WHAT DOES THE DOCTOR THINK THIS MONTH?

Ian discusses the appropriate wear for local GP'sand compared today's "uniform" with that of yesteryear.

August 2011

What should your GP wear in the consulting room?

Hippocrates advised doctors to be "clean in person" (no problem - a bath every morning), "well dressed" (As a medical student, I wore RAF shirts with detachable collars, a check jacket with leather patches, and,as soon as I went onto the wards and as a hospital doctor, a white coat over my shirt and tie, with smart trousers. All my years in General Practice, I wore a blue pin-stripe suit and now, as a locum, I wear a suit or a smart blazer and slacks. Occasionally, if the weather dictates, I wear a smart short-sleeved shirt with no tie and I am trying to pluck up the courage to roll up in my Indian Punjabi outfit - white trousers with a white cotton jacket made like a morning coat with tails). Hippocrates also advised doctors to be "plump" (No problem there, I hear you shout!) and to "anoint themselves with sweet smelling unguents" (My Cerruti aftershave will have to do).

Do you ever notice what your GP is wearing for your consultation? One extreme view would be that, within reason, the doctor's choice of apparel is completely irrelevant - what matters is the depth of knowledge and the ability to apply it within the clinical situation. However, a contrary view might be that patients don't have the doctor's cv in front of them and that the doctor's appearance is all they have to go by. If the doctor's appearance does not meet their expectations, the patient's anxiety levels increase. All this, of course, ignores the doctor's style of consulting. So what expectations do patients have?

Many years ago, one of the medical journals carried out an informal trial where the male GP progressively dressed less smartly, starting with a pin stripe suit and working down to jeans and a T shirt. It was only when his T shirt bore the slogan "F*** Off!" that patients made comment after the consultation.

Two more formal studies have been carried out. In the first, The American Journal of Medicine's survey demonstrated that patients overwhelmingly preferred doctors to wear formal attire with a white coat, disliking scrubs, business suits and informal clothes. They particularly disliked jeans and a T shirt in men or above-knee skirts or evident cleavage in the women (It would be interesting to know the sex distribution of the patients questioned!). Many of those questioned said that they would be more likely to divulge their social, sexual or psychological worries to clinicians wearing white coats than to other doctors. The second study took place in New Zealand. Patients were asked to use a validation scale to assess how comfortable they were with different dress styles. Those taking part felt more comfortable with conservative clothing, such as long sleeves and smart trousers or skirts. Facial piercings, T shirts and ear rings on men were really frowned upon. However, in this study, jeans were acceptable to most patients.

A lot of the above has been scotched by the discovery that ties harbour MRSA and doctors are encourage to wear short-sleeved, tieless shirts. Watches are banned, as is anything that dangles loose. (No, not that!) Several places of work have dress codes for doctors - "Hair must be of a natural human colour" for a start. Wandsworth PCT bans the wearing of mini-skirts, Lycra cycling shorts or leggings, transparent or see-through blouses, dresses or skirts, tracksuits, faded jeans, clothing with tears, holes or rips, low cut tops, political badges or emblems, items of clothing bearing logos which could cause offence and large, exposed tattoos. I wonder what sort of doctors they employ.

A GP visiting Debenham's Oxford Street store for advice would be told to go for smart casual -suits for men and trouser suits or linen trousers for women. Jeans and T shirts are a definite NO! Female GPs should wear mid-length skirts and should avoid cleavage. Men's trousers should always reach the ankles. Anything cropped says "beach", not "your life in my hands".

Austin Reed suggest a classic modern theme with nautical colours that emphasise navy and white. Gents could wear tailored pale cotton trousers, teamed up with crisp cotton bold striped shirts, white Breton polo shirts with white jeans. The females could wear linens and silks in white, cappuccino and blues, a cropped jacket over a box pleat skirt or a short-sleeved empire-line dress, or a navy/white polka dress for a crisp and clean 50s look. I don't know why, but my mind is suddenly filled with green-candled vomiting children intent upon trashing the above.

I'll stick with my own style and we shall have to see how many people notice when I turn up in my Punjabi suit.

A woman's joke, telephoned to me by a reader from London. "God gave man a brain and a sexual appendage but only enough blood to operate one at a time".

Why should men not be Agony Aunts? Dear John, Last week, my car stalled on the way to work. I walked home and found my husband in bed with our neighbour's 18 year old daughter. He admitted that they have been having an affair for six months and he refuses to go for counselling. I am a nervous wreck. Please help. Sincerely, Sheila.

Dear Sheila, A car stalling after a short distance can be caused by a variety of faults with the engine. Start by checking for debris in the fuel line, check the vacuum pipes and hoses on the inlet manifold and also check all grounding wires. If these are all OK, it could be a fault in the fuel pump, causing low delivery pressure to the injectors. I hope this helps, John.

Paddy and Mick are on holiday. They wanted to go to Majorca, pronounced Mayorca (the J is silent) in the last week of Une or the last week of Uly, but they ended up in Africa. They sent me a card of a head sticking out of a crocodile's mouth, telling me it was some flash geezer in his LaCoste sleeping bag. Best wishes to you all -

Ian Nisbet