Dressing up doctors

  • Health
  • Sunday, 29 Jun 2003

ALTHOUGH casual dress has become the fashion rule in many workplaces, we prefer our doctors to be dressed neatly and formally in the old-fashioned white lab coat. So says Dr Lawrence J. Brandt, a medical-school lecturer who has become a 21st-century one-man band for the return of dress codes.  

He’s just written a heavily researched commentary in a major medical journal to make his case. A few years ago, the chief of gastroenterology at Montefiore Medical Centre in the Bronx, New York, began noticing that many of the medical students attending his lectures were slouched and unkempt, wearing scruffy jeans and sneakers, toting filthy, beat-up backpacks. There was barely a pressed shirt or a tie to be seen. What a contrast to his medical school days in the late 1960s, when everyone was expected to be neat, well-groomed and professionally dressed.  

He noticed the trend among interns and residents not only at Montefiore, but at other hospitals and medical centres as well. “I have stopped people in the halls who didn’t know me and said, ‘Have you looked in a mirror recently? What would your mother think if she were approached by someone looking like you?’”  

Brandt, 59, wondered whether he was being stodgy, or whether a doctor’s appearance truly matters. After searching medical literature for studies about attitudes toward doctors’ dress, he found that patients do feel more comfortable with a doctor in the traditional white lab coat and name tag. (The exception is so-called “white-coat syndrome” in which patients’ blood pressure goes up when a medical professional approaches, but that’s linked to anxiety, not attire.) It holds true across ages, gender and geographic regions.  

Brandt’s findings are published in an article in the June 9 issue of the Archives of Internal Medicine. He noted that a doctor’s appearance was important to the father of medicine, Hippocrates, who said a physician should “be clean in person, well-dressed, and anointed with sweet smelling unguents that are beyond suspicion. For all these things are pleasing to people who are ill, and he must pay attention to this.”  

The white coat became a medical fixture in the late 19th century, when doctors began to focus on hygiene, because it kept blood and body fluids off a doctor’s street clothes.  

Today, it’s practical, with deep pockets that hold tools of the trade, including a stethoscope, reflex hammer and personal digital assistants.  

The coat has always been rich in symbolism. It confers scientific rigour and seriousness (just note how many drug ads feature a doctor in a white lab coat), along with purity. Since 1993, most medical schools in the US have conducted the “white coat ceremony”, during which medical students don the white coat they’re expected to wear during the clinical part of their training.  

Sloppy and overly informal attire “just brings the whole level of professionalism down,” Brandt said. “As goes the dress, so goes the speech and so goes the personal intercourse.”  

Brandt believes he’s the lone Montefiore doctor to impose a rigid dress code on doctors in training. “If you make the rounds with me in internal medicine, you have to dress as I believe a professional person should dress,” he said.  

A mother’s voice

A DEVELOPING foetus begins to hear at about 30 weeks, and now researchers have learned that as the delivery date approaches, a foetus begins to distinguish its mother’s voice from that of a stranger.  

Sixty Chinese women were divided into two groups, and foetal heart rates were measured before, during and after a pre-recorded two-minute poem was played through a speaker held above the mother’s abdomen.  

The heart rate increased about five beats a minute in 21 of the 30 foetuses who heard recordings of their mothers’ voices. Heart rates slowed about four beats a minute in 21 of the 30 foetuses who heard a recording of a stranger’s voice.  

“There’s some sort of representation that the foetus is matching with the sound,” says lead author Barbara S. Kisilevsky, a professor of nursing and obstetrics and gynaecology at Queen’s University in Kingston, Canada.  

This study was published in the May issue of Psychological Science.  

Starting small

MOST Americans are unaware of the signs of a mini-stroke, which dramatically increases the risk of a full-scale stroke, researchers have found, and they may delay seeking treatment as a result.  

In a random survey of 10,000 people sponsored by the US National Stroke Association, researchers found that 2.3% had been diagnosed with mini-strokes, or transient ischaemic attacks. The number may seem small but, when projected onto the general population, would produce about 4.9 million attacks each year. An additional 3.2% reported symptoms but ignored them.  

In a full-fledged ischaemic stroke, blood supply to the brain becomes blocked; in a transient ischaemic attack, or TIA, blood supply is blocked momentarily. About 11% of people with a TIA have a stroke within 90 days.  

“We’ve been telling people about the signs of strokes, but not transient ischaemic attacks. Now we need to tell them they don’t have to learn anything new – the symptoms are the same except they go away,” says Dr S. Claiborne Johnston, lead author of the survey and director of stroke services at the University of California at San Francisco. “And don’t wait until next month’s office visit to tell your doctor about it ? go to the emergency room.”  

As with a stroke, TIA symptoms occur suddenly and include numbness or weakness of the face, arm or leg, especially on one side the body; confusion, trouble speaking or understanding; trouble seeing in one or both eyes; and trouble walking, dizziness or loss of balance or coordination.  

This study was published in the May 13 issue of Neurology.  

Personality change

CONTRARY to most views of personality, the traits that characterise us are not written in stone.  

Research involving more than 130,000 adults, age 21 to 60, found that people continue to mature well into middle adulthood. After analysing responses to Internet personality tests, researchers at the University of California at Berkeley and the University of Texas in Austin found that conscientiousness changed substantially, increasing most during the 20s and then developing at a slower rate.  

Agreeableness accelerated in the late 20s, continued to increase rapidly in the 30s and then slowed in the 40s. The most dramatic changes in both traits correspond to the ages during which adults care for children.  

“There’s a lot of variability among people, but the general pattern of change in all the traits was more similar between men and women than they were different,” says Sanjay Srivastava, now a research scholar at Stanford University in Palo Alto. The study was published in the Journal of Personality and Social Psychology. – LAT-WP 

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