Medical Matters:Would you have confidence in a female doctor dressed in a mini-skirt and low-cut top? How would you respond to a consultation with a male physician with a midriff revealing T-shirt and low-slung jeans? Would you decline to be seen by a medic sporting a nose ring?, asks Muiris Houston.
Dress codes in medicine have long been considered important. Hippocrates advised doctors to be "clean in person" and "well dressed". Mind you, he also recommended that they be plump and that they cover themselves with "sweet-smelling unguents".
When I was a medical student wearing a tie and a white coat was de rigueur. Although there was no written dress code, you simply did not appear on the hospital wards without them.
General practice was always a bit more relaxed, with sports jackets and ties replacing the hospital consultant's business suit. This fitted in with my mental image of how a GP should be attired.
So when I started my training year in general practice, I invested in a good quality Magee tweed sports jacket in an attempt to add gravitas to my otherwise fresh-faced neophyte look.
Which was fine for the summer months. However, come October and the beginning of the hard frosts, my early morning teeth- chattering signalled the need for a change of attire. You see, the consulting room I used had been converted from a pram porch; with no central heating and three outside walls, it was a struggle to keep warm. So for the rest of the winter I wore the thickest of jumpers, but while I reluctantly compromised on the jacket, I always wore a tie under the pullover.
Now, of course, ties are considered passé, even in the higher echelons of power. Charlie McCreevey has led the way in Brussels, arguing that a tie in summer caused men to perspire more, thus requiring a higher level of air conditioning in office buildings.
Ties can be a nuisance in over-heated hospitals. And dangling neck ties facilitate the spread of infection from one patient to another. They also get in the way of carrying out sterile procedures such as stitching a wound or inserting a urinary catheter. Some doctors prefer a bow tie in the belief that it is less likely to transmit infection.
However, research published in the British Medical Journalfound that there was no difference in contamination rates between conventional ties and bow ties. Which is a relief, because bow ties are very difficult to knot and portray a rather negative image.
But ties are traditionally seen as enhancing patients' satisfaction and confidence in their physician, although a study in Australia that examined the effects of doctors' dress on trust and confidence found that there were worse things a doctor could do than not wear a tie.
The 2002 study of 12 male general physicians and 1,680 patients in a teaching hospital took place over a seven-month period. The 12 doctors sequentially removed, changed or added one piece of clothing during this time.
Firstly, they shed their white coat, then took off their ties, before changing from formal trousers to jeans. The next sequence involved wearing Hawaiian shirts, followed by highlighting their hair before finally donning a nose ring.
Formal attire promoted the greatest patient confidence and trust. The item that triggered the most dramatic loss of confidence was the nose ring, while wearing a formal shirt and trousers was the minimum required to inspire a reasonable amount of confidence by patients in their physicians.
Subsequent research by doctors in New Zealand took a different approach. In a 2005 paper titled Judging a book by its cover: descriptive survey of patients preference for doctors' appearance, some 450 patients were asked for their opinion of photographs showing doctors wearing different dress styles.
They said they were more comfortable with conservative items of clothing, such as long sleeves, covered shoes and formal trousers and skirts than with items such as facial piercing, short tops and earrings in men.
Interestingly, jeans were acceptable to most patients but the highest satisfaction score was for doctors who dressed in semi-formal attire, with the addition of a smile.
A study of outpatients published in the American Journal of Medicinefound that patients preferred doctors who dressed formally and wore a white coat.
T-shirts and jeans on men and women with above-the-knee skirts got the
thumbs down. And the patients said they were more likely to divulge their social, sexual and psychological worries to physicians wearing white coats than to other doctors.
I wonder what these patients would have made of Dr Elizabeth Vaughan, a then 47-year-old general practitioner in Virginia. Dr Vaughan went to work in a spandex mini-skirt, six-inch stilettos and a plunging blouse. Her dress code precipitated a national debate in the US in 2000 when it was revealed that the proportion of her patients who were male was four times the national average for a woman doctor.
She hit back at her critics saying: "I am a highly qualified woman and it makes me happy to dress this way."
And the editor of the local newspaper put it succinctly when she said: "People realise she is a good doctor first and a provocative dresser second."
Dr Houston is pleased to hear from readers, but regrets he is unable to respond to individual medical queries.