Should tattoos be taboo for doctors?

Many years ago, we lived in London’s Braemar Avenue, where Ginger Baker of the super-group Cream had stayed in the 1960s. Despite my fondness for Ginger’s drumming, it was another resident — our local GP — who eclipsed Braemar Avenue’s rock god.

Impeccably clad, often in a Marengo dinner suit, white shirt, bow tie and cummerbund, this fine Asian gentleman received patients in his well-appointed consulting room.

The atmosphere evoked Edwardian Bloomsbury, not 1970s Neasden, and one felt less of a patient but rather a member of an establishment club. “So, how’s that cyst doing, hmm?” he might ask in his received-pronunciation English, reclining in a leather-upholstered chair and rolling an unlit cigar between manicured finger and thumb. We could have been dining in Belgravia, recalling an Old Etonian chum, now administering a distant outpost of Empire. The last thing our immaculately-tailored GP looked at was his watch. Consultation over, diagnosis made, treatment finalised, one emerged to find an orderly queue, its members drawn to his unhurried temperament and determination to treat patients, not diseases.

So how to respond to Cohen et al’s recent ‘An observational study of patients’ attitudes to tattoos and piercings on their physicians: The ART study’ in the <em>Emergency Medical Journal</em> (doi:10.1136/emermed-2017-206887)? This American study of over 900 emergency department patients concluded: “In the clinical setting, having exposed body art does not significantly change patients’ perception of the physician.”

Well, if I were admitted to an emergency department with a cardiac arrest or a smashed kneecap, I would uncomplainingly endure the ministrations of a medic as ‘inked’ as a tugboat captain and with ornamental ironmongery dangling from his — or her — ears like carabiners from a mountaineer’s hip. But faced with such an individual in the relatively relaxed surroundings of a consulting room, I might be less interested in what’s causing my gall bladder to swell like a wind-sock in a typhoon, and more interested in why, precisely, my doctor has tattooed on his — or her — forearm a shotgun-toting chipmunk.

In these ‘anything goes’ times, many would assert that it’s none of my business if a physician chooses to heal the sick with the Gettysburg Address tattooed down one side of his — or her — neck. Yet for all I know, beneath his impeccable Savile Row threads, Braemar Avenue’s star GP of the 1970s might have sported the Battle of Thermopylae all over his back; although my impression was that no tattooist’s ink had despoiled his skin. And one’s impressions help determine the success of a medical consultation. For example, writing in <em>Clinical Paediatrics</em> (2016, 55: 915-920), Johnson et al considered the ‘Adverse effects of tattoos and piercing on parent/patient confidence in health care providers’. In this American study, 314 voluntary participants were shown photographs of tattooed and non-tattooed practitioners, both with and without facial piercings. The participants “rated tattooed practitioners with lower confidence ratings when compared with non-tattooed practitioners and reported greater degrees of discomfort with greater degrees of facial piercing”.

And would you blame me if I were to hesitate before giving a surgeon — whose gamboge-hued bicep portrayed allegiance to ancient human-sacrificing Aztecs — the free run of my innards for a few hours of an afternoon? I only ask having been given cause to speculate that the psychological landscapes of some individuals who opt for tattoos might contain one or two darker contours than those who choose to remain unadorned. This was contemplated by Dr Viren Swami, whose ‘Written on the body? Individual differences between British adults who do and do not obtain a first tattoo’ appears in the <em>Scandinavian Journal of Psychology</em> (2012, 53: 407-412). His investigation of 136 British residents who visited a tattoo parlour found that “… compared to individuals who did not subsequently obtain a tattoo, individuals that did were significantly less conscientious, more extraverted [sic], more willing to engage in sexual relations in the absence of commitment and had higher scores on sensation-seeking”.

All in all, I prefer my physicians not to be inked… at least not so that I can see, but nor do I expect them to achieve the sartorial heights attained by Braemar Avenue’s star GP (although his ability to express himself clearly in plain English is a gift that has deserted many present-day practitioners and is one to be prized). However, I do recommend the findings of Dr Selena Au, who considered ‘Physician attire in the intensive care unit and patient family perceptions of physician professional characteristics” in <em>JAMA Intern Med</em> (2013, 173:465-467) and found that most respondents “indicated that it was important for physicians to be neatly groomed, be professionally dressed and wear visible name tags, but not necessarily a white coat”.

To many, I suspect, such strictures may represent a reluctance to change with the times and given the grave nature of these times, a tattooed medic is surely a trivial matter. Indeed, it is… which is my point. As Howard Jacobson once observed in the context of sexism: “To trivialise is also to dishonour.”

A tattooed medic dishonours the star GP of Braemar Avenue.