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Cancer Care Chronicles
April 30, 2020

The Importance of Physician Attire—The Socks With the Bulls

Author Affiliations
  • 1Oncology Division, Kaiser Permanente San Jose Medical Center, San Jose, California
JAMA Oncol. Published online April 30, 2020. doi:10.1001/jamaoncol.2020.0577

My patient was in crisis. She was hospitalized because her cancer had recently spread from her lung to her lymph nodes, causing the blockage of her bile-draining duct. I entered her room when she was resting after having received a catheter to relieve her pain. While she usually appeared upbeat and optimistic, today, it was obvious she felt the opposite.

After having acknowledged the recent unfortunate events, I tried to reassure her by suggesting some other measures that could alleviate her discomfort. Today, however, she felt she would rather refrain from engaging in any conversation regarding her now-inevitable outcome. Her disease was terminal, and she understood.

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    1 Comment for this article
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    What about the patient population?
    Chris Gardner, B.S. | Sidney Kimmel Medical College
    Thank you for the insightful piece. It really is amazing how much of an impact one's physical presentation can have on a patient-physician relationship.

    I disagree with the conclusion that, "data suggest that if physicians dress more professionally, patients may feel more comfortable talking about personal matters and may even adhere more closely to prescribed therapy or return for follow-up visits." This idea fails to take into account the different environments and patient populations one may work with.

    I am young in my training, but I have already had experiences where dressing professionally has hindered my conversations
    with patients. I volunteer with my school at an acute-care clinic in Kensington, Philadelphia, a neighborhood that has been hit very hard by the opioid epidemic. The patients we serve suffer from homelessness, substance use disorders, and mental health issues. It was hard to connect with patients the first few weeks, and it is very possible that my button-down, ironed chinos and polished dress shoes were too much for the men who had been homeless and injecting heroin for ten years. Following a wardrobe change to jeans and a t-shirt, I have had much more engaging interactions about HIV and HCV transmission and medication assisted treatment programs.

    Clothing is so important because it impacts the patient's ability to relate to the clinician. Always dressing professionally might not be able to foster that relationship. Maybe the focus of clothing should take into account the location or service one is on. And that it is possible to make an impact in street clothes.

    https://www.acponline.org/membership/medical-students/acp-impact/archive/august-2019-0/dr-james-s-withers-md-facp-on-26-years-of-treating-the-homeless-and-living-by-the-motto-go-to-the
    CONFLICT OF INTEREST: None Reported
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