Some friends scoffed at her intention to go to medical school. “You’ll never get in,” they predicted. Others expressed surprise: “You want to be a doctor?”
But Amanda J. Hersh, OMS III, who describes herself as “very heavily tattooed,” didn’t let the naysayers squelch her dream of becoming a physician. She not only was accepted into her first-choice med school, the Rocky Vista University College of Osteopathic Medicine (RVUCOM) in Parker, Colo., but also is in the top 10% of her class and has been voted Student DO of the Year by students and faculty.
“During my interviews and when I first started at Rocky Vista, I covered up my tattoos because I thought there would be a stigma,” says Hersh, a Colorado native. “Then I thought, let’s throw caution to the wind and just be myself. I have never had any negative feedback on the campus. This is part of who I am.”
Her most prized tattoo, which covers her right arm from shoulder to elbow, commemorates her late fraternal twin sister, who died six years ago. “I wanted the tattoo to be beautiful like she was,” Hersh says. “We’re Irish, so the tattoo features a Claddagh symbol and shamrocks, as well as her favorite flower, daffodils.”
Fellow RVUCOM student John W. Cruz, OMS I, has a single tattoo, a silhouette of a kangaroo on his left shoulder, which his classmates and instructors see during osteopathic manipulative medicine lab.
“On our campus, there are students with tattoos that are always visible with short sleeves, and it has never been an issue,” Cruz notes. “RVUCOM does not discourage self-expression. The comfortable atmosphere is certainly part of the reason that I chose to come here.”
A survey published in the Journal of the American Academy of Dermatology in 2006 indicated that among Americans born between 1975 and 1986, 36% have at least one tattoo, 32% have had a nontraditional body piercing and 20% have had both—a dramatic increase over previous generations. Thus, it is not surprising that many med students and young physicians have body art.
But RVUCOM may not be typical among osteopathic medical schools, several of which have dress codes that prohibit visible tattoos and nontraditional piercings. And acceptance of body art in clinical settings remains spotty, given the overwhelming conviction that patients prefer physicians who conform to the prevailing norms of professionalism. What’s more, carelessly administered tattoos and certain types of body piercings carry health risks, which adds to the body-art stigma within the medical community.
Similar to their penchant for sharing their daily lives on Facebook, the affinity for tattoos and piercings among members of Generation Y has created tension between proponents of free expression and proponents of professional conformity.
Draion M. Burch, DO, an attending obstetrician and gynecologist in Pittsburgh, stresses that physicians should present themselves in a way that makes patients feel comfortable and respectful of their expertise and authority. He often asks medical students and residents to cover tattoos and remove piercings. “The most outrageous example I’ve seen was a medical student whose neck is tattooed with his girlfriend’s name,” Dr. Burch says. “He had to hide it under makeup. I’ve also seen a pierced belly button on a student who wore a blouse that was too short.”
“If I had tattoos and piercings and wore jeans, my patients wouldn’t take me as seriously,” says Dr. Burch, who is rarely seen without his signature bow tie. “Even patients of lower socioeconomic status want to see doctors who look professional. On the few occasions when I haven’t worn a bow tie, patients have complained. It is part of my brand.”
Dr. Burch contends that patients are more apt to comply with the instructions of physicians who look professional, which leads to better health outcomes. “Your brand can also affect referrals,” he says, noting that he also dresses nicely while on personal errands in the community in case he encounters any of his patients.
When it comes to physician dress, grooming and other elements of self-expression, regional cultural differences dictate what is acceptable, observes Thomas E. McWilliams, DO, the interim dean of the A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA) in Mesa. He notes that when he practiced in rural Alaska, he had a bushy beard, which he shaved off upon relocating to Kirksville, Mo. “One of my patients in Missouri, a woman who had referred several other patients to me, confided that had I kept the beard, she would never have become my patient,” Dr. McWilliams remembers. As a college administrator in Arizona, he considers the closely cropped beard he currently sports to be appropriate.
Cultural norms similarly circumscribe the appropriateness of tattoos and body piercings on physicians, Dr. McWilliams says. Though increasingly common among college students and young professionals, tattoos and piercings still by and large make older patients and experienced physicians uncomfortable, he notes.
Room for flexibility
Whether strict or loose, medical school dress codes shape students’ perception of professionalism.
With a moderate policy, the Edward Via Virginia College of Osteopathic Medicine-Virginia Campus (VCOM-VC) in Blackburg expects first- and second-year students to wear the equivalent of business casual attire, says William P. King, the associate vice president for student services. “The dress code helps students fit in with their profession,” King says. “And the students like it because we, in turn, treat them with professionalism and respect.”
Then when VCOM-VC students go on rotations in their third and fourth year, “they adapt to the environment they’re in,” King says. Hospital training sites have their own dress codes, he points out.
ATSU-SOMA has a detailed, somewhat restrictive official dress code that soon will be undergoing re-examination, according to Dr. McWilliams. Clean athletic shoes and dress sandals are allowed. Forbidden—on paper at least—are exposed tattoos, facial piercings, T-shirts with logos, blue jeans and shorts. “The dress code is not strictly enforced, however,” Dr. McWilliams says.
Dr. McWilliams has instructed students to remove or cover body art in only a few situations. He once urged a student with a pierced eyebrow to remove the piercing before going on residency auditions. “I expressed my concerns that he might be alienating a portion of his network because of his decision,” Dr. McWilliams says, noting that residencies are competitive enough as it is.
While comfortable revealing her tattoos on campus, RVUCOM’s Hersh says she uses more discretion in clinical settings. “When we’re on rotation, we represent the school and we need to look professional,” she notes. “Once I put that white coat on, people look at me differently. And I do understand that patients need to feel comforted by physicians.”
Because of the lab coat’s long sleeves, patients and attending physicians typically don’t notice her tattoos, Hersh says. However, when she has needed to wear short-sleeved scrubs, on surgical rotations, reaction has been mixed. “One physician remarked, ‘You have way too many tattoos. It makes you look stupid,’ ” Hersh recalls. But most physicians and patients who learn about her tattoos are receptive, she says.
Recognized for her congeniality, leadership skills and helpfulness to other students at RVUCOM, Hersh is optimistic that she will find acceptance in her future years as a resident and practicing DO. “I’m not afraid to be myself,” she says.