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Tailoring a dress code: How to write the rules

Everybody knows what they're supposed to wear to the office, right? Well, no. That's why experts recommend that physicians write down what is permissible. But there's a lot to consider.

By — Posted Dec. 19, 2005

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Many, if not most, small- and medium-sized physician offices do not have an official dress code. After all, it's clear that employees are expected to appear neat and presentable. So why spell it out?

Experts say one reason to have a code is that, without one, a sartorial problem can evolve so gradually that you don't notice it until you get complaints from patients. And by then, your group already might have taken a serious hit to its image -- one that can take a long time to repair.

"It's like a paint job. You're there every day and you don't notice that the walls have been getting dingier," says Maureen Mahoney, corporate manager for service excellence at Children's Memorial Hospital in Chicago. Children's is one of a handful of hospitals that are developing or beefing up dress codes.

And while hospital dress codes affect only employees, the efforts could be filtering out to independent medical groups in their areas. "When I look at doctors coming to the hospital to see their patients, I'm seeing a lot more ties and jackets," says Claire Young, chief nursing officer at The Cleveland Clinic. The organization recently changed its dress code to require nurses to wear whites, nursing assistants to wear hunter green uniforms, and doctors who are not in scrubs to wear a white lab coat (as well as a tie for men) with distinctive lettering identifying their departments.

While many smaller groups may be reluctant to institute a written dress code for fear of alienating staff, experts say that can backfire.

"If you don't have a dress code, you have to leave it to the practice's administrator [or the physician] to make decisions on a case-by-case basis. That ambiguity can lead to strife," says Terry L. Bradley, president-elect of the Raleigh-Wake Human Resource Management Assn. in North Carolina. Bradley has helped a number of companies create dress codes.

If you're ready to move your dress code from seat-of-the-pants to a formal written policy, there are two important issues to consider: first, how to decide what clothing should be allowed or forbidden; and second, how to stay out of legal trouble by avoiding a discriminatory policy.

Creating the code

Experts say the first step is to determine the business requirements. "Ask yourself: What are you trying to get out of it? What problem or potential problems are you trying to solve?" says Bradley.

If you're concerned about the look of the office, you may require receptionists and others who deal directly with the public to dress more carefully then those who are rarely seen.

If you feel some items are becoming distracting -- say, low-cut tops, body piercings or messages on T-shirts -- you might want to ban them. And if you want to distinguish clinical staff from each other and from office staff, you may dictate different modes of dress for each type of clinician.

Mahoney says Children's Memorial Hospital's code was drafted partly as a reaction to patient feedback. But it came about mostly because the organization is continually trying to improve its professional image.

Officials at the medical center concluded that employee dress is an important factor in how patients and visitors view the organization. "We wanted to project the idea that your child is in good professional hands. If parents see people walking around with inappropriate clothing, that works against the image we're trying to project," Mahoney says.

To create its code, a team at Children's looked at styles of dress both inside and outside the facilities. The organization's code prohibits beachwear, sweats, workout attire, leggings, shorts, form-fitting pants, sheer clothing, backless dresses, halter tops and excessively short mini-skirts.

In addition, tattoos and pierced jewelry, other than earrings, must be hidden under clothing.

In addition to following the general dress code guidelines, doctors employed by Children's Memorial Hospital "are asked to think about their appearance and make choices that reflect professional standards," Mahoney says. The organization decided for the time being not to mandate specific clothing for doctors.

Dressing the doctor

But other dress codes include physicians and other clinicians, too. Some image experts are very specific about how they believe doctors should dress. Sandy Dumont, an image consultant who has worked at Chesapeake (Va.) General Hospital and Bon Secours DePaul Medical Center in Norfolk, Va., on projects (neither yet implemented) to mandate nurse whites, believes that male doctors should wear a shirt, tie and blazer or sport jacket. She recommends female doctors wear a jacket and shirt with pants, or a dress. The outfits, she says, help a physician look like a doctor in the eyes of patients.

This can have far-reaching consequences, she contends, even affecting patient compliance. "Patients are more likely to obey the instructions of a man or woman who looks like a polished professional and an expert than a person who dresses casually," Dumont says.

The Cleveland Clinic's Young adds that distinctive dress for clinicians helps avoid confusion. For example, she has received feedback from patients such as, "the nurse who brought me my lunch wasn't very helpful." (A nurse would rarely bring lunch.) When nurses are uniformed, patients can easily distinguish them from other workers.

Young says that nurses themselves feel better when they can be distinguished from other workers. "I just feel they're walking taller; they have a sense of knowing they are respected," she says.

The legalities of the code

But before writing that dress code, something else has to be taken into account -- the law. "There's the potential to step on established legal rights. If it does, it can result in the practice being sued," says Peter Carmen, an attorney with Mackenzie Hughes LLP in Syracuse, N.Y. Carmen specializes in labor and employment law.

While this warning should encourage doctors to include an ounce of caution when writing their codes, it should not scare them off, or even necessarily send them scrambling to get their attorneys to sign off on any documents. "Many people are already familiar with the rules of dress codes since they're basically the same as in hiring practices. They have to be non-discriminatory on their face and in their carrying out," says attorney April Boyer, a partner with Kirkpatrick & Lockhart Nicholson Graham, in Miami.

In general, Americans are protected by law from discrimination based on sex, race, national origin, age, religion, disability and health history. Of these, the primary sticking point for dress is religion, although sex, national origin or even disability might play a part.

Attorneys say you can't prevent people from wearing clothing that's required by their religious faiths. Required religious attire can include head coverings such as yarmulkes, turbans, scarves, or hijabs. An employee's religious faith also can dictate hair length or facial hair.

But attorneys say practices do have some leeway to consider safety and ability to perform the job over religious preference. For example, if a burka, which covers a women's face, renders an employee inaudible, and she is required to communicate with patients or others, you can insist that she uncover at least her mouth, attorneys say.

A potentially difficult problem arises when a worker appears to be falsely claiming a religious requirement for attire or grooming. While it might be tempting to dismiss such claims -- especially if they appear outlandish -- doing so leaves you open to legal trouble. "Courts have shown over and over that they will not question the validity of any religion," Carmen says.

You can, however, ask the employee for some proof that the religion actually exists. You can also question the employee's level of adherence. "If they say they have to wear a particular article of clothing all the time, and you see them some night without that article, you can question their sincerity and deny them the right to wear the article," Carmen says.

Groups are not required to allow employees to wear clothes that have no religious significance but are commonly worn in their country of origin. But if you do allow one group to wear cultural clothing, you can't ban another group from doing the same.

While you can't discriminate based on gender, you can have a code that "recognizes the innocuous, socially accepted difference in dress between the sexes," Carmen says. So you can allow women but not men to wear earrings, and specify the length of men's, but not women's, hair. And in some states (with California being a notable exception), you can require women to wear skirts.

To avoid being sued for sexual discrimination, however, be careful that rules for both sexes are similar in terms of level of formality. "You can't allow men to wear jeans and ask women in similar positions to wear skirts," says Boyer.

Despite all the possible pitfalls, a dress code can be a relatively bare-bones document, with everything covered in the space of a few paragraphs, experts say. But they add that its simplicity belies its importance in maintaining proper office appearance, avoiding morale-busting disputes and shielding the group from charges of discrimination.

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ADDITIONAL INFORMATION

You are what you wear?

Gastroenterologist Lawrence Brandt, MD, was inspired to gather data to write "On the Value of Dress Code in the New Millennium" after delivering a lecture to casually attired medical students at New York's Albert Einstein College of Medicine, where he is a professor. "Obviously, these men and women were not aware of or chose to ignore Hippocrates' advice that the physician should 'be clean in person, well-dressed, and anointed with sweet-smelling unguents,' " Dr. Brandt wrote in the article published in the June 9, 2003, Archives of Internal Medicine. Struck by how much more formal students' attire used to be, Dr. Brandt continued: "I looked at these differences and wondered, 'Does it matter?' "

Why physicians wear the white coat

  • To be recognized easily by colleagues and patients: 25%
  • To carry needed medical items: 23%
  • To keep underlying clothes clean: 15%

And why they don't

  • 29% of physicians and medical students did not wear a white coat
  • 82% of those were in psychiatry or pediatrics
  • 50% of those said they were trying to avoid a perceived negative effect their coat would have on patient rapport

One reason why maybe they shouldn't

  • 30% of 100 samples from white coats showed Staphylococcus aureus.

What physicians think they should wear

Thirty-five residents and 77 staff physicians in two Midwest residency programs were questioned:

Viewed positively: White coat, name tag, shirt and tie, dress pants, skirt or dress, stockings, dress shoes.

Viewed negatively: Sandals, clogs, athletic shoes, scrub suits, blue jeans.

What patients think physicians should wear

A survey of 200 patients from teaching hospitals in Boston and San Francisco found that about a third didn't care. Of those who did:

Viewed positively: White coat, name tags, visible stethoscopes, tennis shoes, ties for men and skirts for women.

Viewed negatively: Blue jeans

What adolescents think

  • 85% do not want their doctor to "dress like them"
  • 78% want their physician "dressed as a doctor should dress"

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Business casual

Many employers allow their employees to wear "business casual," every day or on certain days. Here's how Michigan's Dept. of Civil Service defines it:

Slacks: Cotton slacks are acceptable provided they are clean and wrinkle-free. Inappropriate items include jeans of any color, sweatpants, windsuits, short shorts, Bermuda shorts, bib overalls, leggings, spandex or other form-fitting pants.

Shirts: Casual shirt, golf shirt, sweaters and turtlenecks are acceptable. Inappropriate items include tank tops; sweatshirts; shirts with large lettering, logos or slogans; halter tops; tops with bare shoulders; and T-shirts unless worn under another blouse, shirt, jacket, or jumper.

Dresses and skirts: Casual dresses and skirts, and split skirts at or below the knee are acceptable. Dress and skirt length should be no shorter than four inches above the knee. Mini-skirts and spaghetti-strap dresses should not be worn to the office.

Footwear: Loafers, boots, flats, dress sandals, open-toed shoes, clogs and leather deck shoes are acceptable. No stockings are acceptable if it's appropriate for the rest of the outfit. Athletic shoes, sneakers, thong sandals, flip-flops and slippers are not acceptable.

Jewelry: Should be conservative with no visible body piercing other than in the ears.

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