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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 Discover how shifting norms are challenging outdated standards and empowering health care professionals to embrace authenticity.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.” Lea, 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 Spanish—enough to be dangerous because of the year I took in college—and I noticed there were signs up all over the hospital, of course, encouraging us to wear our masks in English and Spanish. The Spanish word for mask on the signs we had in our hospital was “máscara,” and I thought it was really interesting because I love words. I was an English minor, I do creative writing, so I noticed the similarities between the Spanish word for mask, “máscara,” and the English word for mascara, which is typically associated with women’s makeup.

I was going to give a lecture to the neurology residents, and (though we’re on audio, you may see some video) I don’t usually wear a lot of makeup. I’m not wearing any makeup now—I usually don’t wear any makeup. But sometimes, when I’m public speaking, I’ll put on a little bit of lipstick or some tinted lip gloss just to look a bit more animated. I was preparing to give this lecture to the neurology residents, looking for my lipstick—which 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’ll be wearing to give a lecture to these residents. What’s the point?”

It really got me thinking about the daily appearance that we have, not only as physicians but specifically as a woman physician—how we appear to other people. Why does it matter if I was wearing lip gloss or lipstick? Why do some women really commit to wearing mascara every day, or feel like they need a full face of makeup to look like a doctor? It got me thinking about what it means to “look like a doctor,” and specifically, as a woman physician, what people expect me to look like as a woman doctor.

I thought about not only makeup but also appearance. I have a fairly youthful appearance—I’d like to thank my Filipino genes for that—and sometimes, when I’m attending on the inpatient wards in the hospital or when I’m seeing patients in my dementia clinic (I’m a behavioral neurology specialist), I get a lot of comments: “Oh, you look so young, too young to be a doctor.” Sometimes I feel like I have to look older. When I round with my team of residents, I got tired of the male intern being recognized as the attending by the patient, when I was the one who was the supervising physician. So I’d wear my white coat, feeling like I had to look a certain way. I wrote this article as a reflection of these expectations that we have to look a particular way in medicine, again specifically for women physicians. At the end of the day, as long as we look professional and act professionally, how we look shouldn’t matter so much. Certainly, we should be clean and presentable, but I don’t think we all have to look like, for example, “Dr. Barbie.”

Kevin Pho: You talk about those expectations, especially for 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. Part of this is because I work primarily with an older population, so the comments like, “Oh, you look like my child,” or, “You look old enough to be my grandchild”—some of them are meant kindly, but sometimes there’s an 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 unspoken questions sometimes arise. Thankfully, I don’t really get it as much from colleagues, though I do sometimes wonder—thinking about some colleagues who have been doing this much longer—”Do they take me seriously if they think I haven’t been doing this for very long?” But I’ve been an attending for over a decade. So yes, I think the majority of those sorts of expectations come from patients, not as much from colleagues.

Kevin Pho: You’ve been practicing for a while. Sometimes you hear these comments from patients: “Oh, you look so young.” How do you feel when you receive those comments?

Lealani Mae Acosta: I try to put a positive spin on it, as in, “Thanks, I appreciate that compliment.” I’m grateful as I get older that I still look young, and I do try to take care of myself. At the back of my mind, though, there is that question of, “Are they calling into question my authority, my knowledge base, my capacity to serve in this role?” So I just underscore that I appreciate the compliment, and emphasize that I have the training and experience to be a well-trained physician to take care of their medical questions.

Kevin Pho: Do you talk about this issue among your other female colleagues?

Lealani Mae Acosta: It does come up sometimes, especially questions about makeup or, “What should I wear to this conference? How does this blazer look? Should I wear a blazer, do I have to wear heels?” Those sorts of questions come up not infrequently among me and my colleagues. In the article, I shared a story: even when I was applying for residency programs, my favorite suit was navy blue, and I was stressing because I didn’t have matching navy blue shoes. I was complaining about it to a friend who was also in med school, and he said, “Why can’t you just wear black shoes?” and I said, “You’re a man, you don’t understand.” You can wear black shoes with a navy suit, and nobody notices, but if a woman’s shoes don’t match her suit, people see it as “not good.” Those sorts of conversations do come up more among my female colleagues than with my male colleagues.

Kevin Pho: Do you feel that male physicians are scrutinized less for their appearance?

Lealani Mae Acosta: To some extent, yes. Based on my personal experience, I haven’t had many conversations with my male colleagues about fretting over, “Is this lipstick the right shade,” or “Should I highlight my eyes,” or “Do these colors look good on stage?” Not to say my male colleagues don’t care about their appearance, but I don’t outwardly hear them having the same concerns or actively thinking about it like I do more with my female colleagues.

Kevin Pho: How do you feel about the implicit association between a female physician’s appearance and her professionalism? What does that say about larger questions of how society perceives men and women in medicine?

Lealani Mae Acosta: I think it speaks to an older stereotype that has existed for a long time—women weren’t even trained to be physicians historically, so there’s a stereotype of the older male doctor, or maybe the female is a nurse or some other health care worker, but not the physician. Some of those stereotypes still persist, even if they’re not explicitly stated. We have to educate people that almost half the students entering medical school now are women, and a lot of departments and hospitals recognize that we need more women to be represented in our fields, that we need to strive for equal parity—not only numerical representation, but also ensuring equal pay and opportunities. Many studies show that women are disproportionately underrepresented in C-suite roles, chair roles, or division head roles. So recognizing the role of women physicians in the health care fields and giving them the recognition and opportunities they haven’t historically had is important.

Kevin Pho: Now, of course, you wrote your article in the midst of the pandemic back in 2020. People aren’t wearing masks all the time now, they’re not wearing scrubs all the time. Have you noticed any changes in how much scrutiny women physicians face regarding their appearance?

Lealani Mae Acosta: I don’t think specifically for women. I have noticed some trends in overall physician attire. During the pandemic, I wore scrubs all the time, partly because we didn’t know about transmission. I’ve transitioned mostly back to my business attire, but I see a lot more physicians comfortable wearing scrubs every day, either in the office or the hospital. Certainly some specialties—like surgical specialties—wear scrubs more, but now I see even non-surgical specialties doing so. We used to think of scrubs as more “casual,” but it’s become more accepted. For me personally, I also appreciate my own perception of how I appear. I don’t wear my white coat as often as I used to, originally because of transmission concerns, but also I realized I didn’t want to hide behind it. In the past, I wore it in clinic every day. Now, I’m not seeing that the “Oh, you look too young to be my doctor” comments come less often since I’m not wearing the white coat. So that’s interesting to me.

Kevin Pho: Do you think there’s a balance between personal self-expression—whether it’s fashion or cosmetics—and professionalism?

Lealani Mae Acosta: I think so. They’re not mutually exclusive. People need to be authentic in how they represent themselves, but also keep in mind what it means to look professional. For some women, they’re horrified if their hair starts turning gray, and they rush to dye it because they feel they won’t look as professional. Others might be fine letting it go gray. There have been interesting studies about how patients perceive physicians if they look a certain way, especially for women regarding makeup, etc. But generally, as long as you’re presenting yourself in a professional way and acting courteously, we have physicians of all shades of the rainbow and all different fashion senses. Be authentic and maintain professionalism. I’ll show you one quick prop: I have this knit model of Einstein’s brain that I crocheted. It was published in the journal Neurology. I wear it around the hospital because I’m a neurologist, and people often recognize it as a brain. When I first made it, I worried that people might not take me seriously, but I’ve gotten tons of positive comments—from colleagues, hospital staff, even while running errands. One time, I had a conversation with someone at Trader Joe’s whose mom had dementia. That’s a reminder that there’s more to being “professional” than just how you appear at face value. You can have personal self-expression, and it’s still within professional boundaries.

Kevin Pho: You work at an academic medical center, so you see the next generation of physicians. Are the new physicians carrying the same stereotypes that we’re talking about?

Lealani Mae Acosta: I think they’re not as rigidly adhering to them. Society in general is changing—tattoos, for instance, are more common. Some people worry about covering up their tattoos to look professional, but I recall a medical student who bonded with a patient who also had tattoos, so it became a positive instead of a negative. The idea of “what a doctor is supposed to look like” is 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 you want to leave with the KevinMD audience.

Lealani Mae Acosta: I hope people feel comfortable expressing their authentic personalities in their appearance and dress, and still maintain a professional appearance with colleagues and patients. We don’t need to commit ourselves to a stereotype of what a physician is “supposed” to look like—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.