The doctors' ties.
(aired in different form on All Things Considered December 10, 2004)

 

Almost every morning when I get ready to go to the hospital these days, I put on a tie. It's an old tradition: for many decades, male doctor fashion has been an only slightly changing uniform, with the shirt and tie as the central element.

More than a hundred years ago, doctors adopted white coats from the laboratory, as part of a branding effort. They wanted to look like scientists to beat out their competitors, like faith healers and snake-oil salesmen. But even before the white coat, male doctors wore nineteenth century versions of ties as a sign of respectability. The ties said, this man was not some backwoods herbalist. He belonged to a certain social class. He was respectable and serious, like a minister, a banker or a lawyer.

The baby boom generation rebelled against that kind of respectability. And now in industries like software, biotech or advertising, too many guys wearing ties is bad news; if your work is supposed to be creative, ties might actually undermine your image. In scientific research, male senior scientists wear open collars most of the time, while guys who actually perform experiments in the lab are likely to wear t-shirts. The evolution of professional clothing for women is more complex and subtle. But the tie or lack of it is a more and more fine-tuned barometer of what sort of job a man thinks he does.

Which is why it's interesting that men of the medical profession are still wearing ties. They seem to agree that the tie now functions as a show of respect and seriousness, and almost to a man, my male medical school teachers cite the tastes of our older patients as a reason to keep wearing ties.

But our older patients can't be the only reason, because even male pediatricians still wear ties. So the tie is probably really about something else. It shows that the doctor's credibility still rests on the authority of a profession, even as more and more people resist that kind of credibility. At least in theory, doctors now have to constantly show their credibility by showing empathy and knowing science. Folks don't just accept "because I said so" justifications these days.

In jobs outside medicine, ties don't symbolize empathy; in fact, they function as an emotional limit of sorts. And as the cultural meaning of the tie changes, my tie connects me more to professions like law and business and less to the world of science and ideas. In other words, as the men of science leave ties behind, the male doctor's tie has become the anti-white-coat: it now reminds people that their doctor is not a scientist.

As patients and doctors renegotiate their relationships with each other in the coming decades, I think that the tie's survival will be a useful indicator of where the negotiation is headed. Is a doctor more like a scientist, or more like a banker? Is a doctor someone who's curious and creative, or someone who's solid and stable? Is a doctor someone who you trust because of what he says and does, or because of who he is?

Doctors and patients have spent the last several decades saying all sorts of things about how they want medicine to change. Over the next decades, we can all watch the male doctors' ties as a marker of what kind of changes we're actually making.

copyright 2004 joe wright