Monday, September 29, 2008

Doctor, you are hot!

I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:

Zardari then called her "gorgeous" and said: "Now I know why the whole of America is crazy about you."

"You are so nice," Palin said, smiling. "Thank you."

And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."

I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.

I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?

I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.

But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.

The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?

What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?

To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.

But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.

I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.

Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.

None of this is to say that I am as gorgeous as Sarah Palin.

16 comments:

  1. The first time it came from a 30 year old it profoundly disturbed me. (Actually that was the first time a patient had actually asked me out, so that may have contributed). But a constant stream of innuendo on another occasion from the husband of a patient I was looking after (while her myocardium was starving of oxygen) just made me angry and disgusted.

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  2. Normally, I just smile and say thank you and move quickly on (especially if I am rounding with my housestaff and students and everyone is watching for my reaction). If I sense there is more behind the comment, I try to politely deflect it. Recently a patient (not mine) stopped me in the hallway and asked me if I wanted to get coffee sometime. I told him, "I don't drink coffee since I'm nursing."

    I have accepted compliments, though, and at times it has helped with my therapeutic relationships. I tend to get a lot of compliments on my shoes - from men and women patients both - and honestly, this has helped me bridge relationships who some difficult patients (rejecting my housestaff, being angry with the system, but always wanting to see what shoes I was wearing which gave me an in).

    If it's a lewd remark, I let them know it's inappropriate and that has settled things down quickly.

    I don't know what the best response is though. Always saying that compliments are inappropriate can be awkward.

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  3. I'm not at the stage of my education where I'm seeing patients yet, but when volunteering at the hospital I've had several patients make comments. My general rule is similar to yours -- I try to trust my gut... if it's an elderly patient just being nice then I won't say anything, but then there are cases that need to be dealt with, like the 50-something patient who tried to convince me to marry him.

    It's tricky, because I'm never entirely sure where to draw the line. I expect this issue will only get worse as I enter the clinical years.

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  4. This is the perennial line-walking when it comes to females in power. If she were too hard-nosed up front she would be a bitch, with something too prove, but if she had agreed to let him hug her, she would have been using her sexuality to get ahead.

    Women have come a LONG way in this world, but double standards still abound.

    I hadn't thought of this in terms of medicine before, wonder how I'll handle it myself.

    I did, however come upon my first chauvinistic comment at a seminar recently, and I was surprised how much it bothered me. Guess I'd better get used to it, though.

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  5. I am nowhere near as attractive as Palin and I usually dress pretty frumpy and wear no make-up. I can say that I have never worn an outfit to work that was even remotely provocative... whereas I've seen some of my female colleagues wearing outfits that literally made me gasp (then they complain about stares). For those reasons, I get very few comments from male attendings. The ones I get are usually from some grandfather-type figure on liking some horrible, bulky patterned shirt that my mother picked out, that I'm forced to wear because it's close to laundry day.

    I get comments from patients from time to time though, since some of the psych/brain injured ones like me even in my frumpiness. I usually just smile, nod, and move on to the next question.

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  6. Comments about my appearance make the hair stand up on the back of my neck - there is no faster highway to my psyche than to tell me how I look. It's my own issue - brains versus looks - that goes back to my earliest memories - fueled by traditional Southern upbringing. Professionally I struggle with these comments because it seems to derail my encounter and puts the focus on me instead of my patient. Two years ago I had a major weight loss and lost 70 pounds, and that was tough because I fielded so many more comments about my appearance then. At first when people we're sure abou the weight loss - the comments were all about my hair - had I changed it, colored it, cut it (brushed it?!?). You would think that as a pediatrician, I would be kind of immune to what kids say - but not always. Kids are pretty truthful and have an absence of filter on their comments.
    My strategies are pretty much the same as other commenters - react from the gut, remember what my mama taught me and smile, try to leave the personal out of the professional, change the focus of the encounter back to the patient as quickly as possible.

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  7. I remember my younger days when the compliments would come fast and furious. I still get them but usually more along the lines of how young I look. I'll take them all. Just make sure you pay me equal pay and treat me like an equal otherwise.

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  8. Not that much of a problem when I was young. Not pretty enough, I guess. Now I'm old and nobody notices much.

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  9. The only time I didn't know how to react (accepting the complement or quietly stating the inappropriateness of the comment) was when one of my attendings in residency took an uncomfortable interest in me. He actually went so far as to buy me a gift (nothing illicit, just a stethescope). I kept trying to ignore the undertones, but I was uncomfortable nonetheless. In retroscect, should have spoken w/ my advisor, however, at the time, I felt I needed somehting more concrete than squirrly feelings from him.

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  10. If a man tells you that you are beautiful, there is always innuendo. You can convince yourself otherwise, but if you do so, you aren’t treating either party with respect.

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  11. Part of how I managed this issue, especially in residency, was by deliberately never looking my best at work. This was easy in a neurosurgical residency, where we were always sleep-deprived, overworked, and in scrubs. On top of this, I never wore makeup and kept my hair in a long, straight ponytail. As a result, I seldom got comments of this nature.

    Occasionally, I would have fun by going (with my husband) to the annual Christmas party in a cocktail dress with makeup and loose, curly hair. The difference in how my co-residents treated me was amusing. Most amusing of all, my own chairman didn't recognize me!

    Maybe it was selling myself short, in a way, to do this, but I just didn't need the hassle of fending off advances in an already overwhelmingly stressful, male-dominated job.

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  12. Thanks for the very interesting comments.

    momwithastethoscope - I particularly liked your point about how the problem with compliments is that it puts the focus on the physician instead of the patient.

    KC - Are you justifying your shoe budget as a work expense?

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  13. I was just thinking of this the other day, I had the most awkward scenario happen.

    I was checking on a postpartum patient (who was breast feeding), the patient's MOM says to the patient's husband (after finding out who I was) "Your wife's Doctor is so Hot, OMG"

    Hmmmmm. I just completely ignored the comment.

    But how incredibly awkward, for the patient. Immediately postpartum is never a good time for those type of comments.

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  14. Can there really be a neutral comment about someone's attractiveness? Do men have this problem? Do male doctors have people telling them how handsome they are?

    Palin likes to flirt. She uses it. That's why she was coquettish with the Pakistani President, it's how she always is. It's not appropriate. It's not professional.

    Returning the focus to the patient I think is the best course. I can certainly understand playing down your appearance to avoid this issue altogether. Though I'm willing to bet you still got looks. There's a large school of people who prefer the natural look. I get comments, ogles, etc. (not a doctor) I generally ignore them -- though I'm not in a position to have to interact with the commenters.

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  15. This is very tough for me--I agree with the comments above that it puts the focus on me instead of the patient, to the point of arising anger in me if it is anything but innocent (and yes, you can always tell the innocent ones).

    I have been asked out to dinner, told I'm hot (to my face, not to someone else in front of me--although yes, how declassee, RH+!), and had guys lament to me about their girlfriends, fiancees, wives (while the said women wait patiently out in the waiting room). It is very uncomfortable-- more so if you know you will be seeing the patient again. I try to thwart future comments by asking my medical assistant to 'hang out' in my office on future visits (stocking supplies, filing, etc). Sometimes it works, but not always--these guys can really push!
    It is much easier for me to field the "You look too young to be a surgeon," or "I thought you would be a man" comments, as far as I am concerned.
    (By the way, for the little old men and women, I often give them a compliment before they have a chance to give me one. Is that hypocritical?)

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  16. I await the wrinkles and gray hair - I feel it makes the parents trust me more with their kids - I've definitely got more acceptance and trust from them now that I've gotten older...

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