Conforming to expectations in the way you dress is an unspoken rule of professional life - just don’t isolate yourself from other groups, says Miriam Fine-Goulden

“Dress for the job you want” I was once advised. I also found that dressing in different ways influenced my behaviour: “dress the part, act the part”, or possibly “fake it till you make it”. I have come to realise the degree to which we declare our professional allegiances sartorially. These thoughts occurred to me at a recent Melting Pot Lunch, organised by social enterprise consultancy Thought Space.

Changing the look

I am a paediatric intensive care doctor in my final year of professional training but have spent the past year on a fellowship working in a non-clinical role in NHS England. I have swapped my medic scrubs-trainers-stethoscope attire for a more managerial look, and I have really enjoyed dressing this way.

I have greater confidence expressing my views, and feel that those views are taken more seriously

I feel professional and empowered. I have greater confidence expressing my views, and feel that those views are taken more seriously. 

So why not continue to dress this way? Well, aside from the practical considerations of the blood/fabric interface, as well as standing at bedsides rather than seated at a desk, I now appreciate that “dress for the job you want” could also be a warning: step too far outside the accepted boundaries of your professional tribe and you risk exclusion.

Going to “the dark side”, even temporarily, is viewed by most of my colleagues with a degree of bewilderment and a certain amount of suspicion. In my role, two particular instances this year have led my loyalty to be challenged

I recently visited a trust where I previously worked clinically and was mocked (albeit affectionately) for my smart dress and heels by beloved colleagues and peers. The light-hearted jesting belied the underlying sentiment: you no longer look like you want to be one of us.

Going to “the dark side”, even temporarily, is viewed by most of my colleagues with a degree of bewilderment and a certain amount of suspicion. In my role, two particular instances this year have led my loyalty to be challenged.

The first was a national review published by my team in NHS England, the recommendations from which had significant implications for the configuration of services for my specialty and were very unpopular amongst many – including some close colleagues and friends. The second was the junior doctor contract dispute and industrial action.

Working in NHS England close to the National Medical Director, Sir Bruce Keogh, during this time has raised more than a few eyebrows. The significance of dress was apparent on the picket lines: striking and protesting junior doctors (including many who don’t usually wear scrubs or carry stethoscopes around their necks) donned the clearly identifiable uniform of our profession.

Re-entering the clinical world, I would like to be embraced, to feel that I belong, that I am “back”, and can be relied upon to demonstrate the expected level of proficiency and appropriate values and behaviours.

“Clinical credibility” is valued highly, and this doesn’t denote simply having the requisite knowledge, skills and experience, it also incorporates trustworthiness, integrity and believability.

Inherent tribalism

Few professional (or indeed social/cultural/religious) groups are immune from this relationship between belonging and attire. In medicine – and in healthcare more generally – it highlights our inherent tribalism.

We are less willing to work with those who aren’t members of our tribe and don’t necessarily consider it important to understand them

We are all aware of certain sub-specialty stereotypes or caricatures: the orthopaedic surgeon in a three-piece suit, the obstetrician/gynaecologist in twin-set and pearls, the paediatrician in comfortable shoes and cartoon socks… but it hadn’t occurred to me until recently the extent to which these may be reinforced. At a recent Thoughtspace Melting Pot Lunch, an orthopaedic surgeon in training described the clear hierarchical dress code in his department.

As one moved up the ranks from junior to senior trainee and then consultant, the sartorial expectations shifted: shirt/chinos/tie progressed to blazer, which was then replaced by a (well-cut) suit. Any junior trainee dressing too smartly would be seen as attempting to overstep the boundaries of (usually) his grade, and advised discreetly to take it down a notch.

Doctors are by no means the only group to experience the need to conform to expectations. Nurses have notoriously strict uniform policies, as do many other allied health professionals.

Detrimental impact

I challenge any healthcare professional to deny that they set the tone of their initial interaction with a patient based upon how they are dressed, and most of us fear turning up to a party or new job in the “wrong” clothes.

We are more likely to demonstrate altruistic behaviour towards those whom we view as members of the same group – working extra hours, covering clinics etc. – lending tremendous social capital to the workplace. However, a more adverse consequence is the perpetuation of a protectionist tribalism.

We are less willing to work with those who aren’t members of our tribe and don’t necessarily consider it important to understand them. Staying within our professional groups is the norm: exploring further afield and developing relationships outside the unit may be regarded with apprehension.

In medicine, this can have a detrimental impact on our ability to interact and cooperate with others. Straddling the management/clinician divide this year has felt like being in a jar of salad dressing: however hard it is shaken up, sooner or later the layers seem to separate.

We need to think far more creatively and radically to redesign the healthcare systems we need for the future, and that requires tribes to work together.

So now, when I think about dressing for the job I want, I will give far greater consideration to what I think that job should be.

Miriam Fine-Goulden is a national medical director’s clinical fellow