Early in our time as the Baltimore Convention Center Field Hospital (BCCFH) COVID Contingency hospital I started wearing a bow tie to work every day. My co-director Dr. Jim Ficke and I made the decision together and it became something of a trademark for us as we worked in the various testing, vaccination and treatment sites across Baltimore and Maryland. We joked with the staff that if anyone had a complaint, they should tell them to look for one of the guys with a bow tie. We got plenty of feedback from our patients. But it was largely compliments about our team rather than criticism. Several of the other executive leaders also wore bow ties as they came on board. They thought it was part of the uniform.
The tie is part of a larger set of lessons about professionalism that I have been learning throughout my health care career. A med school professor told me that he never wore blue jeans to the hospital because he didn’t want to create too casual an impression with patients. Since then, I haven’t either. I started wearing bow ties as a medical student when I decided on a career in pediatrics because I thought they were less likely to get urinated on than a neck tie. (The latter have been suspected of carrying pathologic bacteria. Though disputed, it’s another reason for a bow tie preference).
After retiring from the Army, I started my foray into “civilian medicine” as a suit from the executive suite. But with COVID and the need to frequently wash clothing worn in and out of the hot-zone, I abandoned suits in 2020 and haven’t gone back. (I may not go back into suits because I wonder whether they can create a distinction between the front office and folks on the front lines that could create barriers to open communication.)
I have however stuck with the bow ties because I think there is something about them that communicates an important message to patients and peers. For example, I’ve worn them whenever I visit any of our COVID operations sites including most weekends over the past several years. And on the very rare occasion that I have worked at home during the pandemic, I also put on a bow tie, dress shirt and slacks because I think it still signals even to myself a level of professionalism. While another seasoned leader has written about bow ties and leader integrity, for me at least, it seems bow ties particularly capture the essence my first two principles of leadership: honor and humility.
When I put on the tie before work it is a signal that I am taking myself, my colleagues and the work that I am doing seriously. This isn’t just me puttering around on a weekend or hanging out on our city rooftop garden. The essence of honor is to regard self and others with respect. I hope it is the message this deference to formality communicates to patients and peers.
On the other hand, it is really difficult to take oneself too seriously in a bow tie. After all, clowns wear bow ties too. And so, a quick glance in the mirror or a passing window to straighten the tie is also a small dose of humility and a reminder that not everyone is cowed by my magnificence. Like any leader, I am always a very short distance from a misstep that could cost me the respect of those with whom I have the privilege of serving. And so the bow tie can be a reminder, a caution against arrogance, pride and an overblown view of my own importance. I merely need to remember the clowns.
Leaders need orthodoxy (“straight thinking”) when they study and teach the philosophy, history and theories of leadership. But we also need to embrace orthopraxy (“straight or right actions”) with equal fervor. Orthopraxy represents a wide range of disciplined, consistent leader practices. Examples include spontaneous recognition of accomplishments with hand written notes or on the spot accolades, active listening during executive rounds and efforts to rapidly resolve identified staff concerns. It means being a leader who is accessible, approachable and affable, as a former boss once reminded me.
And perhaps for some leaders, it’s wearing a bow tie too.
Chuck Callahan Henry V 4.3 – Lead from the Front https://henryv43.com/
Great insights and new ways of interacting in the world… as usual
Nice! I like the concept of a “uniform” for esprit de corps and team pride.
I did stop wearing neck ties during Covid out of concern for pathogens until a patient said they missed seeing my colorful ties (something I didn’t wear in the Army!). I started wearing them again with a new purpose – a way to connect with my patients.
Thank you Dr. Schaefer. Obviously a matter of taste, style (maybe infection control!) When it comes to leader “orthopraxy” there are certainly plenty of things less leader-specific!
I love the dichotomy of taking work seriously, but not taking yourself too seriously. This is an important take away.
Good to see a post–I was worried I got dropped off the distro list! Uniforms were easy for us in the Army–near automatic alignment with our colleagues and patients, and set the “internal” switch to work mode.
Not quite as easy these days, even 7 yrs out. I find that the “ideal” uniform often not the same for myself, my patients, and my colleagues (even varies from my leader role to my clinical role). But as always this has been thought provoking!