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masterofmonkeys

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So I had a question about whether any of you felt like the ultra fancy clothing that seems to predominate among medical students and residents can be a barrier to therapeutic alliance.

At least at my school (a lowly state school), 200 dollar shoes, 50 dollar pants and shirts, and 30 dollar ties seem to predominate. These kind of cost outlays represent things that a lot of people can't begin to afford, let alone would be comfortable in.

When most of your patients don't even own a single pair of pants or a shirt as nice as the ones you wear day in and day out, could that foster a sense that you couldn't possibly relate to them?

Or in the case of working with teenagers or young adults (as I want to), could it have the effect of making you seem like 'the man'?

While I'm not much of a cultural anthropologist, I do know that throughout history clothing has been one of the things used to differentiate between the classes.

Just curious what yall think.
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While you're at it, you might as well try to hide the fact that you have an advanced degree, as that will probably alienate people who have not been able to obtain an education, no?

Seriously, though, we are not there to be equals or friends with our patients; we are there to use our expert knowledge to help them and they expect us to be high functioning and to show it to a reasonable degree - it's part of the treatment frame. I would probably not wear a tuxedo to work, but nice clothes are not a barrier to a therapeutic alliance. Actually, I would imagine that the opposite, like wearing torn pants and flip-flops, would be a barrier. Besides, since when are $200 shoes and $50 pants and shirts considered expensive?
 
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How can you really know how much someone else's ties and pants really cost without asking them? I have pants from various clothing stores that range from 20-60 dollars, but I don't think I could tell the difference in the price by how they look. I do find that the more expensive ones tend to fit me better and that is why I continue to buy them.

Also, I think how "fancy" you look depends on how you wear your clothes and whether you look neat and clean-cut or not.
 
masterofmonkeys said:
Or in the case of working with teenagers or young adults (as I want to), could it have the effect of making you seem like 'the man'?
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If you get the impression as a Child Psychiatrist that your young patients view you as something other than "the man", I would think they're probably playing you.

The fact you're called Dr. ____ comes with a ready-built gap. Whether you wear $50 pants or $30 pants (and $30 is about as cheap as I can find Levi's these days) probably isn't going to have as big an impact as the fact that they're the patient and you're the doctor.
 
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billypilgrim37 said:
Um, as soon as you step out of NYC? ;)
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Must be nice to find stuff that cheap. I'm not in NYC and I'm still lucky to find some jeans that cost less than 50 in my size!
 
MossPoh said:
Must be nice to find stuff that cheap. I'm not in NYC and I'm still lucky to find some jeans that cost less than 50 in my size!
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Maybe I'm just married with a wife who makes about half of a resident's salary for her full-time public sector "but I love it so much!" job.

Costco has some surprisingly great deals on some surprisingly good brands. And I haven't found that any of these clothes have been irregulars, which was not true when I tried to make the same purchases at Sams Club.

TJ Max, Marshall's, if you try hard enough, you can get some pretty expensive ties for 15 bucks or less.

Dress shirt-wise, Macy's and Penney's, etc., pretty regularly have sales where you can get 50 dollar shirts for under 30 bucks. And a lot of nicer dress shirts you can get on Amazon for some pretty severe discounts.

Point being, folks, you can dress pretty nice. I think my 80 dollar shoes from DSW (originally 140) are pretty great. 200? Wow.

Now, I could be convinced that a 200 dollar pair of shoes that would last forever and be really comfortable could totally be worth it. But, if you try, you can dress pretty nicely sale hovering and never have to pay that much!

But I live in a city where you're expected to wear jeans at most decent bars and clubs.
 
ha ha ha, a bunch of guys complaining about how much men's clothes costs.

It's funny though, the different specialties have different takes on how they should appear. I've heard complaints about overdressed pediatricians and underdressed emergency doctors. I guess it behooves a pediatrician to appear at least slightly humble. Psych, hmmm?

Actually MOM, I think your question would be especially interesting if you asked women. Because we have a wider spectrum of styles and prices to choose from. I see no need to look like a killer banker, for example. Or a school librarian on the verge of retirement. Something way in between seems best. Women's business clothes can make statements that could be off-putting not only to patients but to a wide swathe of people out there in any situation, but I don't see that happening with med students and residents. You'd need a lot more time and money to do that.

If anything, at least from what I've seen, most people in the hospital dress in business casual, not actual fancy business attire, though some people dress up more than others.
 
is wearing a really nice suit with no tie, first two buttons of your dress shirt left unbuttoned, considered too casual or make me look like im about to go to the club? Because that is my favorite look.......and I plan on utilizing it once im in practice....hopefully without looking like an idiot or like im trying too hard.
 
masterofmonkeys said:
Or in the case of working with teenagers or young adults (as I want to), could it have the effect of making you seem like 'the man'?

While I'm not much of a cultural anthropologist, I do know that throughout history clothing has been one of the things used to differentiate between the classes.
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Don't teenagers rip into adults who try to dress younger though? The thing adults have going against them, really, is age. The clothes just go with the territory in a way. I think kids would be onto someone who tried to get around that.

I think your point about class differences would be very true, say, in a situation where you were going into the field, such as if you were going into a war zone or famine zone. When the patient is coming to you in the hospital, though, then my thought is that they would arrive with certain expectations about the hospital and the people in it.

Just like when I go to a bank, if they are dressed like, ugh, doctors... I wouldn't really trust them with my money!

But anyway, an interesting question.
 
Just a thought from my inpatient psych rotation but isn't a tie kind of like wearing a noose around your neck for the first disgruntled psychotic patient to grab?
 
i also might be bitter because I have yet to find a shirt brand that I don't need to get tailored
 
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I don't wear a tie in any situation where I suspect the patient may become violent.

I wear a button down shirt or a polo shirt, khackis & walking shoes to work. I only dress up on days where I go to court. Even then I started dressing more informally when I noticed the lawyers not all wearing the expensive suit. I would just wear a jacket & tie, keep the khackis.
 
masterofmonkeys said:
i also might be bitter because I have yet to find a shirt brand that I don't need to get tailored
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I don't think I have ever owned a shirt that costs more that the price of tailoring...
 
OldPsychDoc said:
In our hospital, the only people wearing suits are drug reps and residency applicants. :smuggrin:
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exactly!!!
i popped a bottle of champagne when i got to retire my residency interview suit. suits are not fun.
 
grandslam521 said:
How can you really know how much someone else's ties and pants really cost without asking them? I have pants from various clothing stores that range from 20-60 dollars, but I don't think I could tell the difference in the price by how they look. I do find that the more expensive ones tend to fit me better and that is why I continue to buy them.

Also, I think how "fancy" you look depends on how you wear your clothes and whether you look neat and clean-cut or not.
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i agree with this. i dont think anyone can tell when im wearing a pair of pants from target or banana republic. the only difference is i can get alot more wear out of the banana republic pants without them starting to look like crap.
its not like im walking around with "juicy" plastered on my butt in big, sparkly letters.
 
Thorazine said:
its not like im walking around with "juicy" plastered on my butt in big, sparkly letters.
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The fact that I did walk around like that might explain my less than stellar professionalism evals...
 
Doc Samson said:
I need pockets to carry all my stuff around (man bags are not an option), so my choice is white coat or suit. I choose suit.
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"Its not a bag..its Euro" -Jerry Seinfeld

Doc, white coat or suit? how about a white suit,,now that would be one sharp looking psychiatrist..
 
I don't know. I'd imagine different patients would respond differently. If you see a regular bunch of patients you could try a new look and ask them what you think if you really want to know, I guess. Could help some feel that you are more 'on their side' and / or feel more comfortable talking to you... On the other hand could make some wonder why they spend to much to see you and wonder about professionalism / competency.
 
Interesting thread. There's definitely a wide array of what psychiatrists choose to wear to work (socks and gladiator sandals, anyone?).

On my first day rotating on the child c/l service as a fellow, I was told "lose the jacket, we don't dress up for consults" (I was rocking the jacket and shirt without a tie, mind you, so it was not terribly "dressy"...or so I thought). This was relayed by a socks and sandals wearing attending, so I took it with a grain of salt, but complied.

I find myself playing the game of "don't outdress your boss" (attending) on a regular basis. I see myself leaning toward wearing suits when I am an attending, and also plan to spend a fair amount of time on the floor doing therapy with kids. I'm sure I won't wear the jacket all day, but it does provide pockets to keep extra stuff, which is a nice option. I also probably won't always wear a tie with the suit, but I'm not so sure I'd open the top two buttons (as was suggested above) and risk looking like Dr. Christian Troy.

I also echo the above comments about basing the decision to wear a tie on the acuity of the clinical setting. I'll wear a tie many places, but wouldn't ever think of it when working in our crisis service. I remember a patient on the inpt unit during my intern year reaching to my neck and adjusting the crooked knot in my tie (then proceeding to do the same to the med student with me), and having a bit of a fight or flight reaction before realizing he meant no harm!
 
HCE said:
I don't think I have ever owned a shirt that costs more that the price of tailoring...
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I've been paying about 20 dollars to get a shirt tailored. I can usually get polos and pullovers that fit passably, but button-downs almost never. Blah.
 
Not to be sexist, but I love the male-dominated thread about wardrobe choices for psychiatrists. This was a hot topic in my residency training, but always focused upon the women's apparel.

I am starting my first job out of fellowship in 2 months, as the attending on an adolescent boys inpatient unit and I've been thinking a great deal about wardrobe choice. My compatriot on the adolescent girls unit is a 100% woman's business style pant suits with high neck shirts, and my style is much more relaxed (think cardigans and knee length skirts). Now I'm stuck deciding between dressing up so as to not appear less professional than my colleague, or maintaining my own style. This would not be a big deal if I were in private practice, but in a hospital the higher-ups can't help but compare us. Any thoughts from those of you who've been out in the real world for some time?
 
MossPoh said:
Must be nice to find stuff that cheap. I'm not in NYC and I'm still lucky to find some jeans that cost less than 50 in my size!
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I buy pretty nice (mostly wrinkle-resistant) stuff at Eddie Bauer and comfy shoes at Ecco. I never spent more than 20 bucks on a shirt or 30 bucks on a pair of khakis. You can buy nice and VERY comfortable shoes for 60-80 bucks at Ecco. I have always been told that I look very professional, and several colleagues asked me where I get my clothes (and got kinda pissed off that it was not in the UK:D )

A couple of suits that I have, I got from Macy's - designer brands for less than 100 bucks each.

I do need to add that I do my shopping at outlet malls and on major sale days. But, I totally agree with billypilgrim - you can dress nicely without paying silly prices.
 
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Doc Samson said:
I need pockets to carry all my stuff around (man bags are not an option), so my choice is white coat or suit. I choose suit.
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A couple of folks have mentioned this. Where do all the pockets come on the suit?

Maybe I'm just thinking from the overburdened, carry-it-in-case-the-attending-needs-it viewpoint. But when I think of a suit coat, I can't imagine stuffing much in the breast pocket of one of these.
 
notdeadyet said:
A couple of folks have mentioned this. Where do all the pockets come on the suit?

Maybe I'm just thinking from the overburdened, carry-it-in-case-the-attending-needs-it viewpoint. But when I think of a suit coat, I can't imagine stuffing much in the breast pocket of one of these.
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The only thing I carry around with me is the pharmocopia.

What you carry is what you need, not what others need. At least when you are done.
 
Regnvejr said:
The only thing I carry around with me is the pharmocopia.

What you carry is what you need, not what others need. At least when you are done.
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Got it. That makes sense. The thought of walking on light feet makes me happier than it probably should...
 
An attending/mentor of mine in med school mentioned that he bought several extra white coats when his wife pointed out that he sees pts in the surgical ward while wearing a coat he hasn't washed in months. In some instances, sterility is the issue.

http://blogs.acponline.org/acpinternist/2008/09/dress-for-success-or-sterility.html


There is a fair amount of info/opinion about this on the web:

http://linkinghub.elsevier.com/retrieve/pii/S0736467906005117

http://virtualmentor.ama-assn.org/2001/05/ebyt1-0105.html

http://www.citeulike.org/user/laurap/article/436442

http://www.ncbi.nlm.nih.gov/pubmed/12464001

http://www.acpinternist.org/archives/2007/04/dressed.htm

http://www.ncbi.nlm.nih.gov/pubmed/15167876
Patients attending the obstetrics and gynecology clinic in which residents provided the majority of direct patient care were invited to participate in this study by completing a questionnaire....CONCLUSION: Resident physician attire makes a difference to patients. Our patients prefer the white coat with surgical scrubs. Casual clothing is less well liked by our patients.
 
notdeadyet said:
A couple of folks have mentioned this. Where do all the pockets come on the suit?

Maybe I'm just thinking from the overburdened, carry-it-in-case-the-attending-needs-it viewpoint. But when I think of a suit coat, I can't imagine stuffing much in the breast pocket of one of these.
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My usual routine:

Inside left breast pocket: Notebook (Moleskine) and 2 pens

Inside right breast pocket: sunglasses

Left outside pocket: Blackberry (with Epocrates)

Right outside pocket: Keys and reflex hammer

Add a pager on my belt and an ID badge, and that pretty much gets me through my day - still too much to fit in pants pockets alone though.
 
Doc Samson said:
Inside left breast pocket: Notebook (Moleskine) and 2 pens

Inside right breast pocket: sunglasses

Left outside pocket: Blackberry (with Epocrates)

Right outside pocket: Keys and reflex hammer

Add a pager on my belt and an ID badge, and that pretty much gets me through my day - still too much to fit in pants pockets alone though.
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Definitely. I'll have to start looking more closely at suits. The one I have has fake outside pockets I believe. I seem to remember getting irritated with that once...
 
notdeadyet said:
Definitely. I'll have to start looking more closely at suits. The one I have has fake outside pockets I believe. I seem to remember getting irritated with that once...
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fake or sewn shut? A lot of suits come with the pockets sewn shut. Cut it open and voila, pocket. I always cut mine open because I friggin hate the flaps.
 
masterofmonkeys said:
fake or sewn shut? A lot of suits come with the pockets sewn shut. Cut it open and voila, pocket. I always cut mine open because I friggin hate the flaps.
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I checked. They look like real fake pockets to me.

It's the rage in Europe though, don't you know...
 
Since we're now giving each other shopping advice, can anyone advise on stores that sell shirts with a large amount of chest-waist drop? I've tried every department store and men's warehouse didn't cut it either.

I found a target (yes target) brand that I don't look stupid in without tailoring, and cleaned them out. But that only gives me about 4 or 5 shirts now.
 
masterofmonkeys said:
i also might be bitter because I have yet to find a shirt brand that I don't need to get tailored
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Have you tried Express?

Fairly decent quality shirts with out all the extra material and in the current economic environment they're always running sales (that you can bargain down even further).

As for myself... I have an all scrubs, all the time policy.

Safe, nimble, sterile & professional :)
 
masterofmonkeys said:
Since we're now giving each other shopping advice, can anyone advise on stores that sell shirts with a large amount of chest-waist drop? I've tried every department store and men's warehouse didn't cut it either.

I found a target (yes target) brand that I don't look stupid in without tailoring, and cleaned them out. But that only gives me about 4 or 5 shirts now.
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I notice it got quiet when there was a mention of chest-waist drop....:laugh:
 
Still Kickin said:
No fair! Where is the female equivalent of this product - ?!?!!

I've been wearing butt-ugly Dansko clogs with most everything for the last 2 years.
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and you think Dansko clogs are butt-ugly....

http://www.oddee.com/item_96499.aspx

personally, I find the fish flip flops to be a great conversation starter with any potential patient...
 
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