our novice status.

The medical student coat looks like this and usually has the institution's emblem sewn on to the breast pocket. We had to buy several our freshman year of medical school but weren't required to wear them continuously until our clinical years (third and fourth years). The short coat set us apart from the doctors whose coats were longer, to mid thigh. The pockets, however are the same in all these coats and what we carry in them is fairly traditional with individual variations.

Some of us were so turned on by the symbolism and perceived status of the white coat that they were worn first year whilst  dissecting cadavers.  I have to admit that I enjoyed wearing mine but thought it a tad out there and arrogant when a guy I dated liked his coat so much that he wore it into a Tex Mex restaurant on a Friday night. Oy. I thought he was pretty much of a jerk  back then and things haven't changed. I've seen him at various reunions through the years. He's just older now but still the guy who craves the center of attention no matter what. He's also a neurosurgeon.

The long white coat back in the day was the sole purview of the full fledged M.D., whether in training as a resident or the real deal. Nowadays, lab techs, Xray techs, the occasional nurse  and others wear long white coats. The change occurred gradually and no one seemed to notice or care. The part that hasn't changed is the requirement that medical students wear the short, dorky coats. A rite of passage this and one of many on the journey.

I've worn a long white coat my entire career as a physician.The stuff I carry in the pockets changed over the years. I now carry no money, less food, and the "peripheral brain" took a hike.. The stethoscope, the sole, absolutely required medical tool stores nicely in the lower right pocket. My I phone slips into the breast pocket along with pens and business cards. Lots of docs use their I phone apps as "peripheral brains" these days; amazing what you can look up in a pinch with a hand held bit of technology.

What I've noticed in the last 5 years is a movement away from doctors wearing white coats. My three male colleagues for example, rarely put on a white coat. They throw the stethoscope around their necks and off they go. I'm not sure patients expect to see the white coat anymore. Again, a gradual shift in the look happened while no one noticed or much cared.

I keep up the habit for more than the convenience of hauling around "stuff". And, if my women colleagues were truthful, they might admit to the same second big reason. What could that be you ask?

Check it out: from the back, most well fitting white coats hide the butt really well.  I shouldn't speak for all of my gender in Medicine but I suspect this is the reason you'll find the majority of female physicians wearing a white coat. I'm just saying....