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In the News, Medicine and Society

The medical community and complicity: Our role in the Eric Garner case

The medical community and complicity: Our role in the Eric Garner case

die-in photo2Last week, more than one hundred Stanford graduate and medical students gathered to commemorate Martin Luther King, Jr. Day and remember the lives of Mike Brown and Eric Garner. On a white board that proclaimed “Black Lives Matter,” attendees wrote their thoughts. On the board, I wrote “Keep the conversation going,” and as part of that effort I’d like to examine one instance where the practice of medicine is deeply entwined, for good and bad, in the movement for equality.

Over the past several months, the role of racial bias in policing practices and the judicial system has been the subject of extensive discussion and protest, but what hasn’t been adequately discussed is the lesson in this for medical professionals. A catalyzing event for our national discussion has been the video footage of police use of a chokehold and its role in the death of Garner. However, there is a second video from the same incident that warrants scrutiny, particularly from the medical community.

The second video follows the minutes after Garner’s death. After prolonged moments of police prodding and the encouraging of his motionless handcuffed body to cooperate, emergency medical services arrive on the scene. In gloved hands and comforting voices, they appear to very briefly check for a pulse and then encourage Garner, unconscious, to cooperate with getting onto a stretcher.

In the background an observer asks why Garner is not receiving CPR, and a police officer replies, “He’s still breathing.” Given the video, it’s unclear whether or not Garner was actually breathing. What is clear is that progressing from a witnessed loss of consciousness, he eventually entered respiratory arrest followed by cardiac arrest in the presence of multiple medical and police personnel trained in CPR. To perform CPR in such an instance is standard of care and may have saved his life, but basic life support was not performed. Why? And I wonder: Would CPR have been administered if Garner had been white?

There were likely a complex mixture of assumptions, prejudices, and biases that led these health-care workers to not act to save Garner. There is no evidence of overt malice, but race, socio-economics, and deference to the authority of the police all likely played a role in influencing the medics’ actions, or lack of action. As they arrived on the scene, did the medics believe that CPR would just delay the inevitable? Were they worried of offending the authority of the police and exposing the police’s failure to initiate CPR? As medical professionals, we must learn from this incident and begin to recognize and dismantle our own prejudices and biases, wherever we may find them.

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In the News, Medicine and Society, Parenting, Pediatrics, Pregnancy, Stanford News

Grandparents update their baby skills at children’s hospital

Grandparents update their baby skills at children's hospital

2057241787_0f89a0276f_zThe past century has been flooded with trends and new information surrounding pregnancy, birth, and infant care. From doctors Spock, Lamaze, and Bradley in the ’50s, to the promotion of new technologies such as epidural anesthesia and formula feeding in the ’60s, through various iterations of the natural birth movement in the 70’s and 80’s… From the licensing of non-hospital midwives in the 90’s, to the boom in doulas in the 2000s, through the proliferation of maternity apps in this decade, the “right way” to bring a baby into the world has evolved.

To get grandparents updated on their baby knowledge, Lucile Packard Children’s Hospital sponsors a “Grandparents’ Seminar” as part of its course offerings. As a recent San Francisco Chronicle article notes,”Hospitals commonly offer classes in labor, lactation and baby CPR. But adding grandparents to the mix is a modern twist. It used to be that grandparents didn’t go to classes for advice. They dispensed it.”

The two-hour course covers infant safety, sleep, and feeding. Though most of the class participants were conscientious and up-to-date when they were raising their own children, some accepted practices have changed – babies are now swaddled tightly like burritos, laid to sleep on their backs without pillows, and exclusively breastfed when possible. Umbilical cords are cleaned with water instead of alcohol, the specifications for car seats have changed dramatically, and there is a potentially overwhelming array of new products on the market. Medical communities are increasingly becoming aware of perinatal mood disorders, and informing patients about practices that were once “fringe” – like co-sleeping and intervention-free birth.

The course also touches on the complex emotional issues that come with becoming a grandparent, and offers advice on etiquette – which the course instructor, Marilyn Swarts, a labor and deliver nurse and nurse manager quoted in by the Chronicle, sums up with “Seal your lips.” Parents want their parents involved with the baby, but they also want autonomy and to incorporate modern care practices. Indeed, many people who take the course learned about it through their children.

Swarts has been teaching the course for the nearly ten years it has been offered. In a 2009 interview with a grandparenting blog, she said:

It’s so hard because we’re still in the parent mode and just want to help our children, but they must learn for themselves. Better to ask them: What do you think would be a good solution? I want grandparents to empower the new parents, help them believe they’re the best parents for their child and make them feel comfortable and confident in their new roles.

Related: Classroom catch-up for expectant grandparents
Photo by surlygirl

Chronic Disease, Medicine and Society, Mental Health

Boldly Me: Bay Area non-profit helps build self esteem in those who feel different

Alanna headshot

Alanna Powell

Boldly Me is the dream-come-true of founder Alanna Powell, who was diagnosed with Alopecia Universalis as a toddler and consequently spent the majority of her life completely bald. Powell has built upon her own experience with shaky self-confidence and self-doubt to support and inspire those who “feel different.”

I recently had the chance to talk with Powell, who founded the Fremont, CA-based organization in 2009. Boldly Me programming, which aims to improve the psychological health and self-esteem of both kids and adults, takes place around the Bay Area: The Fremont Unified School District has widely adopted it, and Powell reports that Stanford physician Joyce Teng, PhD, MD, is advocating for it to reach Palo Alto schools.

Boldly Me offers a variety of classes and assembly presentations teaching self-compassion and communication, starting with one called “Me and my thoughts.” Programming also includes activities like hula dancing, baton twirling, and arts and crafts, and community events showcase the kids’ talents and celebrate individuality. The company bases its approach on cognitive and dialectical behavioral therapy, and it has volunteer psychologists and doctors on its advisory board.

image

Kids dance hula at a Boldly Me event

While the core of the program is creating personal compassion and self esteem to enable internal resistance to external reactions, it also approaches the problem from the outside by educating peers and parents. However, Powell says that programming directed at parents is often met with defensiveness, so Boldly Me starts with the kids by teaching them how to communicate problems to parents. Once the parents receive this information, they are receptive to suggestions.

Powell’s personal story was initially a big part of the programming; participants found it inspiring. When I spoke with her, she shared how her parents, with the best of intentions, were overprotective and encouraged her to always wear a wig in company. Her self-consciousness limited her in school, and as a young woman she was afraid to get married and have kids because she worried that a bald woman was unlovable. Her now-husband inspired her by saying that if she was afraid of her wig falling off, she should just “go bald!” She began to do things she never thought she would, such as river rafting and roller coasters. But the process of self-confidence is gradual – she wore her wig during labor, nervous to meet her new baby. Now her kids – ages 13, 11, and 9 – talk about their “cool bald mom!”

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Medicine and Society, Mental Health, Stanford News

Helping those in academic medicine to both “work and live well”

Helping those in academic medicine to both "work and live well"

stethoscope with blue backgroundOne of the perks of working for a university is that I get, like a regular ol’ student, a nice long winter break. I was off work for more than two weeks in late December and early January, and I used the time wisely (if I do say so myself) – by working out a lot, playing lots of games and doing lots of crafts with my young daughters, cleaning out my ridiculously packed garage, and even settling down with a 278-page book I had found the time to check out from my local library. The title (a rather ironic one given that I felt, during those glorious days off, as if I had all the time in the world)? Overwhelmed: Work, Love, and Play When No One Has the Time.

The book was penned by journalist Brigid Schulte and published last March, and I quite enjoyed reading Schulte’s take on, and the science behind, the work-life demands of hard-working professionals (especially ones with kids) and “our addiction to the daily grind.” And while many of her stories – like how she once stopped doing housework in favor of eating soup and watching the rain with her kids – resonated with me personally (ah, the importance of slowing down and savoring life’s little pleasures!), I was also happy to see a shout-out to my place of work.

In a section on workplaces that have been remade to help their employees both “work and live well,” Schulte described how Stanford’s medical school is:

seeking to ‘rewire’ [the beliefs that success in academic medicine only comes from working 24/7] by changing the narrative of success. They have ambitious plans to remake their culture, to provide career counseling and multiple paths to success at various speeds. And they’re starting by showcasing a different kind of role model, in prominent displays along corridors and on the university website, focusing on those who have achieved excellence at work and have a rich life outside of it.

Schulte briefly discussed the work of Hannah Valantine, MD, former senior associate dean for leadership and diversity and now the first chief officer for scientific workforce diversity at NIH, who alongside Stanford colleagues had been working to change the workplace culture in academic medicine. Valantine and pediatrician Christy Sandborg, MD, co-created a pilot program called Academic Biomedical Career Customization (ABCC) in an effort to help faculty achieve balance; the program, which ran from 2012-14 and is described in an excellent 2013 article from the Clayman Institute for Gender Research, encouraged “faculty to address work-life issues by varying their workloads and responsibilities over the course of their careers” and included “a ‘time banking’ system, where faculty earn credits they can cash in for help with certain tasks at work or at home.”

Schulte quoted Valantine as saying, “We decided to include the housework benefits, because when [molecular biologist] Carol Greider got the news that she’d won the Nobel Prize in Medicine, she was doing the laundry.”

While grant funding for the ABCC program ended last year, folks at the Office of Faculty Development and Diversity told me that Stanford is applying the lessons and successes of the program into new work-life and work-flexibility initiatives throughout the School of Medicine.

Previously: Program for residents reflects “massive change” in surgeon mentality, NIH selects Hannah Valantine as first chief officer for scientific workforce diversity, Amplifying the physician-mother voice and Hannah Valantine: Leading the way in diversifying medicine
Photo by Michael Tam

Aging, Medicine and Society, Podcasts

Living loooooooonger: A conversation on longevity

Living loooooooonger: A conversation on longevity

Hourglass

As I age, I’m becoming more and more interested in how I can prolong a healthy life. I hope I have a long life but more importantly, I want a healthy one.  I’ve witnessed the other side. My father died in his late 80s; his final years ravaged by Parkinson’s. He was infantile and had bolts of anger and confusion. It wasn’t pretty. In her early 90s, my mother had a stroke. She passed away from heart complications after being aphasic for nearly a year. This 30-plus year English teacher lost all ability to converse in the final year of her life; she was reduced to incoherency. As I held their hands or fed them, I kept on telling myself, not me. This is NOT how I want to live my final days.

In recent years, aging research has been turned upside down. As Stanford bioethicist Christopher Scott, PhD, and his co-author, Laura DeFrancesco, PhD, write in Nature Biotechnology, it has a new face and it’s longevity:

How science approaches the questions of aging has changed. Lifestyle, environment, epidemiology, nutrition, genetics and the tools of big data are coming together in a host of new ways. The new approach – called longevity research – is an effort to extend the period of healthy life by slowing the biological process of aging.

I can see the scrawl on the wall: Aging research is dead. Long live longevity research.

Penn bioethicist and public-policy guru Zeke Emanuel, MD, stirred a recent debate about how long a viable  life when he thrust his body up against today’s immortality zeal of the baby boomer. In an Atlantic article entitled “Why I Hope to Die at 75,” he theorized that post-75, it’s all a pain. His article is a great read that might depress you if 75 is within focus, yet it poses one question clear for each of us: How do we want to live our final days on earth?

Will longevity research produce answers that quell the anxiety stirred by the belief that the aging process means everything is headed south? Scott and DeFrancesco signal that while aging research “failed to come up with any viable approaches, let alone therapies to forestall the ravages of aging,” longevity research in animal models “have shown that life span is indeed malleable, that it can be manipulated by genetics or the environment…” Is there a stairway to longevity emerging in science?

The Nature Biotechnology paper poses some fascinating questions as the science of longevity joins with a new generation of commercial entities that hope to seize its potential. To be sure, longevity research will need to avoid inflated hype. The authors say that Craig Venter, PhD, who has started a company, Human Longevity (HLI) is “….frustrated that the handful of fully sequences human genomes, including his own, has provided little insight into aging.” But I assume, as do the authors, that Venter’s bet is that there’s an abundance of sunshine down this path and science will emerge with ways to manipulate aging that will lead to better health and disease management. But when?

In my latest 1:2:1 podcast I take up these questions with Scott as the longevity era of science develops and matures. My colleague Krista Conger also authored a blog post earlier this week on Scott’s feature.

Previously: Golden years? Researcher explores longevity research and the companies banking on its success, Exploring the value of longevity with bioethicist Ezekiel Emanuel, Tick tock goes the clock – is aging the biggest illness of all? and Researchers aim to extend how long – and how well – we live
Photo by Michael Himbeault

Aging, Ethics, Medicine and Society, Research, Science, Stanford News

Golden years? Researcher explores longevity research and the companies banking on its success

Golden years? Researcher explores longevity research and the companies banking on its success

Elderly Japanese woman for Scott blog postAlthough I haven’t had a birthday yet this year, the transition to writing 2015 on all my checks (whoops, did I just date myself there? ahem) has made me feel older. Coincidentally, I’ve also been working on an article for an upcoming issue of Stanford Medicine magazine about aging and longevity. So, yeah. I’ve been thinking a lot about the passage of time.

That’s why I was really interested to learn that Stanford bioethicist Christopher Scott, PhD, teamed up with Nature Biotechnology senior editor Laura DeFrancesco to c0-author a feature article examining the commercialization of longevity research. The article layers research advances with the rise and fall (and rise again) of companies and organizations that have tossed their hats into the anti-aging ring since the 1990s. With it, Scott and DeFrancesco paint a picture of a dynamic field on the brink of something big. As Scott explained in an email to me:

Aging research, as we knew it in the 1990s and 2000’s, is being abandoned in favor of something much more ambitious. The central features of longevity research include an embrace of big data, a pivot away from studies hoping to find aging genes, a recognition that aging is best thought of a collection of diseases, not just one disease.

I’m fascinated by how quickly this new direction has taken off, especially since classic aging research yielded so little, and became saddled with hype. Longevity research has that same feel to it, and from an ethics and policy perspective one question is whether the promise of healthy lifespans will outrun the reality of the science.

And there’s the rub. As Scott points out, it’s not enough to just live long. No one wants a prolonged, but unhealthy, old age. We need to live long and well. The concept that gained ground is “healthspan” rather than “lifespan.” And from Google’s Calico to Craig Venter’s Human Longevity, Inc , there are a lot of bright minds (and plenty of $) focused on this problem. But there’s a lot at stake.

As Scott explained:

These are highly consequential decisions (funding research, creating new companies, establishing new scientific disciplines), technological inventions, and social changes that are being pursued on the tacit assumption that such decisions, inventions, and changes do lead to a healthier, longer life and the promise of a better future. In ethics, I think these assumptions are largely unexplored and unacknowledged.

The article is a fascinating cross-section of a rapidly growing field, but, as Scott points out, there are still many questions that scientists haven’t addressed. It’s well worth the time to read, whether you’re a writer on a deadline or just a person trying to figure out how to gracefully change that “4” into a “5” on …all your paperwork.

Previously: Exploring the value of longevity with bioethicist Ezekiel Emanuel , Tick tock goes the clock – is aging the biggest illness of all? and Researchers aim to extend how long – and how well – we live
Photo by Maya Stone

Events, Medical Education, Medicine and Society, Stanford News

Diversity is initial focus of new Stanford lecture series

Diversity is initial focus of new Stanford lecture series

directory-281478_640How often does a psychiatrist stop to chat with a bioengineer? Or a first-year medical student with an established postdoc? At Stanford, more often than you might think, yet there’s always room for improvement, building community and promoting dialogue.

Hence the Dean’s Lecture Series, a new series launched by none other than the dean himself, Lloyd B. Minor, MD.

Initially, the series will focus on diversity, kicking off Jan. 23 with a presentation by Rosalind Hudnell, the chief diversity officer and global director of education and external relations at Intel Corporation. (Her talk is timely, given Intel’s announcement yesterday that they’re allocating $300 million “to improve the diversity of the company’s work force, attract more women and minorities to the technology field and make the industry more hospitable to them once they get there.”)

Minor said he launched the lecture series to unite students, faculty and staff and to spark dialogue on issues of importance. As for the first topic: “We all benefit from the transformative power of diversity,” he said. “It is an integral part of what it means to lead the biomedical revolution and a core value of the Stanford Medicine community.”

Following Hudnell’s inaugural talk, Vivek Wadhwa, MBA, a fellow at the Center for Corporate Governance at Stanford, will speak on Feb. 20, and Ruth Simmons, PhD, president emerita of Brown University, will speak on May 1. All lectures will be held from 12 to 1 p.m. in Berg Hall at the Li Ka Shing Center for Learning and Knowledge on campus.

I’ll be there. How ’bout you?

Previously: NIH selects Hannah Valantine as first chief officer for scientific workforce diversity, Report explores student diversity in medical schools and Lloyd B. Minor, Stanford medical school’s dean, shares five principles of leadership
Photo by geralt

Ethics, Health Policy, In the News, Medicine and Society, Research

Watching your spouse die on a TV reality show: De-identification as a myth, in death and life

Watching your spouse die on a TV reality show: De-identification as a myth, in death and life

Much biomedical research relies on the idea of “de-identification.” The Common Rule, the federal regulation on human subjects research, applies, as a general matter, if the researchers make some kind of intervention with the research subject or if they use “identifiable private information” about the research subject. But the “Private information must be individually identifiable (i.e., the identity of the subject is or may readily be ascertained by the investigator or associated with the information) in order for obtaining the information to constitute research involving human subjects.”

De-identification doesn’t mean that no one will recognize the research subjects’ identity. Federal regulation says the researchers must not be able to ascertain it readily.

If the private information was not collected by the researcher (it comes from someone’s medical record or was collected as part of someone else’s research) and the research subject’s identity is not known to and cannot “readily be ascertained” by the researcher, it doesn’t count. No consent is required, no IRB review is required – it isn’t “human subjects research.”

And why should it be? If no one knows it is you, you cannot be hurt, or so the argument goes.

[Last Friday], the New York Times published an extraordinary article entitled “Dying in the E.R., and on TV Without His Family’s Consent” by Charles Ornstein, a reporter for ProPublica. It recounted how Anita Chanko, a 75-year-old widow, watching an ABC reality television show, NYMed, suddenly realized that she was watching her husband’s death in the emergency room. More than a year earlier, the 83-year-old man had been hit by a garbage truck while crossing the street and had died in the NewYork-Presbyterian hospital. The televised version blurred his face, but not the face of the surgeon, the description of the accident, or the sound of her late husband’s voice, asking “Does my wife know I’m here?”

At no time were any of the family told  that Mr. Chanko’s treatment was being filmed or asked their consent to its use on television.

The dead man’s widow and children were traumatized. One of their sons wrote in a complaint “I had to unnecessarily relive my father’s death at your hospital a second time, while knowing that the public at large was able to — and continues to be able to — watch my father’s passing, for the purposes of what can only be described as drive-by voyeuristic ‘entertainment.’ ”

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Medicine and Society, SMS Unplugged

Why I screamed when my boyfriend hugged me

Why I screamed when my boyfriend hugged me

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

black and white rocksI was checking my email when it happened. My boyfriend had texted me saying that he was late arriving to the airport. So I stood outside with my suitcase behind me and clicked to an email from my mother.

I didn’t notice until too late that someone had approached me, and I screamed when I saw a black man reach out to grab me from the corner of my eye. Before the sound reached my ears, I realized it was my boyfriend, excited to have surprised me. I unfroze my arms as quickly as possible and embraced him.

We never talked about it. In the car ride back to Stanford, where we were both seniors, we talked about our upcoming spring break. I wondered if he had noticed other people on the sidewalk turn to stare at us. I wondered if he would ever surprise me at the airport again.

Mostly though, I chewed on the newfound knowledge that I had prejudices. Would I have screamed if a white man had grabbed me? An Indian man? A Hispanic man? Probably. I knew girlfriends who had been assaulted by all of the above during our time in college.

Regardless though, the thought in my mind when I screamed was not fear of being assaulted, it was fear of a black man. And I’m so ashamed to put this to words. I am half white, half Hispanic and grew up with a family that values diversity. I have been blessed with friends of all different backgrounds. So if I, with a liberal, multicultural upbringing had a prejudiced reaction in a moment of stress, I shudder to imagine what lies dormant and unrecognized in other people’s minds.

The question is not whether we are prejudiced. We are. Every single one of us in some way or other categorizes people by how they look and assign a danger factor to them. It’s how we are biologically wired to survive in nature.

The question is what we are going to do about it. In the quiet of our own home when no one is watching, are we going to unpack our assumptions and examine how we can improve ourselves? Are we going to encourage each other to go out of our comfort zone, to open ourselves to ridicule for admitting that we are imperfect, to challenge ourselves to be better?

My boyfriend and I are no longer together. We are at separate medical schools and I know that one day, when we are doctors in our respective specialties, I may call him for advice on the health of a loved one. I know that I will trust him more than I trust many of my peers who happen to be white.

And it hurts me to know that sometimes, it won’t matter that he has a gentle soul. Sometimes, the world will see him as dangerous before even looking.

Ferguson has hit our nation, our people, hard because it lives in every home – black, white, yellow, red or brown. It’s not a controversy over hyper-reactive policemen or a history of slavery. It’s a slap in the face that every single one of us has to own up to our discriminatory thoughts and grow. Americans need to grow as people and as a people. We the people need to become a we, not an us and a them.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo by Chris_J

In the News, Infectious Disease, Medical Education, Medicine and Society, Patient Care

A doctor’s attire – what works best?

A doctor’s attire – what works best?

Lab CoatsDoes what your doctor wear matter to you? You may simply want your doctor to be competent and compassionate, but a recent article in The Atlantic points out some subtle issues in the effects a doctor’s dress may have. Most people seem to prefer “formal” to “casual,” but the author recalls being put off by a well-coiffed female doctor dressed in a smart business suit. But if there’s such a thing as too formal, a doctor in cut-off shorts and a tee isn’t likely to get too many repeat patients either.

I’m pregnant and I have a toddler, so I’ve had more than the average number of visits to the doctor in the past couple of years. I also like clothes and notice what people are wearing, but even I had to stop and think about what, if anything, I remembered about what my OB/GYN or my daughter’s pediatrician (both women) wore during recent visits. Mostly I remember slacks and simple blouses, or in the unforgiving summer heat typical in this area, something a little lighter. My daughter’s pediatrician also has a couple of small Disney character toys attached to her name tag to entertain the youngest patients.

There’s a middle ground that doctors have to strike that may be tricky depending on their specialty, their hospital or clinic’s dress codes (Mayo Clinic requires all docs to dress in a business suit) among other things. And that’s not even considering the issue of how a doctor’s clothes can spread infectious disease. From the article:

The definition of what counts as professional clothing is also in flux, thanks to increasing knowledge of infectious risks. Earlier this year, the Society for Healthcare Epidemiology Association (SHEA) published new guidelines for healthcare-personnel attire in hospital settings. Their goal was to balance the need for professional appearance with the obligation to minimize potential germ transmission via clothing and other doodads like ID badges and jewelry and neckties that might touch body parts or bodily fluids. The SHEA investigators’ take-home points regarding infection: White coats should be washed weekly, at the minimum; neckties should be clipped in place (70 percent of doctors in two studies admitted to having never had a tie cleaned); and institutions should strongly consider a “bare below the elbow” (BBE) policy, meaning short sleeves and no wristwatches or jewelry. Although the impact on reducing the risk of infections remains to be determined, it’s considered potentially significant enough that a number of countries have adopted BBE requirements for all clinicians. (And it leaves me wondering: When will the Mayo clinic update its dress code to short-sleeved business suits?)

The other factor doctors have to consider is that the “business casual” that I’ve seen on most doctors may need to be upgraded for more formal meetings – something I’d never considered as a patient. Again from the article:

Last week, two days in a row, I ran into a colleague who’s a pediatrician. The first day, she wore a beige pantsuit (I’d label it formal, or business) and looked fairly corporate. I wondered to myself if she realized that her clothes were sending a message to her patients, a message that indicated that her medical practice was a business and that she wielded the power. The next day, she wore a loose-fitting knee-length navy dress (professional informal, perhaps, or smart casual). I asked her if she had seen patients the first day. She had not; it was a day of meetings, and when I told her I was writing about doctors’ clothing, she laughed. “When you’re seeing patients,” she said, “you have to look like you’re not afraid to get dirty.”

I’m not sure how I would have reacted if at our first appointment our pediatrician had worn a formal business suit. At the very least, I would have felt under-dressed (jeans and tees are my de facto uniform these days), but I would have likely judged her as cool or somehow distant, not suited to working with kids. Which may prove nothing, but only hint that that the best attire is the kind that your patients don’t notice.

Previously: NY bill proposes banning white coats, ties for doctors
Photo by Pi

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