Over the five years that I have been writing Perspectives and/or Editorials for the Bulletin, I often have been asked by physician friends from where I get my ideas for my columns. My long medical career, that spans nearly 60 years (including medical school), has allowed me to see the many aspects of our profession. In some columns, I shared events in which I participated (gorilla barium enema1); in others, I indulged my urge to comment on things that I thought needed to be changed. And on occasion, another Editorial or Perspective will stimulate me to express my opinion(s) on the subject (Mentoring2).
Recently, ACMS Bulletin Associate Editor Anna Evans Phillips, MD, PhD, wrote an Editorial commenting on how physicians should and should not dress on the job.3 This triggered thoughts on a list of “rules” I had posted in the reading room that the MSK radiologists used. The list reminded me of John Irving’s novel (1985) and subsequent movie (1999), “Cider House Rules,” a long list of rules to be followed by the migrant workers at an apple orchard. These were the “Reading Room Rules:” No gum chewing; no aftershave, cologne, or perfume; shirt and tie for the men and professional dress for the women; and no sitting in my chair (which was a gift from a former fellow and had my name embroidered on the back). Sounds curmudgeonly, right?4 Let me explain.
Three of the Reading Room Rules dealt with professional appearances and behavior; the fourth (my chair) is strictly personal. Gum chewing is a common habit. I have always had an aversion to watching people grind their jaws, often with their mouths open. When a professional person (nurse, technologist, or physician) chews gum in front of a patient, it looks very unprofessional. In my opinion, the only difference between somebody chewing gum and a cow is the contented look on the cow’s face.
I, and many other people, have allergies to strong chemical odors, such as those emanating from perfume, cologne, aftershave lotion, or even certain deodorants. I can’t understand why some people feel the need to surround themselves with a miasma of chemical odors. Just walking through the cosmetics area of a department store will cause my nose and eyes to water, and to induce vigorous sneezing. Several years ago, my wife and I were attending a Pittsburgh Symphony concert at Heinz Hall. The woman sitting in front of us had doused herself in a strong perfume, the aroma of which set off a cascade of sneezing. The woman turned around and said, “Why don’t you go outside to do that.” I replied, “Madame, I’ll be happy to go if you come with me and wash your perfume off.” (Yes, by that time, I was in full curmudgeon mode.) Before she could respond, her husband told her, “I told you, Blanche, you’re drowning yourself in that stuff.”
I was fully indoctrinated in professional dress requirements early on in my education. My undergraduate degree, in the 1960s, was in pharmacy, and we had a dress code at the college. Men were expected to wear jacket and tie in class and swap their jacket for a white coat for our many labs. Women were to dress professionally as well. I remember that toward the end of our senior year, we were getting sloppy in our dress. During a Pharmacy Jurisprudence class with the dean, a kindly older man, he told us that for the next class, he expected to see all the gentlemen in tie and jacket. And that’s what we did – tie and jacket, and no shirt!
In medical school, the dress code was the same. As interns and residents, we wore a variety of professional smocks, short white coats, and/or lab coats. I remember one day during my internship rotation in the Emergency Room at the county hospital, I sent a medical student home to dress more professionally after he showed up wearing a plaid shirt and torn jeans, with a rope for a belt. Before I sent him off, I asked him if these were the only clothes he had. They weren’t. I guess I was a young curmudgeon even then.
And finally, regarding my chair. It’s comfortable. What more can I say? One morning, I walked into our reading room and a medical student was waiting to begin his radiology rotation. He was sitting in my chair, chewing gum, dressed in dirty scrubs and smelling like a French house of ill-repute from his very strong aftershave. (I could smell it from the corridor outside the reading room.) His back was to the wall, on which I had posted the Reading Room Rules. I slowly rotated the chair around and pointed to the Rules. The look on his face was priceless as I said, “Well, doctor, you’ve just hit a grand slam – you broke all four rules. Now please go into the bathroom, get rid of the gum and wash off the aftershave. And tomorrow, dress like my residents and me (shirt and tie).”
To be fair, in our radiology department, it was necessary for those people doing procedures to wear scrubs. Most of my partners who weren’t doing procedures wore a dress shirt with an open collar and no tie. The only other area in the department with a dress code was the Breast Center, where the radiologists had direct contact with the patients. On those days when we had to do an arthrogram or a bone biopsy, we would wear a white coat when seeing patients. Those on my service also would don a surgical gown to protect their clothing while doing the procedures.
So, yes, it sounds a little old-fashioned. However, as Dr. Evans Phillips comments in her Editorial,3 patients have an image of what they believe a physician should look like. Dressing professionally instills a sense of confidence in our patients and eases their anxiety levels. Sloppy-looking physicians will always sow doubts regarding their competence in the minds of patients regardless of their professional skills. In fairness, I must confess, I hate wearing a tie. Now that I’m retired, the only times I wear a tie are to weddings, funerals and religious services. My “working clothes” now? Jeans and a turtleneck in cold weather; shorts and a tee shirt in the summer. I do “dress up” for my medical appointments.
Dr. Daffner, associate editor of the ACMS Bulletin, is a retired radiologist who practiced at Allegheny General Hospital for more than 30 years. He is emeritus clinical professor of Radiology at Temple University School of Medicine and is the author of nine textbooks. He can be reached at firstname.lastname@example.org.
1. Daffner RH. My strangest “patient”. ACMS Bulletin April 2021, pp 99 – 100.
2. Daffner RH. Mentoring. ACMS Bulletin Dec 2019, pp 440 – 441.
3. Phillips AE. Sartorial choices. ACMS Bulletin July 2021, pp 198 -199.
4. Daffner RH. Curmudgeons. ACMS Bulletin Sep 2020, pp 271 – 274.