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Musings: Blog of the JAAPA Editorial Board
Monday, July 14, 2014
Appearances matter…
Amy M. Klingler, MS, PA-C
 
Like it or not, we live in a world where appearances matter. Opinions and assessments are made in the blink of an eye. Working in rural family medicine and urgent care, I have a moment (which I refer to as “sick/not sick”) when I walk into the examination room and make snap judgments about the patients in front of me. Are they sick? Meaning, do they need an immediate intervention? Or are they not sick? Do we have time to examine, assess, and discuss the issue at hand?
 
Because the actual time we have to spend with our patients can be counted on our fingers, we must ingest information about them through a variety of sensory clues. Understandably, our patients are making similar assessments about us. When we get too focused on our job of diagnosing and treating, we may forget that in every encounter, our patients are judging us and deciding whether or not to trust us with very personal and private information about themselves. I believe that our appearance and that of our surroundings can profoundly affect our interactions with patients.
 
Opinions conflict about the iconic white coats worn by many healthcare professionals and revered in ceremonies at the initiation of medical education. On one hand are recommendations that white coats, wristwatches, jewelry, and neckties should not be worn in medical settings because they can be vectors of disease transmission. White coats have also been vilified as the cause of “white coat hypertension,” that transient rise in patient BP at the mere sight of the white cotton/polyester blend thigh-length jacket. On the other hand, studies demonstrate that patients have greater trust and confidence in a doctor (or, presumably a PA or NP) who wears professional attire and a white coat, regardless of the infection risk.
 
Personally, I follow the standard at each of the clinics where I work. These offices are located in very different communities and have their own personalities and spectrums of acceptable attire. In my primary practice location at a rural health clinic (in a town where a buttondown shirt identifies you as an outsider), I wear tailored, embroidered scrubs; in another more formal practice location, it’s professional attire; and at the local health department, I wear business casual attire and a white coat. As a PA, I want to project competence, trustworthiness, and humility no matter what I am wearing, but I have to admit, I stand a bit straighter while wearing a white coat; especially one that is laundered at least once per week using a bleach solution.
 
If different clinics have different dispositions, what does your building say about you? Have you ever walked in the front door of your office, just as a patient would? Have you ever sat in the waiting room chairs and looked around? What about lying on the examination table and seeing the room (and the ceiling) from a patient’s perspective?
 
I recently supervised a project to remodel the interior of the Salmon River Clinic, my primary office. This was the first major renovation in the history of the 42-year-old clinic, and took several years to plan and several months to execute. I am grateful that the board of directors who operate the clinic saw the value in updating the facility to one that was more modern, clean, and comfortable (see before-and-after photos at right). My argument in support of the renovation was that patients (consciously or unconsciously) judge the type of care they will receive by the surrounding environment. Because many of the patients I treat are tourists who are meeting me for the first time, I feared that if the office itself was outdated and cluttered, patients would expect substandard care, even before they talked to a member of the staff. Now that the work has been completed, I feel a sense of joy when I walk into work each day and a sense of calm that I don’t have to apologize to patients for the state of the facility. So far, the reactions from locals and visitors have been overwhelmingly positive. I believe that patients and their families feel a little less anxious as they walk into an unexpectedly modern office in a rural Idaho town. The city streets may not be paved (really) and you may be 3 hours from Target (true), but there is a real clinic in town.
 
If appearances make an impression, how do you want to be remembered?
 
Amy M. Klingler practices at the Salmon River Clinic in Stanley, Idaho. The views expressed in this blog post are those of the author and may not reflect AAPA policies.