Hospital vs research takes: Are tats, piercings, etc. 'professional'?

Once upon a time, tattoos were considered tasteless and low class. They belonged on the body parts of disreputable characters like criminals and not those of dignified persons. More recently, however, there’s been a shift in how tattoos are viewed in society—particularly in professional realms. Research indicates that 76% of people would hire others with tattoos, as reported in an article in HCA Healthcare Journal of Medicine.^[] Moreover, the number of people with tattoos is considerable. In 2021, around 26% of Americans had a tattoo, while 9% had one tattoo, and 17% had more than one. By comparison, in 2019, 30% of Americans had tattoos, and in 2012, 21% had them, per Statista.^[]

Just because tattoos are receiving increased acceptance in the public sector doesn’t mean that the field of medicine responds similarly. 

“When imagining a doctor,” say the authors of an article published in the Canadian Medical Association Journal (CMAJ), “many people picture a clean-cut, conservatively dressed person in a crisp, white lab coat. Almost never do they conjure electric blue hair, an octopus tattoo, or a row of eyebrow piercings — yet these sorts of looks have become more common and accepted in modern society. If young doctors follow suit, will it become a problem in the conservative world of medicine?”^[]

The appearance of a snake tattoo or an eyebrow ring could either shatter this illusion or endear the physician to the patient, depending on how you look at it.  

Indeed, there are both proponents and opponents to visible tattoos or certain piercings and so forth in healthcare contexts. Moreover, physicians with visible tattoos or piercings themselves express concern over how patients and attendings will react. 

What the hospitals say

The Equal Employment Opportunity Commission (EEOC) allows employers breadth when it comes to appearance and dress code. Thus, policies on tattoos and piercings vary by health institution. Most hospitals allow inoffensive tattoos to be exposed, but others require tattoos to be covered. Policies on appearance, note the CMAJ authors, also address jewelry, hair color, facial hair, and so forth. 

For instance, Yale-New Haven Medical Center prohibits any visible body piercings other than earrings.^[] They do not allow tongue piercings (because they can interfere with communication), and they require concealment of any tattoos or body art that is considered offensive, sexually explicit, racist, or threatening.

What the research says

Patients care about how their physicians look, the CMAJ authors assert, citing studies supporting this notion.  Appearances that patients prefer include formal clothing (e.g., neat blouse, collared shirt), replete with a white coat. Survey data indicate that nose and lip piercings are associated with decreased ratings of competence and trustworthiness by patients and colleagues. Results of another study demonstrated that patients rated tattooed health care providers lower than those without tattoos; these results did not vary by respondent sex, age, or location (urban vs. rural).

One reason why patient satisfaction is important is that it is associated with positive outcomes, such as following up with testing and medication adherence. 

An issue with previous studies exploring how patients viewed physician tattoos and piercings is that many of these studies are hypothetical. They ask how patients would feel based on pictures of physicians. US researchers wanted to know how patients would react in the real world, so they used physicians wearing temporary body art to gauge this.^[] The ED physicians in the study had no body art modification (their “control” appearance), non-traditional piercings, tattoos, or both piercings and tattoos. The researchers found that, after encounters in which the provider’s tattoo or piercing was exposed, patients did not perceive a difference in professionalism, caring, approachability, competence, or reliability. To boot, many ED patients complimented the body art and had piercings and tattoos themselves.

The take-home message seems to be that when patients encounter a real-life attending, they don’t have a problem with visible and inoffensive piercings or tattoos. 

In commenting on the study for the CMAJ article, one of the study investigators remarked that, in the ED at least, “It’s not the patients who have a problem with it. It’s more something we impose on one another.”

Gray area

There are people on both sides of the tattoo debate: Those who hope to be able to display their tattoos without tainting interactions with patients, colleagues, and superiors, and others who find tattoos unprofessional. For those who have tattoos, insecurities abound, as explained by a family practice resident with an arm sleeve tattoo, author of the article in the HCA Healthcare Journal of Medicine.

“Before starting my residency, I was quite hesitant and anxious about allowing my tattoos to be visible to my patients and more so to my superiors. Despite the growing cultural acceptance regarding the connotations associated with tattoos, I was still nervous,” he wrote. 

His hope, he said, is that “we have arrived at a time and place where preconceptions surrounding an individual with visible tattoos do not necessarily influence how they will be judged as a human being.” 

A physician interviewed for a feature article published in The DO—an ED attending, who was president of the American College of Osteopathic Emergency Physicians—took a harder stance on tattoos.^[] “I know some of our docs have tattoos, but they’re covered by their scrubs, not out in the open. Some of our medical technicians have tattoo sleeves. I personally don’t think that’s professional.”

Despite such polarized views, experts contend that there is no clear black-and-white answer with respect to tattoos and piercings in the context of health care. They recommend that the dress code in a workplace setting align with the patient population. They also note that when medical students are asked to dress “appropriately,” they usually do, and this usually results in conservative choices.