Doctors’ uniforms change, but a 20-year-old sitcom should not be our model.
“Ffor clothyng oft maketh man.” (Peter Idley’s Instructions to His Son, 1445).
I wish to discuss uniforms. The matter came up as I was having breakfast in a hotel and noticed a man sitting nearby, wearing ninja-black scrubs bearing the name Dr Matt Black (not his real name).
By way of disclosure, each morning upon awakening, I ask myself: “How will the universe conspire to amuse me today?” I then mindfully approach my dress-ups box and select the appropriate clown outfit to meet the day’s amusement correctly attired.
This habit started in 1970, when I shed the shackles of my boarding school uniform. After six solid years, I’d had enough of that one-trick-pony buffo outfit. Wardrobes were designed to be natty and variable, in line with the wildest nonsense that is life. Surely, life is theatre.
I had an early hint that via something called neurolinguistic programming, our outwards appearance, among other things, was a way of changing someone’s else’s thoughts and behaviours to help achieve desired outcomes. Put simply “Clothes (help) make the man (woman/non-binary person)”. This proverb has a distinguished literary provenance.
A deep dive into Google indicates an elite contingent of literati have placed their mark on the proverb from Mark Twain to Shakespeare, Erasmus, Quintilian, and Homer. In the Odyssey, Homer (7 or 8 B.C.) wrote: “From these things, you may be sure, men get a good report” and “At first I thought his [Ulysses] appearance was unseemly, but now he has the air of the gods who dwell in the wide heaven.” Thus, the impact of making a good impression by way of fine threads and bling was acknowledged by the classicists millenniums ago. I began to reflect how things have evolved.
In my small medical bubble, black scrubs were the insignia of fully minted Emergency Medicine Specialists employed at the Royal Brisbane and Women’s Hospital Emergency Department (RB&WH ED). It was their tabard and theirs alone. Those lower down the hierarchy had their own colours. Deviation from this pecking order was verboten. My initial thought therefore was that the good Dr Black was a highly esteemed member of the RB&WH ED ninja pack.
Back in the 70s medical students wore short white lab coats, junior doctors wore long white lab coats, and consultants wore upscale three-piece suits. Sometimes all donned scrubs, but only ever in the operating theatre. These garments were a predominantly boring pale little boy blue, shapeless and threadbare. In some rare hospitals, scrubs were hunter green. If for any reason you left the theatre, you were expected to discard the scrubs and return to your muftis. Female nurses all wore a uniform dress. The latter changed in the 80s.
Casualty departments were rebadged as Accident and Emergency (A&E). We called them All and Everything Departments. Suddenly female A&E nurses were allowed to wear trousers. Jumping onto a bed doing CPR in a dress was deservedly seen as unbecoming. Nurses’ uniform for those in critical care were also changing. The trousers were complimented with a uniform tunic. But that was not the only change.
Infection control became the new shiny thing. Long sleeves became transferers of disease. A gastroenterologist colleague of mine used to jest that his tie was for wiping his sigmoidoscope on following extraction. Obviously, ties had to go.
Hospital doctors doing overnights shifts, optimistically imagining that they might get some “sleep” in between ward calls, graduated to donning scrubs as they doubled as pyjamas. And that was pretty much the state of play until 2001, when something extraordinary happened. Scrubs, the American sitcom hit the airwaves. And scrubs as clothes took off either by correlation or causation. Boring pale little boy blue, shapeless and threadbare garments were gone. What replaced them was sure haute couture.
Put the words “scrubs Australia” into Google and you will get 199,000,000 results. And everyone is getting into the act. Figure-hugging, high-performance, easy-care soft-touch fabric in every conceivable colour and pattern. The perfect fit for a dress-ups box – or are they?
Why am I even writing about this? Here’s why. Scrubs have become ubiquitous. I walked into the community mental health unit the other day and found the resident medical officer wearing grey scrubs during the day. They are everywhere, even in the hotel breakfast area. And my problem is?
Once again, some disclosure. At one point in my early teens, my entrepreneurial father ran a chain of lady’s hairdressing salons. To cement staff camaraderie, he had the staff wear bespoke uniforms. They epitomised the modern scrub. Nowadays my dentist, dental hygienist, barber, barista, physiotherapist all appear to be critical care clinicians. Dr Matt Black was a general practitioner, grabbing a quick bite before work. I’m not suggesting his work wasn’t “critical”, but what’s happened to the upscale three-piece suit, and where is the bling?
Plus, it was a Friday. Whatever happened to Hawaiian Shirt Fridays?
Now, what you chose to don is your own business. Sure, professionalism needs to be considered. I hold that professionalism is a judgement call made by those engaged with the profession. It does not exclude a sense of playfulness. I can still be authentically me in a real clown suit and accessorised bling which adapts to the changing fortunes of daily life.
“A man becomes the creature of his uniform,” chanted Napoleon Bonaparte. He of course was a soldier and uniforms have a definite role in war. Combatants need to know whose side you are on. Tribes need to be alert to those that are foreign and therefore a threat. Surely doctors (outside an operating theatre) ought to be non-combatants and above that kind of tribalism.
Day-to-day life is brimming with movement, change, folly, paradox, and irony. As Virginia Woolf said, “Rigidity and conformity are death”. Enter the clown. I refuse to become boring and nonresponsive to the vicissitudes of the comedic universe.
Irrespective of my clown-like attire and bling, I still manage to connect with those children of God (my preferred alternative to: patients, customers, clients) that I seek to help, and they almost invariably say “thank you doctor”. Could it be that the other components of neurolinguistic programming override the façade? Or could it be that the irreverence towards the façade invites true humanity and thus connection?
In their defence, these latter-day scrubs wearers might say that they don’t have to expend mental energy exploring the world of wardrobe. I call that a missed opportunity. A copout. Then again maybe they have a desire to fit in with the normal homogeneity. My retort would be quoting a duo of greats who seem to be in perfect harmony.
1. Carl Jung: “To be normal is the ultimate aim of the unsuccessful.”
2. Dr Seuss: “Why fit in when you were born to stand out?”
What will you impulsively pull out of the dress-ups box for your doctor role tomorrow? Surely not the drab apparel of a 20-year-old sitcom. A part of me wonders if scrubs make us look like a bot in a dystopian world. I prefer my general practitioner to be in smart casual.
I refer you all to William Shakespeare: “All the world’s a stage, and all the men and women merely players.” In Bill’s world those in black scrubs are just roadies or “invisible” stage crew in a pantomime. Is that who you want to be?
Associate Professor Kees Nydam was at various times an emergency physician and ED director in Wollongong, Campbeltown and Bundaberg. He continues to work as a senior specialist in addiction medicine and to teach medical students attending the University of Queensland Rural Clinical School. He is also a poet and songwriter.
