September 12, 2022

Tattoos and White Coats: Shifting a Woman’s Appearance in Medicine

I’m sure we’re all too familiar with the universal lady doctor experience of not being perceived as “the doctor” by our patients. I felt this most recently on my last shift, during which the medical student assigned to me was a lovely man in his late forties who was coming to medicine as a second career. Predictably, when we walked into rooms together, he was addressed as “the doctor” instead of me. Patients took our good-natured corrections well, and I noticed that nobody challenged my position on this shift; nobody asked for an older, more experienced, or more male physician in my stead.

This was far from a novel experience. Since my first day of residency, I’ve been referred to as a nurse, tech, or (most perplexingly) dietary, even as I engage in tasks that are incontrovertibly the domain of the physician. I’m not alone in this experience, but I am shielded from a huge portion of these assumptions by the fact that I’m preternaturally tall, I armor myself with the talismans of physicianship, and, most significantly, I’m white. The denial of qualification that my BIPOC female colleagues experience is magnified tenfold.

These experiences are part of the fabric of being a female physician. We address them with our friends and colleagues, and they are so well known that we teach our trainees strategies to mitigate them. Wear your white coat at all times. Wear business clothes. Look professional, but not sexy. Get your hair and makeup done, but not overdone. Wear “sensible” shoes. Always display the badge tag that declares “DOCTOR” in bold red letters. Well-intentioned as it may be for us to want our fellow women to avoid having these experiences, doesn’t this advice just perpetuate the problem?

We’ve been raised in a culture in which women have to look a certain way in order to “look like a doctor.” More precisely, we have to appear how the men who made the rules have told us we should look. We have to be professional and attractive in a way that appeals to men without looking like we’re trying too hard. We justify this under the guise of “this is what our patients expect us to look like — don’t you want your patients to be comfortable?”

Of course, we all want our patients to be comfortable and to trust us with their care, but to what extent can the expectations of our patients drive us? If our patients don’t think a woman, a person of color, or a person with disabilities looks like a doctor, do their perceptions bear weight? To what extent is it our responsibility to reshape their perceptions instead of caving to them?

So much of medicine is paternalistic. We’ve been raised in a tradition of doctors telling patients what to do, rather than working with them to figure out how they might live safer and healthier lives. For a long time, this strategy was (reasonably) effective. Patients wanted their doctors to tell them what was best. The archetype of the physician as a benign dictator, whose edicts must be obeyed and whose education and status conveyed an unquestionable authority, was required to maintain this illusion of infallibility and superiority in order to be effective. 

However, we’re now seeing a shift in this culture — patients want to be (and must be) active participants in their care. If we want patients to actively participate in their care, presenting ourselves as their superiors, and handing down dictums from on high, is no longer an effective approach. Our health decrees are only effective to the extent to which they’re accepted and internalized. Patients with access to the internet (and the wide world of information therein) no longer take the decrees of physicians as unquestionable truth. Our relationships with our patients have shifted, and the ways in which we present ourselves to them may need to shift as well. 

A month or so after I graduated residency, I got a fairly noticeable tattoo on my forearm. I’ve always liked tattoos. However, having been raised in the Deep South (with the standards of conservative femininity that come along), I was indoctrinated to the attitude that anything so visibly “alternative” would shatter any trust in me as a competent physician. In my experience, nothing has proven further from the truth. 

I work in an emergency department in southern Baltimore. A large percentage of my patients are lower income, and many are of minority populations. I’m a comparatively wealthy, white, over-educated Southern woman. Rapport is an uphill lift. Having an immediately noticeable tattoo has done more to build rapport than I can explain. I look at it as being an emblem, however minor, that maybe I’m not quite as ivory-tower and unapproachable as my role and background might otherwise make me in a community to which I have no inherent ties. My tattoo is just visually startling enough to give me the opportunity to build relationships and connections with patients as humans. It’s the suggestion that I may not approach them with the same dismissive and arrogant attitudes that they’ve come to expect from the physician – that if I’m willing to be perceived as a little more human, a little less “perfect,” that I’ll treat them the same way.

This is not to say that getting a tattoo or altering some aspect of your presentation is sufficient to build trust or rapport, or engagement in your communities, nor do I want to impose a new expectation of appearance onto any of us. To me, my tattoo is symbolic – I don’t practice with the paternalism inherent to the physicians in the 1920s, so why should I hold myself to their standards of professional appearance?

We, as women, have held ourselves to standards of professional appearance imposed by men long ago to the detriment of ourselves and our patients. Upholding these standards perpetuates the misconception that anybody who does not present meeting these various standards cannot be perceived as doctorly. 

We are doctors. We look like doctors. Wearing the correct style of business slacks or white coats, neutral hairstyle, minimal makeup, or whatever it is has never protected us from the “YOU’RE the doctor?” questioning we’ve experienced, so why are we still committed to it?

We owe it to our patients to show up clean and dressed in a way that enables us to perform our essential duties. Beyond that, we owe it to them to show up as humans. Rather than forcing ourselves or our students to look the way we’ve always been taught is acceptable, show up as yourself. Wear your fake eyelashes. Wear your bold prints and bright shoes. Get tattoos and piercings. Wing your eyeliner. Shave your head. Dye your hair. Engage with your patients as a human, rather than an outdated ideal, dressed up in a white coat. We don’t need to adhere to what men decided “professionalism” meant when medicine was young; we don’t need to dress to impress them either. 

 

Laura Haselden, MD, MPM
Georgetown/MedStar Emergency Medicine Health Policy Fellow

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