There was a time in this great health care system when you could tell what role people played in your care from the clothes they wore. Nowhere was this more evident than in hospitals. When I was an intern, it was easy to figure out who did what, and more importantly, who was responsible for what by the clothes they wore. It was a matter of practicality more so than stature or class system. Dress codes promoted teamwork by clearly indicating who was inexperienced and in need of supervision. Nurses wore white uniforms and seniority and experience were evident by markings on the caps. Nurse's aids wore plain caps. Maintenance staff usually dressed in dark blue uniform, volunteers in striped garb, and kitchen staff had their own distinctive uniform. When entering a hospital, male interns were expected to change out of their street clothes into "hospital greens" or dress shirts and ties covered by appropriate-length white coats. Mid-size white coats for trainees, and full-length ones for staff physicians who would also wear suits. It was an essential and strict rule well designed to keep outside bugs, outside. Venturing outside with "hospital duds" on was met with reprimand. Head nurses were highly respected by trainees, not only for their knowledge but also for their ability to run a tight ship on their watch. Common sense was the order of the day, and you could not get past the desk with a sniffle, soiled clothing or unwashed hands. Contrast that with the recent SARS crisis in which fully gowned and space-suited workers would check for fever and have you wash your hands, but allow filthy clothed visitors to walk on by. The real irony lay in the realization that anyone rejected at these checkpoints spent the previous 10 minutes huddled, coughing and breathing with all those who did make it in. "Policies" are replacing common sense.
After completing training, I joined the staff of a local hospital. I can imagine how confusing it is for patients when we, the doctors, cannot figure out who is who anymore. One of my first befuddlements came almost immediately when I was informed that change facilities for physician and staff are about to be completed. In the meantime, it was acceptable to dress-down and wear street-clothes to examine sick patients?? Almost 20 years later, the basic change facilities never did reach completion despite numerous yet necessary administrative expansions. Temporary became permanent, and physicians performed rounds out of necessity dressed in blue jeans, winter garb, trailing gloves, hats and carrying bagged lunches around the facility. In my first week of rounds, I came across an elderly patient standing in the hallway dressed in a blue hospital gown and trailing an IV pole. He was having a hearty discussion about his prostate problems with a lady dressed in greens, whom I naturally assumed was the urologist I had asked to consult on the case. Imagine the surprise when I learned that he mistook the kitchen staff for a consultant. At my first resuscitation code-blue, I was happy to see three other doctors arrive to assist me. Absolute confusion reigned because I was overseeing a process that required rapid delegation of tasks to team members. However, the whole team looked identical and I had no way to distinguish whom the various team members were. As it turned out, not one of those three was a physician with near tragic results. The dress-down revolution had begun, and everyone was craving to look like a surgeon. In small hospitals it was without consequence since everyone knew each other. In large metropolitan hospitals, those days are gone; staff turnover is high, making things more impersonal.
For a while after the dress-down revolution, I discovered that the ancient "chalice of power" otherwise known as a stethoscope might help decipher things. Staff physicians tended to purchase expensive models that aid diagnoses. It worked for a while but pretty soon even the clipboard carriers began walking around with stethoscopes. When this failed, I cleverly noticed that flashlights might render clues. Doctors carried tiny penlights, security guards had huge bat-like ones, night nurses used old scuffed up ones, and maintenance had large square ones, while cleaning staff had not caught on yet. But that didn't seem to work out either.
The only remaining persons with recognizable attire seem to be the volunteers, bless their hearts, and security guards. "Policy" states that you can tell who is who by reading their identification tags. This condemns one to walking the halls with magnifiers on, bent over staring at people's midsections attempting to read small print or decipher colors. With the loss of identity comes the loss of respect. Sadly, this is followed by loss of opportunity - the opportunity to learn from those we once could recognize as experienced senior role models. The only saving grace today is that many professional staff still introduce themselves to you by title and function. You can no longer assume anything by a person's outward appearance. Today, there is one thing you can bet on. Most people who have the outward garb of physicians are not doctors, and many who appear to be nurses are not registered nurses. I guess that means all those dressed up souls cutting lawns, serving food and walking around with clipboards are not doctors? Or maybe they are? Let's not give managers strange ideas, but I think the moral of the story is that "In today's hospital, second opinion is only as good as the source it comes from."