Magazine article Clinical Psychiatry News

Do Clothes Make the Practice?

Magazine article Clinical Psychiatry News

Do Clothes Make the Practice?

Article excerpt

You may not have noticed that I was wearing a tie in the picture for this column, or what the tie looked like. It was not the tie that I was wearing a few months back.

As fall turned toward winter, the weather in Milwaukee became gloomy, and I found myself dressing in bright shirts and ties. I even wore green shirts to remind me of the leaves and grass of summer. To my surprise and pleasure, I encountered some unexpected responses from staff and patients at my clinics.

One patient, who had a recent increase in her lamotrigine dose, commented on the bright pink shirt that I was wearing: "I know the depression must be getting better because your shirt brought a smile to my face!" Then I wondered for a moment whether response to what a clinician wears could be the holy grail of outcome measurement. Several staff members made comments on the order of: "I like your shirt; it brightens the day!" I almost felt that I was a walking Rorschach test. Of course, I realized that those who did not like what I was wearing, whether patients or staff, would be unlikely to comment.

Nevertheless, emboldened by these reactions, I decided to wear an old tie with a psychedelic pattern reminiscent of tie-dyes from the 1960s. That tie evoked more positive responses than any other and even brought forth an admission of prior psychedelic drug use (before psychosis emerged) in one of my patients.

Later, after the Christmas holiday, one depressed patient asked, "Where are your bright shirts?" And then the patient added: "but you also look good in the dark blue color you have on." Another jokingly said, "Are you blue today, Doc?" Well, I had to admit to myself that I was a little "blue" that the holidays were almost over.

Then I wondered, "What would happen if I wore my theme ties? How about the one with a print of Edvard Munch's painting 'The Scream' on it? Would that elicit or provoke unconscious anger? I do know that it's likely not helpful to wear this tie around a young child, given that my 3-year-old grandson got scared when he saw it--calling it the 'Screaming Rainbow' and running away."

How about the tie with the word "Help" repeated over and over? Would that decrease treatment resistance? How about a Christmas tie to build cultural bonds with Christians? And a Hanukkah tie to bond with Jews?

But before getting too carried away, it seemed best to review the whole subject. Was this really something that could help patients, colleagues, and myself; or as Shakespeare wrote, was it "Much Ado About Nothing"? I turned to the American Medical Association's Principles of Medical Ethics. The preamble states: "A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self."

In other words, our dress should be best for our patients but also serve our own needs, ideally be pleasing to colleagues, and not break any organizational dress codes. Our own narcissistic or exhibitionistic--or perhaps even to some degree comfort--needs should not take precedence.

I'm sure all of us have noticed a variety of dress among psychiatrists--men with and without ties, women with slacks or skirts, and varying amounts of jewelry.

I've seen African clothing worn by an African American psychiatrist in a clinic predominantly serving that population, as well as white coats being worn by psychiatrists who work in acute medical care settings.

Psychoanalysts often wear a more neutral gray. What seems "seductive" or overly casual seems partly to be in the eyes of the beholder. Psychiatrists who work with adolescents often say that their patients trust them more if they are more casual in their dress and demeanor.

Your practice's location may also influence professional dress, such as cowboy boots being worn more in Western states. Years ago, in the early 1970s, I was criticized by my residency director for "dressing like a hippie. …

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