One can call it tradition. One can call it habit. One can call it dogma, butone fact remains clear.
Psychiatrists do not wear white coats.
We are the only field of medicine where this is a consistent situation. While some non-clinical fields like radiology or pathology may find persons who do not feel the need to wear a white coat, head shrinkers will not wear white coats even if told they are supposed to. It is not done. Period. Some residencies go so far as to forbid the practice. Emory University is a highly respected residency and does not allow residents to wear white coats, even while completing inpatient rotations. I do not wear one even though I work exclusively on an inpatient setting, and to be honest, could really use the pockets. But I do not and refuse to change my mind.
Why? The official reason is because white coats are too clinical. Psychiatry has a history that, in truth, was not always that pretty. We are not afraid to admit our legacy of excessively long hospitalizations, mistreatment of the patients and ineffective treatments that could in some cases put the patient's life at risk. These days are long gone now and we no longer wish to be associated with the overly authoritative image of the white coated doctor who came in with an emotionless face and sentenced a patient to whatever treatment he felt would somehow fix the patient of his/her ill defined ailment.
The other branch of psychiatry that existed was the psychotherapeutic arm where analysts in suit coats analysed patients lying on couches. The usually affluent patient unloaded all of her inner traumas until some resolution of their problems was arrived at. No white coats. Dated, but still much less threatening, nonetheless.
As a side note, for those of you that have come in contact with several, especially older, male psychiatrists, you are not imagining things. There is a large population of psychiatrists that cultivate the Sigmund Freud look. Most of the men that bear this look are older and trained back in an age when psychiatrists actually did do psychotherapy and used the principles of psychoanalysis in their daily work. I am not sure why, and I really do not have the guts to ask. Maybe I do not want to hear the answer. I am not afraid of the wordy "psychobabble" response. I am just as good at dishing one of those responses out as any other psychiatrist, and actually would know what was being relayed to me. It is a fear of angering the ancient legacy of the "great ones". Much like the curse of Tutankhamen, one does not dare question the past teachings of the old psychoanalysts lest one risk some horrible fate befall him or her.
Returning to the white coat issue, this one is common to all psychiatrists, older and younger, male and female. Psychiatric units are also often regarded differently in that the nurses are often allowed to wear street clothes rather than nursing uniforms. Lately, there has been a movement to have them wear uniforms but the more traditional people, myself included, are opposed to mandating this. This is for the very same reason. Nursing uniforms remind too many people of the evil nurse behind the window in "One Fell Over the Cuckoo's Nest", with her cap and curt dress and tend to be too threatening. Obviously, nursing uniforms have changed quite a bit, looking more like surgical scrubs today, but the connection is still there. Do not even think about asking a male nurse to wear one of those caps. The nurses at my hospital are very quick to respond to my requests and have a very rigid pecking order where the doctor rules. This strict order makes me feel to some degree uncomfortable, but this might be the one time in my career that I would risk getting backhanded.
On a deeper level, psychiatrists like to be the rebels of medicine. They will not say this, but there is that undercurrent. Touching a patient is considered a boundary violation in therapy and while it does sometimes have to occur while working with inpatients, effort will be made to avoid it. Many hospitals actually have psychiatrists examine each others patients to prevent them from actually coming in direct physical contact with their own patient at any time, even in a clinical setting. This is not rebellious, it goes back to the very rigid boundaries that need to be kept to maintain a healthy therapeutic relationship with our patients, but it does make our relationship with our patients much different than other medical fields that provide direct medical care and helps to define us as somehow "different" from other fields of medicine.
In a similar vein, we do not wear stethoscopes, carry oto/ophthalomoscopes, reflex hammers or penlights. Our patients wear street clothes while in the hospital and are expected to be able to get up, go to groups and eat in a general area. No IV poles, electronic beds, heart monitors or oxygen masks allowed. If the patient requires these sorts of treatments, they are not ready to come to our unit yet.
Since our units are different and our treatments are different, psychiatrists tend to be different. Hospital rules tend to require shoes not have open toes, women wear hose, men wear ties, etc. The usual office dress code. They tend to discourage excessively high heels, long necklaces, multiple rings on a hand, more than 1-2 piercings per ear (certainly nothing besides the earlobes, and no lobe dilators). These rules have a tendency to be viewed as "suggestions" by a lot of psychiatrists. I did not have the guts to show up to work with biker boots like a former medical director once did, but I live for my malignantly high heeled sandals and do not handle hose when the temperature rises above 60 degrees. I do not fear my blatant disregard for my consistent violation of the no open toes rule. Or the limit of two rings per hand, two earrings per ear (I have three on one, so I am not really that bad) or not dangly earrings/necklaces policy. A lot of men I know have long forgotten about the tie as an accessory. None of us worry about retribution. I have always said, if someone in administration says something about the way I dress, I will change my errant ways, but only if someone does.
Except for the white coat. I will not wear a white coat. Shrinks do not wear white coats.
No comments:
Post a Comment