Do patients in Laura Ashley and white pants really receive better NHS service?

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Indy Lifestyle Online
"Watch out for the ones in the black pants," a gynaecologist warned me as a student. By "the ones" he meant women, and his justification was an alleged link between those who wear black underwear and those who have gonorrhoea. "The risk is highest in naval ports," he added, in case I was thinking of rushing off to Plymouth in search of some latex. I've tried to establish whether this link actually exists but whenever I type "black pants" into my computerised database of medical research, the closest match is "bed pans".

The point is that doctors make terrible assumptions on account of your clothing. The most extreme example is the observation that hospital staff try harder for longer to resuscitate you if you have your cardiac arrest while wearing a suit rather than, say, split jeans and bailing twine. If you look like a potential litigant or a friend of the consultant, you get the works. If you don't you get rather less. So if you start getting those tell-tale signs of central crushing chest pain travelling down the left arm, hold on the ambulance and rush to the wardrobe for your cardiac arrest suit. Suits work well on women too, although a Laura Ashley frock and a squirt of Rive Gauche will suffice. Then take an aspirin (which reduces damage to the heart) and phone 999. If you want to make absolutely sure you bypass the trolley queue in casualty, pin "Friend of the Professor" to your lapel.

This is just one example of the NHS giving a better deal to middle-class patients. There is plenty of (published) research that shows they get longer consultations, more health education and even quicker referrals, although perversely this doesn't seem to increase their satisfaction with the service. Middle class patients not only complain more, but do it more effectively. Those without nice clothes tend to get less return for their frustration, become desensitised and give up. In one study, a video of bad doctor-patient communication was shown to a group of inner-city mums, nearly all of whom judged it to be OK. The worst poverty of all is a poverty of expectation.

Most patients do, however, have expectations as to what their doctor should wear - at least in Scotland. A study of 475 patients from five practices in the Lothian region found that 64 per cent thought the way their doctor dressed was important. When shown a range of sartorial options (from Motorhead T-shirt to starched white coat), top marks went to the man in the blue suit and the woman in the white coat (so you don't confuse her with the nurse). The least disliked outfit was the man-in-tweed-jacket- with-informal-shirt-and-tie; the Motorhead T-shirt was a low scorer all round (sorry Lemmy). To prevent bias, the patients were shown an unfamiliar doctor, but I suspect if you've been seeing the same GP for years, you wouldn't care (or notice) if he was buck naked behind the desk. Just so long as he hands over the sick note.

As for night visits, appearance is a fine way to make a political statement. I've known GPs pitch up on the doorstep wearing pyjamas or attached to their partners in a "this had better be more important than sex" sort of way. In hospitals, bolshy juniors stalk the wards in dirty white coats, unshaven or unwashed and hair dishevelled for the sympathy vote.

The statement is sadly lost on most patients, who are more concerned about whether they're going to die or when lunch is coming. Some consultants, however, insist their juniors are smartly dressed. I know a surgeon who sends his male juniors off the wards if they aren't wearing a silk tie (with Windsor knot) and brogues. He also exalts them to follow him inconveniently down the centre of the corridor, giving way to no man or trolley, and to only go on to a ward if they've got someone beside them to talk down to. Dress is just one part of a megalomaniac's repertoire.

But it's the white coat not the Windsor knot that has a hold over patients, and hence we'd allow any impostor in one to do anything to us without question. We may be reassured by it but it doesn't necessarily do us good - justy looking at it can raise the blood pressure. As a symbol of power, it very much skews the relationship in favour of the doctor, unless the patient wears one too. Better still, next time you see a doctor, wear a white coat with black pants underneath. Now that really would be worth watching out for.

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