Scrubs in the office...Good? Bad?

[OphthoBean]

Does it matter what we wear to see patients? Especially if it is all covered by a white coat anyway?

Male docs have it easy. All that is needed is several white shirts and some black pants, heck they could probably be the same black pants Monday thru Friday and no one would notice. Add black loafers and the package is complete.

As a female doc I have to match this skirt with that blouse, or maybe a sweater or a shell would be better depending on the weather. Other days it is pants of varying colors and materials and I have to worry if the shoes match and which heel height and if it rains I need closed toe and if it is sunny my pedicure better look fresh in the open toed shoes. Then there is the bag matching the shoes issue and jewelry/accessories.

It is so annoying to haul all this stuff back and forth between the drycleaners too.

I would like to just wear plain scrubs in the office, and nice clogs (not teddy bear print scrubs or nursey white clogs). I could buy 5 pairs and just wash them on the weekend and wouldn't even need to iron.

Is it bad to wear scrubs in the office? Why do we do the banker's attire thing to see patients?

It is more practical for me to sit on my stool at the slitlamp with pants on than a short skirt and strappy sandals because then I don't have to sit side-saddle or make sure I am not giving anyone in my lane a free show. And when I do office procedures, I don't have to worry so much about getting betadine or chalazion ooze on my silk outfit. Doesn't it look more doctorly and surgical to be wearing scrubs than to look like I could just as easily work in HR at Nordstrom's or in the loan dept of the bank or like I am on my way to a real estate showing?

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[Winged Scapula]

I think it depends on your environment. In private practice, patients tend to expect you to dress up a little. In a hospital setting, you can likely get away with scrubs, especially if your partners wear them as well. Most of the time we do the "banker's attire thing" because it is considered professional, mature and well, patients expect it.

But I don't understand the hassle you are placing on yourself over clothes. Why do you have to wear a skirt and change the way you sit? Can't you wear a nice pair of trousers? And if you're wearing a skirt, why is it so short that everyone is getting a "free show"?. That's more unprofessional and worrisome than having to sit side saddle, IMHO.

Why do you have to wear heels or sandals? Wouldn't the black loafers that your male colleagues wear be just as suitable and practical for you? I have plenty of cute and girly flat shoes which are appropriate for work.

Why do your skirts (if you choose to wear one) have to be silk or dry clean only? There are plenty of washable cottons and other fabrics that wear nicely and resist staining. Besides, most things don't need dry cleaned everytime you wear them...especially trousers and jackets.

If you're worried about getting stains on your clothes, how about a lab coat? Studies show that patients prefer physicians who wear one...something about seeming more "doctorly".

Mind you, I'm as fashion conscious and girly as the next. But I enjoy dressing up, choosing my bag to go with my shoes, etc. If I was as bothered by the hassles associated with that as you seem to be, I'd wear a nice white shirt and the same pair of black pants with my loafers everyday as my male colleagues.

 

[deleted87716]

Why do we do the banker's attire thing to see patients?

Because outside of the hospital, that's how a professional dresses, and it's what patients prefer. You will be judged by your appearance, whether you like it or not. As the saying goes, "You only get one chance to make a first impression."

Personally, I believe that "business casual" is one of the signs of the apocalypse. 😉

 

[Winged Scapula]

Because outside of the hospital, that's how a professional dresses, and it's what patients prefer. You will be judged by your appearance, whether you like it or not. As the saying goes, "You only get one chance to make a first impression."

Personally, I believe that "business casual" is one of the signs of the apocalypse. 😉

I'm with KentW here...our society has gotten so casual, that we have to have discussions with medical students, especially the females, about what is considered appropriate workwear. Just read the threads in the Pre-Allo where people are questioning why they have to wear suits for an interview.🙄

Blame casual Friday, the pleothora of celebrities showing their arse crack and wearing sweats to everything or the hippie generation that raised the current crop of students but there's nothing wrong with dressing up and taking a little pride in your appearance. My grandmother still dresses up to ride on an airplane and while I've tried to get her to be a *bit* more casual for church, she's resistant, because adults, especially ladies, are supposed to dress nicely for such occassions, including work, because its a sign of respect. So, just as in church and on the plane, dressing in "banker's attire" is a sign of respect for your patients that you cared enough to make an effort for them.

 

[OphthoBean]

I always wear a white labcoat with my name clearly emblazoned on it. That is why it is so annoying that it matters what is under it because I wear it fully buttoned up.

My skirts are not particularly short unless you consider knee length egregious. But I am petite and sometimes I have a particularly tall or fat patient and it affects how I can approximate myself to the slitlamp and then I have to be mindful of how I sit.

I have to wear heels because as a petite woman all my trousers would be too long (and yes, I have had some professionaly altered already).

I think cotton shirts and loafers look too butch. I see what some of the older women docs wear at lunch and OMG they look soo frumpy. They would look way better in a pair of scrubs than what they currently wear. There is no way in heck I would wear their frumpy cotton outfits. Wool, silk, cashmere, and some synthetics look way better.

I am just venting because it is a hassle and it is silly that in my current clothes my patients receive great care but if I showed up to work in scrubs they would die or go blind. It seems they would care more that I am compassionate, competent, and listen to them than if I am wearing a dress vs scrubs.

 

[Winged Scapula]

I know...there are somedays I am tired and the last thing I want to do is get dressed up (ok, the last thing is getting out of bed...) but patients do expect it and while of course they would prefer compassionate good medical care, what they think about you and the care they receive will depend on first impressions.

Its akin to the fact that doctors that are kind and say "I'm sorry" when something goes wrong are less likely to be sued, even if they do something agregiously wrong. They may have offered bad medical care, but a first impression of a "nice guy/gal" makes a difference in the patient's mind.

At any rate, I don't think knee length skirts are agregious, but they DO tend to ride up when you sit down, unless they are A-line and softer fabrics. I agree that many women physicians tend to be dowdy and I wouldn't want to wear what some of them do, but you can certainly dress up trousers and loafers with more feminine scarves, dangly earrings, etc. My patients with chemo related alopecia have certainly taught me a lot about scarf tying, the importance of lipstick (which I have an irrational fear of unless its flavored, then I tend to eat it).

I"m obviously preaching to the choir - you know we have to do it and it makes no difference in the care we offer, but its expected. Feel free to vent...we'll lay off you!

 

[MossPoh]

Heh. My favorite doctor growing up was a jeans, tshirt, baseball hat kind of guy. Only time I saw him dress up was for a funeral! I know this has no relevance at all..just felt like saying it. Although i did have a GI guy point out to me that it isn't the clothes that make the doctor, it is the skill...but I think when there are two GI guys for an entire county you are bound to have a heavy patient load regardless of what you wear.

 

[Big Lebowski]

Personally, I believe that "business casual" is one of the signs of the apocalypse. 😉

I still remember my first day as an intern. When being oriented to the service, we were told fridays were "Casual Fridays"; and to feel free to dress comfortable. Come the end of the week, by co-intern came to work in jeans and a football jersey. I couldn't believe it...

 

[Winged Scapula]

You should see the doctors in more rural Australia. I know its a more laid back country, but to see an FP in shorts and sandals was a bit much. 😀

 

[DarksideAllstar]

Because outside of the hospital, that's how a professional dresses, and it's what patients prefer. You will be judged by your appearance, whether you like it or not. As the saying goes, "You only get one chance to make a first impression."

Personally, I believe that "business casual" is one of the signs of the apocalypse. 😉

In my experience in a semi-rural (private) family practice clinic last month, patients seem to prefer a doctor who is on time and listens to and addresses their (sometimes ridiculous) complaints. My preceptor wore scrubs everyday. No white coat. His patients absolutely loved him. I never heard one person complain of his attire.

 

[deleted87716]

In my experience in a semi-rural (private) family practice clinic last month, patients seem to prefer a doctor who is on time and listens to and addresses their (sometimes ridiculous) complaints. My preceptor wore scrubs everyday. No white coat. His patients absolutely loved him. I never heard one person complain of his attire.

If I lived in Key West, I'd probably wear Hawaiian shirts to the office every day, just like everyone else. But I don't.

Most people are going to be better off dressing professionally, particularly new physicians. The exceptions don't disprove the rule.

 

[Winged Scapula]

Its obviously situation dependent. A physician in rural outback Australia dressing in a Brooks Brothers suit would be seen as a bit odd, having a bit of the "tall poppy" syndrome.

But I agree with Kent...

all patients prefer physicians who listen to them and care; we aren't arguing that

its better to dress professionally and perhaps more formally than you expect; you can always tone it down as the situation demands

if your tone and demeanor are formal in an informal environment that will hurt you more than any Gucci loafer. I worked with a physician in rural southern VA; his patients were as simple and plain as could be, but they loved him despite his starched white coat, and professional attire.

 

[sophiejane]

I freakin' HATE scrubs. They look terrible on everyone.

I can't wait to get to wear nice clothes to work. I've been doing it for the past couple of years on rotations that are mostly clinic, but now that I am actually going to be getting a salary (meager though it is), I consider that an excuse to SHOP!

At my soon-to-be program, a lot of residents wear scrubs to clinic, but I have to say, the ones who don't and dress up a bit do stand out, in a good way.

I think you can actually wear cotton trousers and pressed cotton blouses that do not look frumpy. There are some very cute flats out there now, so wearing flat shoes doesn't have to make you look "butch".

I also think that I tend to think more on my toes when I'm a little snazzed up, you know? That might sound crazy, but scrubs just make me want to go nighty-night. I realize this is something I must overcome when on call. 😉

 

[danielmd06]

I freakin' HATE scrubs. They look terrible on everyone.

They certainly don't look terrible on me.

But back to the topic at hand...

I think the main issue here is one of professionalism. In my opinion, as long as the patients view you in a professional light, you are accomplishing your purpose. This can have more to do with speech and demeanor than dress.

As newer generations of patients come through hospital doors, scrubs have increasingly come to be associated with physicians - in much the way a shirt and tie did decades ago. Blame it on the apocalypse, television dramatizations of residency, American sloth, or whatever. I'm not saying that it is a good thing...but it is definitely something I have noticed in four years of medical school and on the eve of completing my intern year.

For the record, most attendings I have known insist upon ties on medicine rounds and in all clinics. I've also known quite a few old school surgeons who shed their scrubs at the OR locker and change into shirt and tie for rounds.

I love scrubs. They are exponentially more comfortable to wear for ten to twelve hours straight, are faster, easier, and quicker to put on in the morning, are much cheaper to clean, and are just as functional as a dress shirt and dress pants. It also doens't matter if I get blood or vomit on them AND they don't come equipped with a guaranteed contamination hazard (you know...the tie).

Still, I wear a tie every day I'm not on call or post call - because it is what I'm told to do.

 

[JLT91W]

You should see the doctors in more rural Australia. I know its a more laid back country, but to see an FP in shorts and sandals was a bit much. 😀

At the hospital I work at one of our Cardiologists comes to make rounds on Saturdays (during the summer of course) in khaki shorts, polo shirt, and velcro sandals......oh, and his long white coat. I laugh at him every time I see it. It's not quite professional in my book. But then again, he makes the big bucks....he can do what he wants.

 

[Winged Scapula]

At the hospital I work at one of our Cardiologists comes to make rounds on Saturdays (during the summer of course) in khaki shorts, polo shirt, and velcro sandals......oh, and his long white coat. :

Nice look! 😀 Power does have its privileges!!

 

[OphthoBean]

Friday at lunch I saw a really interesting look. An male pediatrician wearing khaki pants and a green scrub top. The scrub top was tucked into the khakis.

I think one should decide to go casual and do it all the way or wear scrubs and do the complete look. But half-casual half-scrubs, that is not a good look.

But a scrub top tucked into a nice cotton skort, now that would be haute couture.

 

[DOctorJay]

that's the hospital version of a mullet

 

[sophiejane]

that's the hospital version of a mullet

Actually, I've heard that more specifically called the Peds Mullet. For peds residents, it's reversed. They do casual street clothes on top (hoodie, t-shirt, sweat shirt, etc) and scrubs bottoms.

Nice look. 👍 😉

 

[deleted87716]

Actually, I've heard that more specifically called the Peds Mullet. For peds residents, it's reversed. They do casual street clothes on top (hoodie, t-shirt, sweat shirt, etc) and scrubs bottoms.

Correct. The scrub top/khakis combo is the "ER mullet." 😉

 

[carrigallen]

Correct. The scrub top/khakis combo is the "ER mullet." 😉
[/IMG]

The ER mullet is so convenient and comfortable: no tie tightness, no neck irritation, but a plethora of pockets and a belt to put your pager on. 😀 Let's face it, not all necks can tolerate wearing a stiff collar all day.

From shows such as House, ER, Scrubs, Grey's, this is the kind of uniform the public has come to expect of physicians. It is smart to save the the most formal wear for special occasions.

 

[deleted87716]

The ER mullet is so convenient and comfortable: no tie tightness, no neck irritation...Let's face it, not all necks can tolerate wearing a stiff collar all day.

Tip: buy the correct size shirt, and don't overdo the starch. 😉

 

[c.bear]

I would agree with the "if you wear scrubs, do it all the way" thought. This t shirt with scrub bottom or scrub top with khakis looks awfully sloppy. My personal dermalologist wore scrubs on occasion and managed to look pressed and aways elegant.

 

[Winged Scapula]

Actually, I've heard that more specifically called the Peds Mullet. For peds residents, it's reversed. They do casual street clothes on top (hoodie, t-shirt, sweat shirt, etc) and scrubs bottoms.

Nice look. 👍 😉

Correct. Street clothes on top (covered with a flannel shirt or sweatshirt) and scrubs on the bottom is the Peds equivalent of the EM mullett (scrubs on top, pants on bottom). So classic.

 

[angel80]

Correct. Street clothes on top (covered with a flannel shirt or sweatshirt) and scrubs on the bottom is the Peds equivalent of the EM mullett (scrubs on top, pants on bottom). So classic.

I'm IM, but I do the peds mullet all the time. I like the scrub pants, but the tops are too stiff for me. I prefer to wear a short-sleeved or long-sleeved cotton t-shirt instead. I've yet to do the hooded sweatshirt thing, but I've seen it done a million times.

 

[f_w]

If I have to go in on weekends, I usually wear slightly ground up blue-jeans, sweater and a biker jacket. I don't have to see any patients, but I just live for the look on the face of some of the other hospital docs when they run into me in the department. Oh the joys of NPC specialties.

 

[BlahtoThis]

I like my scrubs. But I hate the lack of pockets on the scrubs. They should make cargo scrubs. I'd buy them. Anything for more pocket space.

 

[deleted87716]

I like my scrubs. But I hate the lack of pockets on the scrubs. They should make cargo scrubs. I'd buy them. Anything for more pocket space.

Most uniform shops (including online vendors) sell "cargo scrubs."

 

[Winged Scapula]

I like my scrubs. But I hate the lack of pockets on the scrubs. They should make cargo scrubs. I'd buy them. Anything for more pocket space.

Don't yours have pockets or just not enough?

Check out the "Where does the Stethoscope Go" thread for a nice picture of some cargo scrubs.😀

 

[PediBoneDoc]

i think for ER and specialties with a lot of office procedures ... you should probably wear scrubs ...

but for most, in my not so humble opinion 😀 most should wear something that makes them act professional ...

i can speak for me ... when i wear a tux i am probaly the most formal ... suit and tie, very formal .. shirt and tie, professional ... shirt and no tie, happy hour ... short sleeve shirt and pants (the sports doc uniform), a day golfing... never the ER mullet (tacky) ... scrubs, like pajamas ...

so, what i tell my residents ... i can't tell you what to wear, but i would like a white coat, shirt and tie in clinic ... if they are in and out of the OR, scrubs are OK ...

i am in a male dominated specialty, testosterone driven, fraternity like atmosphere ... they will come to clinic unshaven, in old scrubs with a dirty white coat and bloody shoes if i let them .. you have to give them guidance ... women are usually not the problem .... pants and a nice blouse ... comfortable shoes ... patients don't care about the hand bag ... it's not a fashion show 🙂

 

[DarksideAllstar]

all patients prefer physicians who listen to them and care; we aren't arguing that

I wasn't trying to argue that point, I was trying to point out that if you are good at what you do, aren't late everyday, and address their concerns, patients probably don't care if you wear a 3 piece suit or scrubs (a t shirt and flip-slops might raise a few eye brows). As a previous poster stated, because of medically-themed TV shows, I feel that patients are more inclined to accept scurbs as attire in the clinic setting. Jeans and t-shirt are definitely out, although I had another preceptor who wore khakis and a polo minus white coat. Personally, I wear slacks and a button down shirt (+/- tie) in the clinic. I don't think that I would wear scrubs, but then again, after next week I'll never have to work in a clinic again.

 

[EUA]

This aforementioned "peds mullet" may as well be called a "path mullet" then too. I think we all rock it, unless we're grossing, in which case a scrub top is substituted for the hoodie or t-shirt. I love it. I dread ever having to wear uncomfortable, dry-clean-only, iron-dependent clothes ever again, and with any luck, I won't have to.

 

[sdnetrocks]

At my institution, the "peds mullet" (casual top, scrub bottoms) is the DE FACTO culture in both internal medicine and pediatrics when on call. Some rotators (i.e. from anesthesia) who do PGY-1 months in medicine/peds stick out like sore thumbs in their full scrubs.

I personally love the "peds mullet" look. It has the professional flavor from the scrub bottoms (visible below the long white coat), yet allows a small injection of personal style based on the top you wear, of which only a bit is visible anyhow if your white coat is buttoned up at the top.

 

[dawg44]

I think the most important thing is how you run your practice. Personally I think if you run an on time clinic you can wear what ever you want. I don't care if the guy is wearing a 3 piece suit if he's consistently 2 hours behind I don't like him. If the guy wears scrubs and at the most I'm 30 minutes behind. I'll take the guy in scrubs.
Personally I go with the ortho look. Some call it Dockers sheik. Polo shirt and khakis. That's what I wear every single day. I could be working at foot locker or placing you in a cast. Who knows?

 

[Hoo\/er]

I am just venting because it is a hassle and it is silly that in my current clothes my patients receive great care but if I showed up to work in scrubs they would die or go blind. It seems they would care more that I am compassionate, competent, and listen to them than if I am wearing a dress vs scrubs.

I agree Ophtho. Many of these patients are probably of the variety that either a) can't pay for services, or b) bitch about paying for services. Yet, they expect the doc to "look professional."

Bull$hit.

 

[dpmd]

I am a huge fan of wearing scrubs whenever possible (takes so much less time than picking out an actual outfit, although I have trimmed down the time required to do that too by having a few classic color pants-black, grey, tan-and a ton of tops that are washable-can just go down the line of what's clean if I don't want to pick).

My boss for my research fellowship (an orthopod) wears custom made suits whenever he's not in the OR (will change to a suit even if he is just coming to the office to see one patient in between cases). The guy who makes them lives in hong kong and just comes to the US a few times a year to get orders from his clients. These are some nice suits (he bought one for my husband and I think it was about $500 or so-not bad for custom made, but very nice quality). I don't think he has every worn his white coat. When he does aspirations and stuff he just takes his coat off. He has ruined a few shirts (also from the tailor) like this, but I guess he just likes to look nice. His patients routinely wait hours to be seen (clinic runs to midnight lots of days-he talks to the patients too much), but they all love him and stick around. I don't know if it's the suit, the fact that he chats with them so much, or the fact that for many of them they might lose their leg if he wasn't treating them (he does a lot of infected total joints).

Regardless, I follow his example and dress up on clinic days. I haven't decided yet what to do when I am in practice though.

 

[deleted87716]

My boss for my research fellowship (an orthopod) wears custom made suits...His patients routinely wait hours to be seen...but they all love him and stick around. I don't know if it's the suit, the fact that he chats with them so much, or the fact that for many of them they might lose their leg if he wasn't treating them (he does a lot of infected total joints).

It's not the suit. 😉

I'm a big advocate of looking professional, but you can do it right even on a student's budget. Most people can't tell custom from off-the-rack (OTR) as long as it looks nice and fits well. I also think doctors should avoid looking too much like businesspeople/salespeople, which generally means avoiding anything overly "flashy" (Rolex watches, suits, French cuffs, Gucci loafers, etc.)

Incidentally, don't ever buy a custom suit unless you want to buy them for the rest of your life. They'll ruin you for OTR.

 

[Winged Scapula]

Incidentally, don't ever buy a custom suit unless you want to buy them for the rest of your life.

Why - because they fit so much better or because the tailor will hound you for the rest of your life?🙂

 

[deleted87716]

Why - because they fit so much better or because the tailor will hound you for the rest of your life?🙂

They fit a lot better than you expect them to. It's amazing. On the plus side, spending nearly a grand on a suit virtually guarantees that you won't let yourself gain weight. 😉

 

[Winged Scapula]

They fit a lot better than you expect them to. It's amazing. On the plus side, spending nearly a grand on a suit virtually guarantees that you won't let yourself gain weight. 😉

Even a non-personally tailored suit can spoil you. I went shopping with my former SO to buy a suit - he decided on the Paul Smith suit...once he got hooked on those $2000 babies with the hand stitching and the crazy lining and professional tailoring, he couldn't go back to off the rack from Sears!

 

[hans19]

Friday at lunch I saw a really interesting look. An male pediatrician wearing khaki pants and a green scrub top. The scrub top was tucked into the khakis.

I think one should decide to go casual and do it all the way or wear scrubs and do the complete look. But half-casual half-scrubs, that is not a good look.

Agreed.
The only thing missing is sandals with white socks. 😱

For me its scrubs and a nice pair of sneakers 365... 😀

 

[AlternateSome1]

What patients ever said they prefer business dress to scrubs?

 

[Hard24Get]

What patients ever said they prefer business dress to scrubs?

Well, see the below bottom lines, taken from several examples available from PubMed:

Our patients prefer the white coat with surgical scrubs.
PMID: 15167876 [PubMed - indexed for MEDLINE] This is the only study I could find that tried white coats with scrubs

respondents significantly favored the professional attire with white coat (76.3%, P <.0001), followed by surgical scrubs (10.2%), business dress (8.8%), and casual dress (4.7%) (this one did not do scrubs with a white coat, however). PMID: 16271913

A majority of the patients at the four settings indicated that they had no preference regarding attire (70.5% for male doctors, 66.5% for female doctors): however, 44% of the patients said that neatness of dress was moderately to very important. The aggregate findings were not greatly altered when adjusted for demographic variables such as age, sex, race, occupational status, and education.
PMID: 3239442 [PubMed - indexed for MEDLINE]

From what I've read and experienced, many patients don't care what you wear as long as it's neat. Those who do care would like to see docs in white coats, be it with business attire or surgical scrubs (scrubs being preferred if the pt is potentially getting surgery). I personally like the scrubs with white coat look. Either way, you have to be practical. Though dressing up is fun on cardiology and neurology, it just seems gross on GI and in the ED...

 

[carrigallen]

respondents significantly favored the professional attire with white coat[/B] (76.3%, P <.0001), followed by surgical scrubs (10.2%), business dress (8.8%), and casual dress (4.7%). PMID: 16271913

Is it just me, or was their casual dress choice just bit a too "casual" ?

 

[AF_PedsBoy]

Yeah the first three all look equally acceptable - the third one screams "med student", "technician", or "volunteerin' in the third world country."

 

[kylek044]

For me, only the scrubs (with white coat if possible) or the business casual with white coat looks like a real doctor. The full suit just doesn't look like they're ready to get down and dirty.
The other "look" that I liked that my doctor had always done was a short-sleeved button down shirt (that non-obnoxious plaid stuff) with the top button unbuttoned and khaki pants... it looked descent but comfortable. When you go to a doctor who is in a full suit and you don't even have your shirt on, you feel a little underdressed for the occasion which is uncomfortable...and that's not what a patient's experience should be.

 

[Dr. Dukes]

There was an interesting article in the NY Times (http://www.nytimes.com/2006/11/21/h...821ff47dc5920e&ei=5088&partner=rssnyt&emc=rss) on this exact subject a little while ago. I think the point is this, if you're gonna wear scrubs, look nice. If you're gonna wear "casual" clothes, look nice. If you're gonna wear super fancy clothes (the OP) look nice, and don't flash people...

 

[OphthoBean]

OMG! Those pictures (NYT article) are outrageous!! There can't really be doctors that dress that way! I would be too distracted during patient care to do a good job. I'd have to be constantly monitoring for something to ride up or pop out into view that shouldn't. And the shoes are totally impractical, no way they could be comfortable. I hope the pics are an exaggeration.

 

[dpmd]

I have seen plenty of obgyn residents dressed like the photos (don't mean to perpetuate a stereotype, but they are the ones that come to mind for wearing strappy sandals, and stylish, but clinically iffy clothes). I trained as a nurse in the military and it is so ingrained in my mind that you can't wear open toe shoes I thought it was a law or something, and couldn't figure out how people were getting away with it. I even feel like I am doing something wrong when I wear a sleeveless shirt (under the white coat, there is no air conditioning in the county hospital).