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In this episode, we sit down with neurologist Lealani Mae Acosta to explore the intersection of beauty standards, professionalism, and gender disparities in medicine. From the impact of COVID-19 on personal appearance routines to the pressures women physicians face to look “professional,” we dive into how societal expectations shape perceptions and patient interactions. Discover how shifting norms are challenging outdated standards and empowering health care professionals to embrace authenticity.
Lealani Mae Acosta is a neurologist.
She discusses the KevinMD article, “Putting on my daily máscara.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today, we welcome Lealani Mae Acosta. She’s a neurologist. Today’s KevinMD article is “Putting on my daily máscara.” Leah, welcome to the show.
Lealani Mae Acosta: Thank you so much for having me.
Kevin Pho: All right. Let’s start by briefly sharing your story and journey.
Lealani Mae Acosta: Sure. So this article that I wrote, “Putting on my daily máscara,” I wrote at the beginning of the pandemic, essentially. I speak a little bit of Spanish, enough to be dangerous, from the year I took in college. I noticed that there were signs up all over the hospital encouraging us to wear our masks, in English and Spanish. Of course, the Spanish word for mask is máscara on the signs we had in our hospital. I thought it was really interesting because I love words. I was an English minor, I do creative writing, and so I noticed the similarities between the Spanish word for mask, máscara, and the English word for mascara, which is, you know, typically associated with women’s makeup.
I was going to be giving a lecture to the neurology residents, and, well, there is some video, but in case you have audio, I don’t usually wear a lot of makeup. I usually don’t wear any makeup, but when I’m public speaking, maybe I’ll put on a little bit of lipstick or some tinted lip gloss just to look a little bit more animated when I’m speaking. I was preparing to give this lecture to the neurology residents, and I was looking for my lipstick, which again I don’t use very often, and I thought, “Leah, why are you looking for lipstick to put on? It’s going to be under your mask that you’re going to be wearing to give a lecture to these residents, so what’s the point of wearing it?”
It just really got me thinking about the daily appearance that we have, you know, not only as physicians but specifically as a woman physician, how we appear to other people. So, you know, why does it matter whether or not I was wearing lip gloss or lipstick? You know, why do some women really commit to wearing mascara every day, or they feel like they’ve got to have their face all made up in order to look like a doctor? It really got me thinking about what it means to look like a doctor, so to speak, and specifically as a woman physician, what people expect me to look like as a woman doctor.
I thought about not only just makeup but just about appearance. I mean, not to flatter myself, I have a fairly youthful appearance, I’d like to thank my Filipino genes for that. And you know, sometimes when I’m attending on the inpatient wards in the hospital, or even just when I’m seeing patients in my dementia clinic, because I’m a behavior neurology specialist, you know, I get a lot of comments: “Oh, you look so young. You look too young to be a doctor.” Sometimes I feel like I have to look older. When I’m rounding with my team of residents, I got tired of the male intern being recognized as the attending by the patient when, you know, I was the one who was the supervising physician. So I’d always wear my white coat and, you know, feel like I have to look a certain way.
I basically wrote this article as a reflection of the expectations we have to look a particular way in medicine, again specifically for women physicians. Really, at the end of the day, as long as we look professional and we act professionally, how we look shouldn’t matter as much. Certainly we should be clean and kempt and look and act professionally, but I don’t think we all have to look like, for example, Dr. Barbie.
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Kevin Pho: Sure. So you talk about those expectations, especially as a female physician. Do you think those expectations come more from patients or more from your colleagues?
Lealani Mae Acosta: I would say the majority of those kinds of comments come from patients, because, I mean, again, part of this is because I’m working primarily with an older population. So the comments of “Oh, you look, you know, look like my child,” or “You look old enough to be my grandchild,” those kinds of comments. Some of them are meant to be kind, but with some of them there’s this sort of undercurrent of “I don’t know if I can trust you because you look too young. How long have you been doing this?” Some of those kinds of unspoken questions sometimes arise with that.
Thankfully, I don’t really get it as much from colleagues, even though sometimes, you know, not to be ageist, a stereotype in and of itself, but sometimes I wonder if some of, you know, my colleagues that have been doing this a lot longer, do they look at me, you know, no white hairs? Well, I had one. I plucked it out last year, though. But, you know, do they take me seriously if they think, “Oh, she must not have been doing this for very long,” when I do have, you know, over a decade of clinical practice and attending at this point? But, you know, how do my colleagues perceive me in that regard?
Kevin Pho: So you’ve been practicing for a while now, and sometimes when you hear these comments from patients, “Oh, you look so young,” and things like that, how do you feel? How do you receive those comments?
Lealani Mae Acosta: I mean, I try to put a positive spin on it in terms of, you know, joking about it, just one of those things. I’m grateful as I get older that I still look young, and I try to take care of myself, and, you know, all those kinds of things in terms of maintaining that youthful appearance. But, you know, at the back of my mind there is that question of, you know, are they calling into question my authority or my knowledge base or my capacity to serve in this role? So I really just underscore, you know, appreciate the compliment when it’s given, and just emphasize that I do have the experience and the training to be a well-trained physician in order to take care of whatever medical questions they have.
Kevin Pho: And do you talk about this issue among your other female colleagues?
Lealani Mae Acosta: It does come up sometimes, especially, you know, about just, you know, makeup, or “Oh, what should I wear to this conference? How does this blazer look? Should I wear a blazer? Do I have to wear heels?” You know, those kinds of questions, that kind of stuff comes up not infrequently among me and my colleagues. Because, you know, the story I share in the article was, even when I was applying for residency programs, my favorite suit to wear at the time was a navy blue suit, and I was stressing out because I didn’t have matching navy blue shoes. I was complaining to a friend of mine who was in the medical school as well, and he said, “Why can’t you just wear black shoes?” And I said, “You’re a man, you don’t understand. You know, you can wear black shoes with a navy suit and nobody bats an eye, but if a woman has a mismatched pair of shoes, then, you know, they perceive her as not, you know, not caring about her appearance.” So having some of those conversations does come up more with my female colleagues as opposed to my male colleagues.
Kevin Pho: And that leads me to my next question. Do you feel that male physicians, of course, are less scrutinized for their appearance?
Lealani Mae Acosta: To some extent, yes. I mean, I guess just based on my own personal experience, I haven’t had many conversations with male colleagues about worrying, you know, “Oh, is this lipstick the right shade?” or “Should I wear something to highlight my eyes?” or “Does this color look good on me on stage?” Not to say that my male colleagues don’t care about their appearance, but I don’t really outwardly hear them having the same kind of concerns or actively thinking about it on a regular basis, like I do more from my female colleagues.
Kevin Pho: So how do you feel about all of this, in terms of female colleagues having that implicit association between their appearance and their professionalism? What does that say about the larger questions about how society views both men and women physicians?
Lealani Mae Acosta: I think it speaks to an older stereotype that’s existed about, you know, certainly for a long time women weren’t actually even trained to be physicians. So there’s a stereotype of the older man who is the physician, or maybe the female is the nurse or, you know, some other health care worker, but not the physician. Some of those stereotypes still kind of persist, even if not spoken explicitly, somewhat implicitly. I think, you know, we have to educate people that actually almost half of the women entering, well, half the students entering medical school now are women. A lot of departments and hospitals are really recognizing that we need more women to be represented within their fields, and they’re striving for equal parity, not only just in terms of numerical representation but making sure that we also have equal pay, equal opportunities. You know, a lot of studies have shown that, unfortunately, women are disproportionately not as present in C-suite roles or leadership roles or chair department roles or division head roles. So really recognizing the role of women physicians specifically within the health care fields, and, you know, giving them that recognition and those opportunities that sometimes historically have been purposely deprived of them.
Kevin Pho: Now, of course, you wrote your article in the midst of the pandemic back in 2020. Now that we’ve emerged from the pandemic, people aren’t wearing masks all the time, they’re not wearing scrubs all the time. Have you noticed any changes in terms of the scrutiny women physicians face in terms of their appearance?
Lealani Mae Acosta: I don’t think necessarily for women particularly. I have noticed some trends just in the overall attire of physicians, because I know, especially during the pandemic, I wore scrubs all the time, just because we didn’t know earlier on about transmission and things like that. I’ve transitioned mostly to my regular business attire, in terms of the dresses and skirts and things like that. But I’ve noticed a lot more physicians are comfortable just wearing scrubs every day, you know, either in the office or in the hospital. Certainly there are some specialties that are kind of known more for wearing scrubs, for example surgical specialties, but I’ve noticed even nonsurgical specialties, a lot more people are embracing kind of the more, for lack of a better adjective, casual attire that scrubs is typically associated with, in terms of instead of wearing, you know, the suit and tie every day. I’ve noticed that in particular.
Just for me personally, I’m kind of appreciating my own evolution in, honestly, my own self-perception about how I appear as a physician. I don’t wear my white coat as often as I used to, mostly because of transmission purposes, because I used to wear my white coat in clinic every day, and I don’t do that as much, just because it’s a little bit easier. I just realized, not that I was hiding behind that white coat, but I felt like I had to give that extra stamp of “I am the doctor taking care of you.” I’ve noticed that since I haven’t been wearing my white coat, the frequency of the “Oh, you look too young to be my doctor” comments has gone down since I haven’t been wearing it. So I’m just noticing some of those personal changes myself.
Kevin Pho: Now, do you think that there’s a balance between personal self-expression, whether it’s through fashion or through cosmetics? Is there a balance between that type of self-expression versus professionalism?
Lealani Mae Acosta: I think so. I mean, certainly those are not mutually exclusive concepts, because I think people need to be authentic in terms of how they represent themselves, and I think they also have to bear in mind what it means to look like a professional. So, you know, for some women, they are horrified, for example, if their hair starts to turn gray or white, and they’re in a rush to dye, and maybe that helps give them the confidence to appear more professional, versus other women who are fine with, you know, letting their hair go white or gray. There have been some interesting studies in terms of that perception of, you know, do patients perceive physicians differently if they appear a certain way, and specifically for women physicians, as far as, you know, the makeup and things like that. But I think generally speaking, as long as you are presenting yourself in a professional way and acting courteously, I think, you know, we have physicians of all shades of the rainbow and all different kinds of, you know, fashion sense, so to speak. So I think as long as we can represent ourselves authentically and still be professional.
I do have a prop, if I may, with this. I can show you. I also happen to be an avid knitter and crocheter, and I have a knit model of Einstein’s brain that I made that was published in the journal Neurology, and I’ll see if I can put this on over my microphone here. I often wear this around the hospital because I’m a neurologist.
Kevin Pho: Yes.
Lealani Mae Acosta: And, you know, people often recognize it as a brain. When I first made this, you know, certainly I was a little bit worried that people wouldn’t take me seriously because I’m wearing a knit model of a brain, but I’ve gotten so many positive comments from both other colleagues and also just from people at the hospital. Even when I’m running my errands, I had a lovely conversation one time with somebody at Trader Joe’s whose mom was diagnosed with dementia, when they found out that I was a brain doctor. So that’s just an example of, sometimes, you know, we can worry about how we’re perceived by other people, but there’s more to being professional than just, quote unquote, face value as far as how we look. That’s why I just want to encourage that kind of personal self-expression, which is still, I think, well within the realms of what is considered professional.
Kevin Pho: You mentioned earlier that a lot of the attitudes toward how women are scrutinized in terms of their appearance come from antiquated stereotypes. Now, you work at an academic medical center, so of course you see the next generation of physicians, medical students, residents, and fellows. What are you observing in terms of these new physicians coming up? Are they carrying the same stereotypes that we’re talking about today?
Lealani Mae Acosta: Yes. As far as students, I do think that they’re not necessarily as rigidly adhering to some of the stereotypes of what a doctor is supposed to look like. I know even recently I’ve had discussions. I feel like, for example, within society, tattooing has become a lot more commonplace, and some people have been nervous about covering up, you know, they want to cover up their tattoos for fear of not appearing professional. But I remember having a conversation once with a medical student, that a patient who also had tattoos really commented on the fact that the medical student also had tattoos, and so they had a bonding moment instead of that being something that turned the patient off, so to speak. I think some of those more rigid expectations about how we expect a physician to look have become a little bit looser with the current generation.
Kevin Pho: We’re talking to Leah Acosta. She’s a neurologist. Today’s KevinMD article is “Putting on my daily máscara.” Leah, we’ll end with some take-home messages that you want to leave with the KevinMD audience.
Lealani Mae Acosta: I want to emphasize that I hope that people feel comfortable expressing their authentic personalities as far as their appearance and their dress, and still be able to maintain a professional appearance with their colleagues and with their patients. I just want to encourage people to not feel like they have to be so committed to a particular stereotype of how a physician is supposed to look, especially for my female colleagues.
Kevin Pho: Leah, as always, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Lealani Mae Acosta: Thank you.
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