Rounds is a time-honored tradition in medicine. All hospital patients must be seen by their physician daily or, sometimes, even twice a day. In teaching programs, rounds may include a dozen or more persons, including the senior (attending) physician, residents, interns, and medical students. The patient’s current status is reviewed and plans made for further workup, treatment, or discharge. For over a hundred years, rounds have formed the basis of all in patient medical care.
When I was on medical school, we had an attending physician in internal medicine, Dr. Lee Bricker. Attending physicians are those who have completed their training and are board-certified in a specialty. They have a special place in the medical education of young doctors, serving as mentors and professors to teach the art and science of medicine to medical students and young doctors in residencies. Although he was fairly young, Dr. Bricker was “old school” in many ways. He addressed even the medical students as “doctor” and he had a strict dress code for men, which included ties. While rotating on the internal medicine service, each of us had to give a formal presentation at the bedside of a patient we had worked up in front of Dr. Bricker and our fellow students. These rounds were legendary and formed the basis for a large part of our grade. Our presentation included the patient’s entire medical history, the findings on a complete physical examination, the results of laboratory studies, and a discussion of the diagnosis, if known, or possible diagnoses, if not. All this was to be from memory. Dr Bricker would question us on every aspect of the presentation. The presentation had to be well organized, lucid, succinct, and, most of all, accurate. It also had to be grammatically correct. I remember one student who described a patient as “nauseous”. Dr. Bricker stopped her and said, “So, are you saying the patient made you nauseated?” “No,” was the reply. “Well, then,” he continued, “then the patient was nauseated rather than nauseous, right?” In forty years of medical practice, I have never referred to a patient as nauseous, as a result of those rounds.
My musing is not about that day, however. It was about another time, when I arrived at the bedside for rounds wearing my white doctor’s coat but no tie. As soon as I walked up, he looked at me and said, “Dr. Bosshardt, we’ll excuse you while you go put on your tie.” Red with embarrassment, I dashed out of the hospital, ran across the parking lot that separated Jackson Memorial Hospital from the medical school building and accosted one of my classmates. “Quick, I need your tie. I am on Bricker rounds”, I said. I did not have to explain further. He whipped off his tie and back I went, tying the knot as I sprinted across the campus to rejoin the group. Dr. Bricker never mentioned this faux pas and I never failed to wear a tie again.
Dr. Bricker and others like him not only taught us medicine, they also taught us how to look and act like doctors.
For the next forty years, I wore a tie when seeing patients with only two exceptions. When I was in the Navy, I wore the uniform of the day and when I was in surgery, I wore scrubs. It goes without saying that I always wore shoes and socks. I can only imagine what Dr. Bricker would have thought of sandals or flip flops. When I went into plastic surgery, it seemed that most of the successful surgeons in the big cities wore beautifully tailored suits and ties. Plastic surgery conventions looked like something put on by GQ or Esquire magazine. I always felt a little out of that sphere, coming from little Lake County, Florida instead of Miami, Atlanta, New York, or Los Angeles. A full suit seemed out of place but my professional attire still consisted of shirt and tie, slacks, and shoes.
As I got older, comfort became the overarching principle and, gradually, I segued into wearing scrubs all the time, even when seeing patients. I figured that this was only appropriate, since I was a surgeon after all but, even more important, it was comfortable and took all away all my morning decision making about what to wear, very much like my Navy days when I wore a uniform year around. I figured even Dr. Bricker would agree with this. I guess I wasn’t the only one because now you see medical personnel wearing scrubs everywhere.
Then, in 2004, I began to experience the first symptoms of neuropathy in my feet. It worsened over a couple of years, then stabilized and has remained stable for the past twelve years. I sought an evaluation with an expert in this condition at the University of Miami and was diagnosed with cryptogenic small fiber peripheral sensory neuropathy. This mouthful means that my feet go through periods daily when they feel anything but normal. They feel numb, tingle, ache, and, often, burn to a degree that is very uncomfortable. Sometimes one sensation predominates. Other times several are present at once. It makes wearing shoes extremely uncomfortable so I began to wear sandals more and more.
I cannot recall when I first wore sandals to my office and began seeing patients with sandal-clad feet. I do recall that for the first several weeks I was very self-conscious about this, to the point where the first thing I would do when entering a room to see a new patient was to apologize for the sandals and briefly explain why I wore these. I didn’t want patients to think their plastic surgeon was some sort of a hippie throwback to the 70’s. Then, a funny thing happened. Patients didn’t care. Not only did they not care that I wore sandals, many thought it was cool. Some even expressed admiration or envy. I quit apologizing and just did my thing. Ironically, in all they years I wore shoes, I never received a single complement on my footwear. Maybe this was a commentary on my taste in shoes. Now, not a week does not go by when I do not receive some sort of complimentary comment regarding my sandals. I think patients like that I am casual in this manner.
What should a doctor look like? The answer depends on your personal and cultural perspective. Times have changed since I was in medical school and what is acceptable and what is not in medical practice has become very fluid. Piercings, tattoos, and casual wear have become so common as to no longer be noteworthy. On the other hand, as in so much of progress, in lowering the bar of appearance, we may lost some small, but important, standards of professionalism. Dr. Bricker and those like him still strike me as the epitome of professional appearance. I want my physician to be intelligent, well-informed, and compassionate but ideally, I want him or her to look the part too.