Monday, April 27, 2009

Playing doctors and nurses

A traffic accident this weekend – don't ask, nothing broken – brought us into contact with the emergency services. In the space of a couple of hours up to twenty professionals were inserted, with due urgency, into our lives. All of them were polite and helpful but I couldn't help being confused by what they were or were not wearing.

No problem with the police and the ambulance services who are all uniformed and clearly wear the insignia of their rank. But when you get to A&E you're thrown into an environment whose occupants' habiliments range from uniform through half-hearted uniform to no kind of uniform at all. You're prodded and ministered to by nurses wearing different outfits, examined by a young doctor with his shirt outside his trousers, then another doctor who is presumably more senior because he's slightly older and finally injections and other elements of treatment are administered by people wearing the "scrubs" that are familiar to all lovers of "M.A.S.H.". And then there are the people you don't deal with directly. I was eyeballing a huge, overweight, unshaven, extensively tattooed man with some nervousness until he looked at the board at the end of the bed and I realised he was an orderly. Looking around you weren't entirely sure who worked there and who was just visiting. This may work in a fashionable hotel but I don't know how appropriate it is in this environment.

I'm sure that the treatment was entirely professional and correct but I can't help but think that it looked slovenly. And when things look slovenly, they can often be slovenly. When you're thrown into this kind of environment, usually in some distress, surely it has to help if you can immediately work out who the people are, what role they fulfil and, also, who's in charge. Obviously, I'm old fashioned. The first family doctor I remember checked my pulse against a pocket watch produced from his waistcoat pocket. I don't expect him to come back. Nonetheless I believe that at times of distress there's an enormous amount to be said for formality.


  1. I have been working sporadically at my local hospital. One thing that is frequently overlooked and unappreciated by long-serving staff is how sprawling and confusing the building is to visitors. Patients don’t know the layout; they have no idea of the procedures that determine how and when they are treated, or how the hospital is organised. They need reassurance that they in the right place and that they haven’t been forgotten. I see a lot of minor problems that are the result of poor communication and bad signage.

    Where I work almost everyone who interacts with the public wears some kind of uniform; however it’s not always clear what these uniforms signify. I have an awful waist-length white jacket that causes some people to assume that I am a doctor and will be able to advise them on health matters. In fact the doctors dress in plain clothes and can be identified either by a stethoscope around their neck, or by the general rule of thumb that a doctor will charge around twice as fast as everyone else. I think the porters come off the worst. They are forced to wear an unflattering, dark grey, two-piece ensemble that makes them look like convicts on day release.

    When I first started work at the hospital I had neither a uniform, nor an ID badge, yet wandered in-and-out of terribly sensitive areas with impunity. This is a problem: A few months ago somebody walked into the oncology department and nicked a computer terminal from one of the offices. Evidently lacking an exit strategy, the thief was unable retrace his steps and wandered aimlessly around the maze of corridors until he was confronted by a member of staff, at which point he made his escape by jumping out of a window.

  2. You've hit upon one of my personal bugbears there Mr Hepworth. I've worked in the NHS for the last 24 years and, maybe I'm just turning into an old grump, but it really annoys me the way some other staff dress, and even worse the way they act.

    I get particularly irritated at younger members of staff who insist on addressing elderly patients by their first names as if they're some mate down the pub. They can call me whatever they want, but I think with patients they should be a bit more formal. If a patient asks you to call them by their first name its different.

    Graham (who realises he's probably mixed up "their" and "there" at least once in the last paragraph. It's my own personal blind spot)

  3. Glad you're ok though...
    I once felt similarly towards immigration staff at Liverpool Airport (JWL?). A few years back when I arrived back I noticed that the staff were very dressed down, all casual and cool - I think it was in the midst of what we laughingly call a heatwave. It occured to me that if I was bein refused entry and sent back to Dagestan, or wherever, and had my life generally turned upside down, that I'd be surprised to have it done by people who looked like Saturday staff at HMV. But then maybe I'm just getting older.

  4. We had the same experience when our son broke his arm and we spent a day and a night in the emergency department in a Sydney hospital. The smartly dressed man I assumed to be a consultant turned out to be a drug rep. The nurse had a nose piercing and the doctor appeared to be wearing pyjamas. If they're not going to wear white coats can't they at least wear a big badge saying "Hello I'm a Doctor"?

  5. In London cab drivers have to display their badge at all times. There should be a similar system for doctors.

  6. An A&E doctor writes...

    Sorry to hear about your accident.

    Across different hospitals, there's no formal dress code and in emergency departments both doctors and nurses will default to scrubs. Where I work, the scrubs are emblazoned with "A&E Doctor" or "A&E Nurse" which should make it easy, but even with clear nomenclature like this, a surprising number of people assume man=doctor and woman=nurse.

    As someone of seniority, I don't wear scrubs, rather an open necked shirt and smart suit trousers: sleeves must be rolled up and ties are not allowed as they dangle and cause infection. White coats are gone for the same reason too. For what it's worth I introduce myself and specify I'm a doctor at all times - people can get confused if you just introduce yourself by rank. I also have an ID on at all times. I like to dress smartly but being bled and vomited on can be a bit of a deterrent sometimes.

    I agree with the posters complaining about over-familiarity and people having their shirt outside their trousers, that's unacceptable in any walk of life!

  7. Personally, I blame the influence of all those American tv medical dramas for this lack of formal clothing.

  8. I'm sure you've all long since moved on, but this was of interest to me on my local bulletin this morning.