Professionalism Part 1: Dress

This entry will be one of many addressing issues of professionalism in the practice of cardiothoracic surgery. It is difficult for me to define professionalism, however, I am able to recognize it. Therefore, I will attempt to describe behaviours that I believe reflect it. Choosing a particular appearance in the way we dress is one of these behaviours.

I have come to believe that the manner in which we dress is very important. Although, initially during my training I was less impressed by this. I felt competence could overcome sartorial transgressions. Of course, competence is more important that appearance; nevertheless the latter re-inforces the former and thus both are complimentary.

During the clinical encounter, competence is initially assumed by the patient. This is the benefit that our title affords and is granted by social contract. The initial impression we give by how we are dressed either re-inforces this assumtion or underminds it. Subsequent and consistent 'professional' appearance further re-inforces our competence and instills confidence and trust, which is comforting to our patients.

There is an expression in spanish: 'Como te ven, te tratan'; literally translated: 'How you are seen, you are treated'. What it means is that your apprearance dictates the way in which other people perceive you and thus treat you. In this way, dressing professionally leads to respect. Patients, I believe, want and respect a surgeon whose outward appearance reflects his/her knowledge and experitise.

I think that a lesson can be taken from the bussines world on this subject. In that sphere, professional dress or business attire may be tied to productivity and success. Would you trust a banker wearing jeans and a t-shirt. What would you think about his/her competence as a finacial consultant? Would the CEO of a large company be respected as much if he worked in slacks and a golf shirt? These may be obvious examples. But why would this not apply to surgeons?

One may argue that this point of view is elitist. Dressing professionally means dressing well. This does involve spending a significant amount of money, especially if you are a resident or fellow. This well-dressed appearance usually correlates with socio-economic status, and in this way may be viewed as elitist. If the surgeon uses his appearance as an extension of his status for others to see, this may also be viewed as vain. In the context of eliticism and vanity, some may interpret the surgeon-patient relationship as paternalistic. This is all very true. However, it is what we say and do that will determine whether the way we dress is merely a reflection of an internally inflated ego, or another way to communicate to our patients that we take their care seriously enough to look professional.

In my opinion, dressing well and professionally equals (for a male) a suit or jacket and tie. It also means being clean shaven (especially post-call). As surgeons we have the advantage that we can wear scrubs with a lab-coat and still look professional. However, this should be minimized. Going to a clinic in scrubs is sometimes necessary, but not ideal.

All of what has been mentioned applies also to surgeons-in-training.

As a final thought, I note that the male dominated history of CVT surgery has a long tradition of suits, ties and other formal dress-amenities. This symbolized their status in society; they were respected and admired. Some still percieve surgeons in this way. I believe we should exploit this for the benefit of our profession and, more importantly, for our patients.