Things Unseen

You might have heard the stories about how and where Steve Jobs got his design sense and his obsessive attention to detail. Steve’s father Paul Jobs was a good¬† mechanic with (from his son’s perspective) a decent sense of design. He worked with cars, metal and wood and could build most anything his family needed. Jobs said that his father cared about how things looked, but he cared even more about how the things that were hidden from plain sight looked also. He would never put a flimsy section of plywood on the back of a fine piece of furniture. He would build the back of a fence with the same care that went into the front of that same fence. He cared about the things that were unseen.

Jobs carried that aesthetic into his own work at Apple. He would have rough seams on plastic computer cases sanded and polished. He rejected components that were not precisely made. He wanted employees to sign the inside of some of the computers they made, even though the buyers of those machines would never see the signatures. This was to get them to own and be proud of the quality of the work they were doing.

Today, many of us are working from home. We have set up office space with desks, computers, lights, printers and screens by which we can interview, assess, meet with and deliver services to our patients, customers and coworkers. We spend many hours in front of a glowing screen that is anywhere from five inches to three feet or more across. We are highly visible to the people we work for and with, except for one small detail: the part of us that is unseen.

We are working from the waist, or the mid-chest, up.

I have had several people, when finding out that I do telemedicine from home or office for ninety five per cent of my work nowadays say things like, “Cool! You can go to work in shorts or pajama bottoms or sweatpants! You don’t even have to wear shoes. You can work barefoot!” Yes, that would technically be an option I suppose. Like a television anchorman, you would know what kind of shirt I am partial to (cotton Oxford button down), what kind of ties I wear on the job (NONE!), and possibly a little bit about my taste in jewelry and watches (currently wedding band, Medical College of Georgia senior ring class of 1983, and Apple Watch Series 5 WiFi and cellular capable).

Like Steve Jobs, I believe that the things that are unseen are just as important as those that are. The rest of my working clothes get me into the right frame and state of mind to listen carefully, think clearly and act decisively. You may not see them, but I know I am wearing them everyday, and that makes me feel prepared and ready for whatever the day brings. A nice pair of year round wool slacks, a Hugo Boss or Hanks leather belt, a Bellroy wallet, nice socks from Vermont or (if I’m feeling a little more dressy some mornings) a little mill on the banks of a river in England, and one of my several pairs of Samuel Hubbard shoes. (I am often up and down and on my feet for up to eighteen hours in a day, and I have very unforgiving feet).

So, could I trudge upstairs with a nice fresh Oxford shirt over a pair of khaki shorts and flip flops? Yep, I most certainly could, and no one would ever be the wiser.

Except I don’t. I’m channeling my inner Steve Jobs.

And now, you know.

 

Casual Friday

A disclaimer before I even get started on this post.

Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further.

I am simply writing something that has been kicking around in my head for a long time. Feelings that I have about a concept.

A concept called Casual Friday.

It is fairly common nowadays in companies and facilities and services of all sizes and types to allow employees to wear more casual clothing to work on Fridays. The thinking is, of course, that it’s close to the weekend, things are winding down, people are starting to ¬†loosen up a bit, and that consumers and customers and patients won’t really care one way or the other.

I disagree.

Why?

There are several reasons.

One is that one of my major male role models in life growing up, my father, was a manager for a large textile company for most of his working life. I remember Dad wearing pressed, short-sleeved white shirts, a tie, dress slacks, and business-dressy belt, socks and shoes every time he would go to work. Including Fridays. Sometimes on Saturdays. Maybe Sundays after church if something needed checking on. My memory may have dimmed through the years (Mom, maybe if you read this you can provide a reality check for me on this point), but I never remember him going to the plant in a polo shirt or jeans or anything less than his professional “uniform”.

My Dad impressed me, and impressed his work ethic upon me, because he always cared very much about how he presented himself, how he interacted with his people on the floors of the plant, and how he was a role model for the kind of dedication and hard work he expected from all his subordinate employees.

As I grew and went to school and eventually found myself in a medical school environment, it was impressed upon my very early on that one should present oneself as a doctor at all times, not just when on duty, but at the grocery store, in church, and at the football game on Friday night. Part of this was, of course, how one dressed. Somehow, and I’ve written about this before, people can tell that you’re a doctor without your saying a word. I’m still not sure exactly how that happens, but I know that clothing, in certain situations, quietly proclaims professionalism-or not. It’s part of the package, the persona, the training, the projection of who the professional is. It’s the way doctors of my generation were trained.

Also, we were trained very explicitly to observe every little thing about the patient we were bringing back to our consulting room, including their hygiene, gait, clothing, makeup, hairstyle, arm swing, and level of alertness. Would it not be very naive indeed to think that patients would not be checking us out as well? First impressions are huge, especially when you are entering in to a relationship with someone who is going to be asked to tell you about everything from their drinking to their sexual abuse history to their suicide attempts.

Now, fast forward to the present. I see patients every day of the week, including Fridays in the clinics and now via telepsychiatry on some Saturdays and Sundays. Again, it may just be the way I was brought up, but I feel that every patient, no matter which day they are scheduled or how late in the day or the week it is, deserves the same attention to detail, professionalism and interaction that every other patient gets. I had fourteen patients scheduled in the clinic today, a Friday. Are they any less important to me just because I see them just before I am getting off for a weekend out of town? Of course not. Do they deserve the same presentation and professionalism from me that the Monday, Tuesday and Wednesday patients get? In my opinion, yes.

That being said, I do not feel comfortable wearing jeans or polo shirts or flannel to see these folks just because it’s Friday. Sure, I would be more relaxed and probably be more easy going, but is that the way I’m supposed to be on Friday visits with a suicidal sixteen year old or a defiant five year old and his distraught parent?

i have noticed over these last few years that when I dress professionally for the day, just as when I now wear a close-cropped beard that is more white than it used to be, that I get a lot more “yes, sirs” and “no, sirs” than I used to. A function of age and seniority? Sure. Clothing? Probably? Demeanor and confidence? Absolutely. It’s a package deal, remember?

When one does a telepsychiatry consult, all the folks on the other end of the camera see is you from the waist up, or more if you pull the camera angle back some. You could certainly were jeans or even shorts and flip flops for all that matters. Do I do that? No. Why?

Because the other part of all this for me is that when I am dressed for work, I am thinking work-related thoughts. When I am dressed in casual clothing, I’m ready to head for the beach or the football game or dinner with my relatives. It just goes together for me. Again, I think this is due to upbringing, role models, intensive training, and personal choice as my career has evolved. I have a standard uniform now, I’m comfortable in it, and when I have it on I know it’s time to see patients or run meetings or do supervision or write prescriptions or type progress notes. Anything less and I just don’t feel like the doctor is in.

So, Casual Friday will most likely still be around for some time in some fashion in many of the places that we frequent.

Just don’t expect that if you come see me on Friday that I will look much different than I would look if you came to see me on Tuesday.

Do Clothes Really Make the Man?

I went to the Javits Convention Center in Manhattan this morning to check out the American Psychiatric Association’s Annual Meeting setup. The two paid courses that I’m taking today and tomorrow are in another venue, but I wanted to see the hub of the convention and check out other aspects of the meeting.

Like any psychiatrist worth his salt, I also wanted to go to the central facility for the convention to people watch. Yes, I was spying on my brethren. With tens of thousands of registrants for this meeting annually, seven thousand hotels rooms and fifty motor coaches in play to move these people around the city, this venue rivals any airport in the world for the available wealth of visual stimulation if you simply like to observe your fellow man.

I must admit, we psychiatrists are a fascinating breed.

I saw one tall man in a well-tailored light gray suit, a large floppy knit cap on his head, black semi-casual shoes on his feet, wearing no socks.

Behind him came a twenty something female in a tight black dress, carrying a large bag and wearing three inch dress heels.

Next followed a doctor (he did indeed have a badge with his name and MD after it on a lanyard around his neck) who would easily have passed for a homeless person on the streets of New York City. His long gray hair, bushy gray beard, both barely combed, his rumpled pants, t-shirt and flip flops all made for a strangely cohesive ensemble that somehow just did not lend themselves to the professional meeting atmosphere.

Rushing next across my visual field from left to right, walking in that determined way that I’ve learned you must walk in NYC, came a lady who had to be in her sixties. She was slightly overweight. She sported a bright orange form fitting t-shirt, a lime green knit sweater over that. A tight black skirt barely reached mid-thigh level, and from there a pair of bright purple hose made the journey from hemline to shoetops.

There were men and women in business suits, fancy bright bow ties and cravats, hats of several varieties, cases and purses and computer bags and laptop sleeves in every conceivable color and fabric. Women wore heels, flats, tennis shoes, Nikes and boots. Men looked polished, casual, professional and like they had just rolled out of bed.

I was talking with a good friend about all this, marveling at the amalgam of good taste, questionable style, weird color palettes and functionality, who said something that stopped me in my herringbone-jacketed, oxford cloth-draped, Bass-Weejuned tracks.

“So, who do you think is talking to someone on their phone about what you’re wearing?”

Say, isn’t that my bus over there?

Bye!