Are you a medical student or resident rotating through new parts of the hospital? Then it’s a good time for some nuts-and-bolts advice about what you should wear on your upcoming rotations.
No, it’s not about looking like a doctor (whatever that is). It’s not about whether patients like white coats or not. Or whether white coats carry germs. It’s not about style and personal expression. It’s about how to have a wardrobe appropriate for the vicissitudes of life in the hospital and medical clinic. I want you to be able and ready to take great care of patients, as well as yourself.
Let’s start with hair. If you’re going to really examine a patient, and I mean lean over the bed and listen to the heart with your stethoscope, use an ophthalmoscope to peer into the eyes, etc., you must have a hairstyle that does not let your hair touch your patient. They don’t want to feel your hair, and you don’t want your hair to get all in whatever they have, right? So, short hair, ponytail, braid, clips, surgical cap, something. You also don’t want a hairstyle you have to rearrange. Think about it. You just examined a patient who has a rash, or a wound, or possibly something infectious (lice, scabies). Do you want to flip your long hair back over your shoulder (before you even think about it), before you remove gloves or wash your hands? I think not! And this goes for beards, too. Beards long enough to touch the patient are a bad idea.
While we’re thinking about beards, have you had your N-95 fit test yet? I know you want that mask to fit well when you enter a TB (or COVID) patient’s room. Many men go from full beard to goatee or mustache to ensure a good N-95 fit. Think about it!
Next, jewelry. Big, dangly earrings and necklaces are a bad idea on a pediatric rotation; they’ll get yanked by children. Opt for small jewelry while on pediatrics. Same for piercings; smaller is better while doing pediatrics.
Women need to consider the neckline and hemline of clothes when dressing for work. When leaning over your patient to examine them, does your neckline show more of your cleavage than it should? When you bend over, does the back of your skirt show more than you intended?
Shoes. Ah, shoes. Comfortable, please, because you are going to walk miles every day. Also, I plead for quiet, non-leather-bottomed shoes. A hospital is a noisy place, and patients are bombarded by the sounds of carts rolling down the hall, phones, monitors beeping. They do not need you adding to the noise with your shoes tap-tap-tapping down the hall.
You are entering the world of body fluids: vomit, blood, sputum, diarrhea, pus. You name it, it is going to get on your clothes, especially in pediatrics. So, forget the nice silk and dry-clean-only items in your closet. You need to wear fabrics that don’t easily stain and that survive well in a hot water wash and dry. Learn to love clothes you can just throw away after an especially gross day. So, don’t wear any favorites to the hospital or clinic.
Let’s talk about fingernails. They must be short enough so you can really palpate for lymph nodes, abdominal masses, and hernias without poking your patient. Can you get your fingers up under that liver edge with really long nails? Nope. Can you perform a surgical scrub and don sterile gloves without piercing the glove tip with your long nails? Also, if you’re going to spend any time in the NICU, you will discover that gel nails, fake nails, and French nails are forbidden there. There are many documented cases of infants getting life-threatening infections with germs traced to the cracks and edges of gel and applied nails. Know the rules in your hospital.
Pockets. We need them. Stethoscope, tongue blades, otoscope, medical manual, pen, and so on—you need pockets. I don’t care where you get them; white coat, fleece vest, belt bag, cross-body bag. But human nature being what it is, if you don’t have everything you need with you (and have to go back to the nurses’ station to get it), you might skip that part of the exam. I don’t know how many residents I have seen do a throat exam without a tongue depressor because they didn’t have one in their pocket. Inadequate! Don’t be that person. Figure out a way to have everything you need with you.
Think about this when you’re getting dressed. Does your choice of clothing today allow you to jump on a bed and do CPR at a moment’s notice? Can you dash up a couple of flights of stairs to a code? Can you get on the floor to help a patient who has fallen? Can you sit cross-legged and play with a pediatric patient to put them at ease? Choose what you wear wisely.
This next item isn’t exactly about wardrobe—it is about self-preservation. Train yourself to not touch your face once you enter the clinic or hospital. Studies show the average human touches their face 23 times an hour, and this provides a major pathway for infection. Hospital and clinic surfaces have plenty of germs, and you can easily transmit them to yourself by touching your eyes, lips, and nose. You really don’t want your patient’s gastroenteritis, respiratory infection, or Staph wound infection, do you? Then, hands off your face. It’s a devilishly hard habit to break. Tell a colleague you are working on this and have them tap you every time you touch your face. You’ll be amazed at how many taps you get! But you can learn, and you’ll get sick less often.
Follow these recommendations and you won’t have to think about what you are wearing. You can concentrate on learning the millions of things you want to learn so you can be a great doctor!
Ann F. Beach is a pediatric hospitalist.
