Doctor, you are hot!

I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:

Zardari then called her "gorgeous" and said: "Now I know why the whole of America is crazy about you."

"You are so nice," Palin said, smiling. "Thank you."

And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."

I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.

I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?

I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.

But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.

The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?

What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?

To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.

But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.

I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.

Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.

None of this is to say that I am as gorgeous as Sarah Palin.