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Professionalism is not a dress code

02 September 2022

Dr Yash Naidoo, Case Manager at Medical Protection, reports on a case about a psychologist who received a HPCSA notification of a complaint from a patient about their state of dress.

A would-be patient in a small town in South Africa sought the services of a psychologist. In this particular town, there was only one to choose from. She visited the practice, but the first impression she got, before even consulting with the psychologist, led to her absconding on the pretence that she had to step outside to make a quick phone call. She thereafter lodged a complaint with the HPCSA against the psychologist.

In her complaint, she made the following remarks: “The entrance of the practice looked like a scene from the Jungle Book.” She also said the psychologist had a loud voice and the physical appearance of a motorcyclist, such that she believed he was a patient rather than the practitioner. His jeans were worn out, torn up and loose, she alleged. He had visible tattoos. He wore a sleeveless vest. The complainant even went as far as to rebuke the psychologist’s grey chest and arm hair, and the chain around his neck.

The complainant summed it up by saying that while she was not one to name and shame, her view was that the above needed to be investigated and rectified.

How did Medical Protection assist?

The psychologist, as a member of Medical Protection, asked for assistance after receiving notification of the complaint from the HPCSA. In doing so, he prepared a written report regarding the allegations, which he sent to Medical Protection for our professional views and advice.

We acted swiftly to appoint a firm from our panel of expert attorneys, to assist the member in preparing a formal written response to the complaint. The attorneys then formally went on record for the member; that is, they notified the HPCSA that they acted for the member on the instructions of Medical Protection.

Unfortunately, unbeknownst to Medical Protection and the appointed attorneys at the time, the member had also sent his initial letter (in which he sought assistance and advice from Medical Protection), directly to the HPCSA. The HPCSA quickly reverted directly to the member, asking him to send them a picture of his practice and a picture of himself in a short-sleeved shirt. The member duly obliged, and sent photos of the practice, and a photo of himself wearing a biker’s vest, directly to the HPCSA. From a procedural standpoint, all correspondence, including letters and photos, ought to have been settled and sent to the HPCSA via the attorneys appointed by Medical Protection. Unfortunately that could not happen because the attorneys were only belatedly advised of these developments, and the member had acted before taking advice.

Despite the attorneys raising an objection regarding the admissibility of the member’s letter and photos for consideration by the HPCSA’s Preliminary Committee of Inquiry (the PCI), and despite assurances from officials at the HPCSA that these were removed from the agenda of the meeting of the PCI, to be postponed pending a formal letter of explanation submitted on the member’s behalf by the attorneys, the matter was nonetheless considered by the PCI, who made their decision based on the photos and letter submitted directly by the member to the HPCSA.


Thankfully, despite the procedural irregularities, the HPCSA resolved to accept the member’s letter of explanation, concluding that there was no evidence of unprofessional conduct.

Learning points

If you receive notification of a complaint from the HPCSA, the first thing you should do is note the deadline for submission of your letter of explanation and contact Medical Protection. It is strongly recommended that you avoid responding directly and personally to the regulator, but that you take professional independent advice before proceeding. There is no harm in simply acknowledging receipt of the HPCSA’s correspondence and undertaking to respond in due course.

With that said, you are at liberty to prepare your response personally and send it directly to the HPCSA – there is nothing in law precluding you from doing so – but this is strongly discouraged. Firstly, you may be in breach of the terms of your contract of insurance (if you are indemnified by an insurer, which Medical Protection is not). Secondly, it is often difficult to prepare an objective, dispassionate letter when one is dealing with allegations of unprofessionalism against oneself. Having an objective set of hands assist in the preparation of the letter of explanation is recommended. With the oversight of a professional case manager or medicolegal consultant from Medical Protection, in collaboration with a qualified attorney, an objective, professional and well thought out response can be prepared.

In the above case, the outcome was favourable for the member. What we can read into the outcome is that the HPCSA committee that reviewed the matter did not hold the view that a dress code equates to professionalism or non-professionalism. This is a progressive decision and should be lauded. Perceptions of physical appearances are very subjective. In the matter in question, the practitioner had intentionally designed his practice to be rustic, and to represent an oasis in the desert, incorporating features of nature to create a feeling of tranquility, creativity and relaxation. He had in the past received many compliments from patients who described the practice as “homely”, “artistic”, and “calming”.

Due to the subjective nature of physical appearances, it is perhaps no surprise that the HPCSA’s rules are silent on dress codes. Being professional is not a matter of simply conforming to a dress code. Professionalism entails, among other things, upholding your duties to patients which include: acting in patients’ best interests, respecting patients, getting informed consent before treating patients, respecting their confidentiality, allowing patients to participate in their own healthcare, being impartial towards patients, and providing access to healthcare. Although the practitioner in question did not have any tattoos, it is clear to see that a tattoo does not necessarily have any bearing on one’s duties to patients. If a tattoo has the potential to disrespect a patient, then it probably should be covered up. 

Professionalism is intertwined with community norms and standards. The latter changes over time. For example, in the past, one might find doctors exclusively dressed in white coats. In recent times, one is more likely to find them in scrubs. 

So, while dress codes may change with the times, what remains constant are one’s professional and ethical duties towards patients as healthcare practitioners. If you uphold your duties as set out in the HPCSA’s rules and regulations, you are unlikely to be found wanting by your professional regulator. On the other hand, dressing smartly will not cover up unprofessional behaviour.