Bruce Campbell MD
The Patient’s Clothes Might Be as Important as My White Coat
Published September 19, 2022 on Doximity. This was the sixth and final essay I wrote as a 2021-2022 Doximity Op-Med Fellow.
View the original post here.
It is the 1990s and I am running the head and neck cancer clinic. I open the door, step inside, and greet my new patient, a casually dressed woman in her early 40s.
“Good morning!” I say. After we cover the basics, I ask, “Tell me your story.”
She relates to me that she bit her tongue several weeks ago. Her dentist sent her to see me after the sore spot persisted and was getting larger. She grimaces. “This just isn’t getting any better. It bleeds sometimes.”
After gathering the rest of her information, I grab a headlight and put on some gloves. “Let’s take a look,” I say. Sure enough, there is an angry looking mass on the side of her tongue where it rests against a tooth. I am concerned. She is a smoker, and she has a persistent tongue ulcer. It looks like cancer. “Can I get a biopsy while you’re here today?”
“Sure,” she says.
I ask her to sign the consent form, then step out to gather my supplies. While I am gone, she slips off and hangs up her jacket. When I come back into the room, she is wearing a brightly emblazoned T-shirt with the logo of a tobacco company. It reads: NEWPORT! Alive with Pleasure!
How ironic! I think. Who goes to the cancer surgeon’s office wearing an advertisement for cigarettes?
It makes me wonder: How do people decide what to wear to an appointment?
Somehow, we get up each day and get dressed, although what we choose to wear has evolved over the decades. As a Boomer, I remember my mother having me put on my “nice” clothes to go out to the store or to see the pediatrician. Mom wore a dress to have coffee with friends. Dad always went to work and church in a coat and tie. My parents got dressed in "good clothes" to pick someone up at the airport or the train station. Even though standards have slowly relaxed, everyone must still put at least a little thought into what they wear.
In my office, I have had patients arrive wearing tailored suits accessorized with pocket squares. People coming straight from work might have steel-toed work boots, motor oil-impregnated shirts, paint-splattered pants, carpenter’s suspenders, or lanyards with corporate ID badges. Couples might appear in coordinated Harley-Davidson leathers or full-on Green Bay Packers regalia. Older women might show up in embroidered sweatshirts decorated with chickadees or reading “World’s Greatest Grandma.” More than a few have had orange jumpsuits, leg irons, and handcuffs. Clothes provide context and give me clues about my patients’ lives.
For years, I saw a restaurateur who owned a wonderful dining establishment a few blocks from the hospital. Radiation therapy had affected his sense of taste. Since he always arrived in a chef coat with a meat thermometer in the breast pocket, I never failed to ask about how the treatment was affecting his work. He taught me how slowly radiation effects can resolve. Another man, who struggled mightily against his cancer and its treatment, came to every visit dressed in his security guard uniform, despite having lost his job when the company shut down and merged with another firm. Even as his old clothes became frayed, he never failed to tell a story about working on an armored vehicle or protecting a local business. He sat up straight as he talked.
What I wear is important, as well. I hope my clothes convey that I respect my patients enough to show up a little cleaner, a tad better pressed, and a bit more organized than I need to be. Though many employees must wear scrubs back and forth to work, I personally avoid wearing them outside the hospital because I don’t want patients and visitors to think a surgeon might wear the same clothes from home directly into the OR. My clothes tell people a bit about me.
Our professional lives are full of vanishingly brief encounters. Office visits are packed with the competing responsibilities of discernment, planning, and documentation. As Miuccia Prada said, "What you wear is how you present yourself to the world, especially today, when human contacts are so quick. Fashion is instant language." I believe how we observe others and how we ourselves are observed is part of the dialogue. What we wear shares our stories.
So, when I notice my patient is wearing the Newport logo, it opens the door to a conversation. “Well, that’s an interesting shirt!” I say. “Where did you get it?”
“Oh, I sent in enough coupons and they mailed it to me. I have a few of these.”
“Well, I hope we can get you to stop both collecting coupons and smoking.”
The biopsy goes well, and we schedule her follow-up. I sense she sees no irony in appearing in a cancer surgeon’s office in a shirt she earned by smoking. Maybe she does, though, since through the two years I care for her through multiple surgical procedures, radiation, salvage chemotherapy and, finally hospice, she never wears it again.
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