Why Outdated Rules of “Professionalism” Are Hurting Our Influence, Our Patients, and Our Careers
For decades, healthcare has been governed not just by written standards, but by a web of unspoken rules about what a “professional” physician looks and sounds like. These unspoken rules - rarely questioned, yet deeply enforced - shape how we dress, how we present ourselves, and how we position our authority in the exam room.
And ironically, they may be damaging the very thing they were meant to protect: our ability to influence and connect with patients.
The Fundamental Principles And the Ones We Made Up
If you read the actual professional codes in medicine, the core pillars are clear:
Patient welfare
Respect for patient autonomy
Social justice
You know what’s not in there?
Anything about wearing navy, gray, or black, or keeping hair straight and tucked back, or wearing business suits, or modeling ourselves after white men from nineteenth-century Europe.
Yet somewhere along the way, the appearance of professionalism became a proxy for competence. We built a visual standard rooted in a population that once dominated medicine and still dominates its imagery.
The Data: Patients Still Prefer Nineteenth-Century Wardrobes
There’s no shortage of research on how clothing impacts perceived trustworthiness:
Thirty investigations show physicians wearing white coats and formal attire (tucked hair, collared shirts, ties, slacks, skirts) are rated more “trustworthy”, regardless of actual training or skill.
A 2022 study of 9,000 participants showed a strong preference for white coats with solid, dark, “neutral” clothing.
At academic conferences, the visual “standard of care” is still gray, navy, and black - colors meant to signal credibility, strength, and authority - while oranges, reds, prints, or anything “too feminine” are quietly policed.
These norms are not value-neutral. They disproportionately constrain women, people of color, nonbinary clinicians, and anyone who doesn’t naturally fit the nineteenth-century template.
If that’s not enough of a problem, another issue is this:
Positioning ourselves as a professional authority in a suit and white coat may actually undermine what we are really trying to do - influence, connect with, and guide our patients.
Contrary to what culture tells us, connection is not built on hierarchy; it’s built on synchrony.
Neural Entrainment: The Real Currency of Influence
There’s a remarkable body of neuroscience around neural entrainment, the phenomenon where two people’s brainwaves literally sync as they communicate. The more synchrony, the more effective the communication.
A 2010 study in PNAS demonstrated that the degree of speaker–listener coupling predicts communication success. Higher coupling → better understanding, recall, and rapport.
When two people are matched neurologically, they remember more, disclose more, and trust more. “Matching” doesn’t mean that we mimick a patient’s body language or people-please them. Matching simply means the conversation two people are having is the same type of conversation. As surgeons, we often want to skip straight to having practical conversations. We tell ourselves we don’t have time for anything else. But when we do that, we hinder our ability to have effective communication and the result is: we actually waste more time.
The Four Types of Conversations:
Social. Asks “Who are we?” Goal: Acknowledgment. Example: Patient has a Red Sox hat on, which sparks a conversation about how the Sox are doing this season.
Emotional. Asks “How do we feel?” Goal: Empathy. Example: Patient appears anxious as you discuss risks and benefits of surgery, and you pause to say, “I’m sensing some apprehension around surgery, are you open to exploring what’s behind that?”
Experiential. Asks “What happened?” Goal: Understanding. Example: A new patient wants to take you on a journey of their experience. You already know the diagnosis from a chart review before you entered the room. Instead of interrupting the patient, you go on the journey with them.
Practical. Asks “What’s the solution?” Goal: Decision making. Example: You’ve matched with a patient socially, emotionally, and experientially, and now it’s time to shift into the next steps. You ask, “Are you open to discussing your treatment options?”
I always knew this intuitively. In clinic, I was known for remembering every obscure detail-patients’ hobbies, their jobs, where their kids went to school, their cats’ names. That wasn’t because I had a special memory. It’s because I synchronized with people. I was fully in the conversation with them, and their lives etched themselves into my mind.
This is not something a white coat or a navy blue suit creates.
This is something a human creates.
The Study That Should Change How We Lead
In one study, groups of volunteers watched obscure, context-free movie clips and had their brains scanned before and after group discussions. The more synchronized their discussions, the more their brainwaves aligned.
But here’s the shocker:
Groups with a leader who acted like the “boss” (dominant, assertive, declaring their opinions) had the least brainwave synchronization.
Remind you of someone? You. That’s how you were trained to communicate with patients. You were taught that you have power of information, which should make you superior. You might quietly judge and criticize patients who tell you they’ve googled their symptoms.
But when you walk into a patient exam room with authority - like an ego in a white coat - patients retreat into their own thoughts. They share less and connect less. As a result, influence plummets. That’s not professionalism; that’s disconnection.
While the study revealed that showing up as a “boss” inhibited group brainwave synchronization, the opposite happened when groups contained a high centrality participant, or someone who acted as a “supercommunicator”.
Supercommunicators:
asked 10–20x more questions
looped for understanding (“Here’s what I heard. Did I get that right?”)
clarified (“Can you tell me more about what you meant?”)
matched the emotional tone of others
lightened the mood at tense moments
freely admitted when they didn’t know something
encouraged and celebrated others’ ideas
And here's the wild part:
They were invisibly influential.
Their interpretations became the group’s consensus, and no one noticed it was happening. That’s secret ninja CIA spy magic right there.
This is not the “authority stance” our culture teaches clinicians.
This is relational authority.
This is influence by connection, not dominance.
The Problem With Traditional Professionalism
The old model of professionalism - buttoned up, neutral, detached, authoritative - reinforces a vertical hierarchy. It tells patients:
“I know. You don’t. I speak. You listen.”
But patients don’t entrain with hierarchy.
They entrain with humans.
If our goal is to build trust, improve adherence, enhance outcomes, and advocate for health equity, then the model we inherited is working against us.
Traditional professionalism was never neutral.
It was weaponized against women and people of color to enforce conformity, suppress individuality, and maintain a power structure that limits belonging.
But belonging is not aesthetic.
Belonging is relational.
**What If the Ideal Physician Isn’t the Authority Figure?
What if it’s the Supercommunicator?**
Imagine if instead of trying to look like Victorian businessmen, we focused on becoming high centrality participants:
deeply curious
consistently validating
open about what we don’t know
masters of matching conversation type
generous with encouragement
humble and human
Imagine what could shift in the exam room, OR, and even within our teams and culture.
Our patients would hear and trust us more, and they would be less likely to retaliate against us. Patients do not sue doctors they know, like, and trust. The more we neurologically couple with patients by showing up as a high centrality participant, not a professional authority, the more rapport and “know, like, and trust” we build.
The Future of Professionalism Is Human
If our real aim is patient welfare, autonomy, and social justice, then it’s time to redefine professionalism.
Not as “looking like a nineteenth-century white man.”
But as the ability to connect, entrain, and lead invisibly but powerfully.
Professionalism is not about what we’re wearing or how much we know.
It’s how well we’re listening, synchronizing, and willing to show up as humans.
That’s where real influence lies, and where we safeguard both patient outcomes and our own longevity in this profession.
