Wednesday 8 October 2014

The unwritten rules of stethoscope placement....and what you wear when.


I'm quite fascinated by the culture around what different health professionals wear in hospital, and also what different health professionals wear around campus. In the UK, medical students do not wear uniforms on placements; they wear their own clothes. They no longer wear white coats. When I was a medical student I am sure we were identifiable on wards by our ill-fitting white coats, before anyone saw our university name badges.

Cardiff University medical students are given lanyards to hold their university IDs, and I heard recently that there may be an unwritten rule that this lanyard should not be worn around campus... or people might just think you were showing off.

Of course doctors in the UK don't wear white coats now either, so fitting vs not fitting white coats are not a way to quickly visually distinguish doctors from medical students. Instead, I learnt today that the position of your stethoscope is now an unwritten rule about your seniority in the medical profession. Some (doctors and students) think that only doctors should wear stethoscopes around their necks. Some have even suggested that the unwritten rule might be that you shouldn't wear a stethoscope around your neck until you are a little bit further up the ranks... maybe having passed professional exams! Even more curious, there is a rumour that this unofficial way of distinguishing medical students from doctors may be sabotaged by infection control guidance preventing ANYONE from wearing a stethoscope round their neck.

It's also worth noting that from a patient's perspective just knowing someone is a doctor is not enough.
We need to remember to always say #hellomynameis and explain who we are and why we are talking to the patient on this occasion.

So I was wondering... should it be easier to identify medical students? Should doctors and medical students wear uniforms too? How do patients visually distinguish medical students from doctors, as I'm sure they are pretty unlikely to know these rules, and does it matter? And has the significance of stethoscopes to doctors in the UK gone up as they've stopped wearing white coats?

Edit : Some doctors in the UK do wear uniform! @sally_bobs is a respiratory consultant in Chesterfield. All doctors and medical students in @royalhospital wear navy scrubs which indicate if they are consultants.

And ENT consultant, John McGarva, @IamChirurgicus, even designed his own which highlights his specialty.
More about the importance of the lanyard... some have colour coding to distinguish role. In this particular case they were brought in to help distinguish staff at the time of a cardiac arrest. But interestingly lanyards are seen as an infection control risk in some trusts as well.
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11 comments:

  1. amcunningham8 October 2014 at 19:02

    So why don't pharmacists have uniform either? Not even in Scotland?

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  2. Ceri Haddon8 October 2014 at 19:03

    This exact thing is being discussed at my medical school - how do you identify a student by sight? Yes, we are trained to introduce ourselves clearly, but there are times where this simply does not (or cannot) happen. For this, we're looking at name badges as opposed to ID cards worn on lanyards/belt clips - lanyards can get in the way during procedures and examinations, and ID cards in general have the failing of the text being too small and often located in an unfortunate place to be caught staring.

    As for the stethoscope, as a final year mine goes in my pocket or bag. Round the neck leads to patients (visitors, other staff members...the list goes on) making the logical jump in my status. In the hospital setting it isn't about 'showing off', but in the absence of any clear indicators, trying to indicate that I'm not a doctor (yet).

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  3. amcunningham8 October 2014 at 19:09

    Thank ++ for your comment and sharing that this is being thought about by your school. So you think that visitors/patients/other staff members know that only doctors wear the stethoscope round their neck?

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  4. Ceri Haddon8 October 2014 at 19:14

    Know? 100%? Probably not, but the stethoscope is a traditional signifier of somebody who is medically qualified (although often worn by nurses, phsyios, OTs and the like now, but they have defined uniforms). I think if a patient or visitor sees a stethoscope they're likely to assume "doctor" until something else persuades them otherwise. Medical students exist in an awkward limbo, which makes identification by sight hard.

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  5. amcunningham8 October 2014 at 19:21

    I know we need to do more to reduce the sense of an 'awkward limbo' that medical students can feel. It would be great to know more about the significance of the stethoscope to patients/visitors/other HCPs. Maybe since doctors stopped wearing white coats on wards the presence of a stethoscope has taken on greater meaning (to doctors if not to others)?

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  6. louise beckham8 October 2014 at 20:58

    Qualified doctors wearing stethoscopes around their necks is cultural and almost 'tribal' in the sense that multidisciplinary members of the team are asking 'where do I fit in then?' during our twitter conversation. Interesting :)


    Btw - registrars & post PACEs SHOs wore stethoscopes around the neck, or in the back pocket, despite wearing their white coats. Whereas medical students and consultants had theirs neatly folded into the front coat pocket. This was at a time when ER had just come out and was super popular ;)

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  7. amcunningham8 October 2014 at 21:54

    So what is the stethoscope saying then? It's not about telling patients/relatives/other HCPs that the wearer is a doctor?

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  8. Alasdair Forrest9 October 2014 at 00:40

    Please forgive some special pleading from Psychiatry. The old joke is that it is hard to tell the psychiatrists apart from their patients.

    Frankly, I think that that is worth preserving. People who are mentally ill are no different from those who treat them. It would be a shame if the whole oeuvre of the therapeutic community movement, and the existential psychiatrists - so much of which was so humanising to the hitherto dehumanised - were to be left behind.

    Our daft uniforms better not be used to galvanise thoughts that - anywhere in medicine - we are somehow very different from one another, or from those we treat. Naturally, there are important distinctions of skill and responsibility. These, of course, do not last for more than a few years before someone gets trained up!

    Sometimes I think the overt communication may be, "We do this for infection control", or "We do this for ease of identification in an emergency", while the covert communication is something else indeed.

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  9. amcunningham9 October 2014 at 01:18

    Wasn't it that psychiatrists used to be described as 'the men in white coats'? Do you think that many in psychiatry miss the white coats? It seems that in the absence of white coats, which might have just about helped distinguish students from doctors, by virtue of fit, something is needed to get over the 'awkward limbo' that Ceri describes. There is a worry (particularly from those lower in the medical hierarchy) that medical students might be mistaken for doctors. Lanyards might fix this. A word clarifying role on uniform might fix this. The presence or absence of a stethoscope around the neck might fix this.
    So is it a problem in psychiatry? Do medical students worry that they might be accused of passing themselves of as doctors? And if so which rules, informal or not, try to ensure this doesn't happen.

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  11. Adam Mann22 April 2015 at 12:07

    I've had a similar discussion with my friends-doctors recently. They all have different opinions about that. Your thoughts are very clever as always. - Adam from the college paper writing service

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