I don't think I ever answered him.
Ever since that visit, though, his questions have been doing somersaults in my head. I don't believe it's the personal nature of the inquiry that bothered me (I tend to be a pretty self-disclosing doctor). Initially, in fact, I found it pretty amusing. But after several days of chuckling, I moved from a place of amusement, to one of deeper consideration. It's some of the issues implied in his questions that have lingered. Does having a tattoo take something away from a doctor being a doctor? and Is it okay for doctors to be regular people?
This is a tricky one. I briefly did some Internet research on the topic of physicians with tattoos and came across a plethora forums in which applicants who were interviewing for medical school and residency training were discussing the need to "cover up" tattoos during the interview process. These forums made it quite clear-- in the land of auditions and under the guise of professionalism, doctors shouldn't have tattoos. Many universities and hospitals, in fact, have dress codes prohibiting display of potentially offensive tattoos and promoting the covering of all tattoos "when feasible".
Of course, there are the distinguished doctors who get tattoos to honor their patients (see article here). Or those who tattoo themselves with their end of life wishes (see article here). Definitely interesting twists on a different story.
But then I came across this, an article right up my alley. This article even features a picture of a young hip osteopathic doctor with a pretty sweet sleeve tattoo (look right: she looks a lot like one of the characters from Grey's Anatomy). The story quotes a 2006 study from The Journal of Dermatology that 36% of people born between the years 1975-1986 have tattoos. That's my generation! The article theorizes that if one-third of people in this age range have tattoos, a certain number of those tattooed people will become physicians.
And while the article did commend this tattooed student doctor for her many successes, it seemed to imply that her successes came in spite of her beautiful tattoos rather than because of them. And it wrapped back around to the idea of "professionalism" as the crux of the matter. This begs the question, are tattoos inherently unprofessional? And if so, why? Is this mutable?
Despite my own secret desire to be a rebel, I must admit that I, too, hold onto some pretty traditional ideas around professionalism. Though I don't often wear skirts or a white coat to work, I do believe in dressing professionally for my patients' sakes. I believe patients expect their doctor to look a certain way-- namely, forgettable. By this I mean that the best dressed doctor is literally dressed in something the patient doesn't remember (not flashy, not sexy, not odd, not ostentatious, not ugly or offensive). The outfit that puts the patient at ease is most likely the outfit that that he/she doesn't even recall. This, I would argue, is because the clinical encounter is really about the patient, not the doctor.
And yet, what might a tattoo say about one's doctor? Is a tattoo too out there? Too memorable? Or might it be healing?
I can imagine that some of my patients (especially the ones that sport their own beautiful body art) would just LOVE having a decorated physician. A tatted-out doctor would make them feel more kinship than otherness. That always feels good, no matter who we are. And feeling better is the essence of healing. But many of my older and/or more traditional patients would certainly frown upon a visible tattoo-- tattoos might distract certain patients so much that they wouldn't be able share comfortably, listen to medical advice, or even want to see that doctor (I can almost hear one special patient of mine saying something like "I don't want to see that tattooed person ever again.").
To what extent is it the responsibility of the physician to have appearance that puts patients at ease versus an appearance that the physician feels good about?
I would like to believe that most patients would prefer a brilliant loving doctor with tattoos to a dumb cold one without-- certainly, as I groused about in a prior post, what I really yearn for in my own provider is someone who knows something, listens to me, and cares about me. What he/she looks like doesn't have much correlation with any of these essentials. Or does it?
2) Is it okay for doctors to be regular people?
This question is a pretty easy one for me to answer. The answer is a resounding YES. It has to be, in fact because we are. . . well. . .people. My family knows this (very well), my friends know this, and plenty of my patients know this (I hope).
Yes, physicians happen to have completed medical school and residency training (all of which took many years and a lot of effort), but just like our fellow humans, we have diverse strengths and weaknesses, unique hopes and dreams, fears, fallibility, and yes, even tattoos. And yet, perhaps, this "realness" is a relatively new concept, as medicine goes. In the footsteps of a generation of physicians who worked 100+ hours per week, completely and singularly focused on their patients, my generation of physicians is trying to be more than career physicians-- we are also hoping to be spouses and parents and friends and political activists, musicians, and scholars, and athletes, and dreamers, and community advocates.
I do intentionally share with my patients important pieces of my human self: why I work part-time (to be able to take my three-year-old to preschool and take him swimming), when I don't know something (I believe strongly in transparency when I don't have a good answer for why something is happening or what a patient should do), and even some of my own personal challenges (sharing my struggles with infertility, only when it seems relevant). Obviously, my patients' clinic visits are sacred space-- long-awaited appointments are definitely not about me-- so I don't share or expect to share all of my personal self, but I do disclose the parts that seem helpful for my patients' journeys.
Here are few examples (that I don't necessarily share with patients) of how I am regular person:
I pick up my dog's poop.
I do laundry.
I lose my temper with my son.
I eat ice cream from the carton.
I have sex.
I sometimes feel depressed and watch mindless TV to improve my mood.
I get zits.
I argue with my mom (sometimes in that snarky seventh grade way)
My underwear drawer is a disaster.
I get anxious.
I am often wrong.
And I make mistakes. Yup, plenty.
Since many of my closest friends are doctors, I can also vouch that THEY are regular people too. Though they have uniquely different human traits than the ones I listed for myself above, they are regular nonetheless. I would espouse that all this makes us better doctors-- most of the time. After all, the human experience is what empowers us to ask questions when we are unsure, to admit to misunderstanding when communication is imperfect, to relate personally to our patients' struggles, to ask for help when we need it, and to apologize when we make mistakes.
And that's the kind of family doctor I want to be. I hope it's the kind of doctor you want to have.
Back to my inquisitive patient. . .
I didn't answer my patient right there in the moment because I wasn't quite sure how to answer him. Should I flash him my own stamp? (Not appropriate). Share with him how I got my little tattoo in the midst of an intense break-up with a college boyfriend? (Definitely not appropriate). Should I take the opportunity to talk about clean needles and infectious disease (Very doctorly, for sure). Should I divert the conversation? (Always a good tactic) Should I reassure him that we were all 21 at some point? (Duh). I guess what I would say to him now after months of pondering is just the following,
"Yes, actually, I do have a small tattoo, I've had it for 15 years. And no, there is no explicit rule about doctors not having tattoos. After all, we're all human. We come in all varieties. Mostly, I am just sorry that you aren't going to be able to get your dream tattoo this month, but hey, let's be optimistic and hope that one day, you will be well enough to get the tattoo of your dreams."