Stereotypes in the Healthcare Industry: Do They Care About Your Hair?
An Honors Thesis (HONRS 499)
By
Julia Buben
Thesis Advisor
Dr. Cynthia Thomas
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Ball State University
Muncie, Indiana
May 2010
Gradation Date: May 8, 2010
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Abstract
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Stereotyping is a phenomenon that is ingrained in our culture. Stereotyping can have
devastating physical and emotional effects on people; however, the resulting impact of labeling
someone can be reduced through education . At the beginning of my sophomore year I decided to wear
my hair in dreadlocks. I wore them because I liked the look of dreadlocks and had always wanted to
wear this hairstyle. At the same time, I was beginning clinical rotations in nursing school, and quickly
realized that the combination of my hairstyle and the expected appearance was not compatible. People
judged me differently on the basis of my "new look." I knew I was the same person on the inside, but on
the outSide, my appearance conveyed something different. I was not alone and was aware that other
people were subjected to the same negative effects of stereotyping. While stereotyping or labeling
occurs in all professions, it is especially difficult in the healthcare profession because ofthe patientprovider relationship. This paper discusses stereotyping of people that occurs from body piercing,
tattooing, obesity and wearing alternative hairstyles within the healthcare industry. Healthcare
providers are encouraged to avoid judging their patients negatively on the basis of outward appearance
because the patient-provider relationship may be damaged.
Acknowledgements
I would like to thank Dr. Cynthia Thomas for advising me through the work of this paper. Her immediate
excitement about my topic and excellent editing skills made this paper a success.
I would also like to acknowledge Alexis Pawlarczyk for supporting me through it all. Thank you for your
recommendations, positive encouragement, and emotional support.
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Introduction
Stereotype casting is present in every profession, including the healthcare industry. Intelligence,
gender, ethnicity, sexual orientation, and outward physical appearance are commonly the subject of
stereotyping. In the work environment, employees are expected to conform in appearance to industry
standards leaving little room for individualism . Stepping outside the accepted standards opens the door
for stereotyping to occur. Outward personal appearances such as hairstyles, body piercings, tattoos,
and body weight are subject to the negative impact of stereotyping. Recognizing personal biases and
participating in education programs will help reduce stereotyping in our society.
Review of literature
Stereotyping is a learned phenomenon and is the processing and categorizing of information
about others, or an instrument for gathering data (Chan, 2010). Impressions are formed immediately,
often based on visual information. A categorization process occurs quickly once a first impression is
made . Franzoi, (1996), believed this was a natural process and people could not endure without
engaging in a form of social categorization . The process of labeling is second nature and occurs almost
without conscious consideration. Stereotyping is one step beyond merely categorizing others because it
includes a belief system. Learning begins at a young age and continues throughout life; people develop
beliefs about others according to the thoughts and beliefs ofthose around them . The strength of
stereotyping is usually reinforced by the degree of acceptance. Most people tend to gravitate towards
others that share similarities within the population they belong. A stereotyped behavior can be
maintained when people are unwilling to bypass the original thought or perception encountered, even
when additional information is discovered (Chan, 2010). This behavior is then ingrained and imbedded
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in the person's memory and conceptualized, creating future impression formation and categorization to
fit into these preconceived ideas and beliefs (Franzoi, 1996; Pickering, 2001).
The results of stereotyping range from being helpful or hurtful to the victim. Stereotyping
assists humanity because it frees the mind to consider other seemingly more important information and
alleviates the necessity to thoroughly process the impressions other people are providing (Franzoil,
1996). The negative aspect to stereotyping is the restraint the behavior creates by grouping people into
perceived categories without sufficient evidence. Failure to acknowledge the unique qualities in people
plays a role in forming impressions, leaving humanity destined to form unreasonable conclusions,
inhibiting a fair opinion of others (Franzoi, 1996). A lack of information during a first encounter may
open the door for stereotyping to occur, placing the individual into defined categories. Research has
confirmed that people gravitate towards the use of stereotyping behaviors unless evidence is present to
explain the contrary (Franzoi, 1996). Unfortunately, research also indicates that in spite of new
information compiled through multiple interactions, stereotype labeling remains (Gawronski, 2003).
Stereotyping is unhealthy because once made, the allowance for individual adaption is gone. In
addition, once labeling is accomplished, a person is likely to believe more is known about the individual
than is true.
Outward appearance and superficial features guide humanity in coming to conclusions more so
than individual personality traits. A nurse can be characterized as caring by smiling and outwardly
appearing kind, or by performing caring actions such as cradling a crying child or comforting a patient
after a difficult procedure. However, if the nurse has a visible tattoo or unusual hairstyle, (both outward
appearances) the nurse may be the victim of stereotyping and perceived as being tough and uncaring.
The priority will be given to the stereotyped impression regardless of kind deeds and actions the nurse
subsequently performs. This is only true when the person judging the character of the nurse has a
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strong opinion and association with tattoos and unusual hairstyling, indicating negative attributes. The
strong association prevents even multiple instances of caring to overcome the original bias (Chan, 2010;
Gawronski,2003).
Stereotyping may be considered an easy means of misinterpreting people. Instead of being
open-minded to new and different ideas about people, humans have the propensity to make quick
judgments, which can lead to becoming prejudice (Kruglanski, 2004). Correll, (2007); Kruglanski, (2004);
and Shih, (2009) found that black people are often stereotyped as being less intelligent, more aggressive
and more criminally minded than white people. Chang, (2007) believed that black people are also
stereotyped as being more athletically talented; however, white people are viewed as materialistic and
selfish. Asian people are stereotyped as being smart, introverted, and rule-followers (Chang, 2007;
Rochlen, 2008; Shih, 2007). There are also gender stereotypes, such as men being perceived as "breadwinners," and not as stay at home parents, which is stereotypically a female role (Rochlen, 2008) .
Sanchez, (2009) reported that gay men are believed to lack masculine traits such as being
competitive, or involving themselves in contact sports (Sanchez, 2009). Women, according to
stereotyping, should not participate in math and science professions, but should remain in more caring
roles such as nursing or teaching (Logel, 2009). Wentura, (2003) and Hess, (2006) found that older
adults are stereotyped as being closed-minded, slow in movement, and physically isolated, while
suffering from health problems, and possessing a poor memory. Football players are stereotyped as
being tough, enduring pain, and denying emotional issues (Steinfeldt, 2009). All these stereotypes
formed by beliefs in the American culture can lead to unrealistic and untrue judgments of others.
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Stereotyping within healthcare
Healthcare personnel desire to convey to patients that appearance is important. Physicians are
generally male, portray an image of being smart, donning a white lab coat over dress pants, with a
nametag (Bianchi, 2008; Gjerdingen, 1989; Newman, 2005). Nurses however, are portrayed as typically
female, conservatively dressed, kind, caring, and approachable (Festini, 2009). Physicians and nurses
are viewed by patients as competent and professional (Bianchi, 2008; Gjerdingen, 1989; Newman,
2005). When healthcare employees have an outward appearance that differs from the expected
cultural norm, a negative stereotype is applied .
Menahem and Shvartzman (1998) studied the importance of physician and nurse appearance
from the perception of the patient. Menahem and Shvartzman's (1998) findings suggested that patients
perceived clean, well-dressed physicians to be caring, while untidy, carelessly dressed physicians were
perceived as being unqualified and uncaring. The perception portrays an image of a healthcare
professional's physical appearance as a powerful symbol of job success, and that appearance affects
confidence and communication, concluding that appearance is crucial (Stein, 2007).
Mehahem and Shvartzman, (1998) found that a good personal appearance was not a substitute
for needing excellent clinical skills, but appearance was an important component in the development of
the physician-patient relationship. The relationship between a healthcare provider and patient is very
delicate. Trust is an important factor to the patient physician/nurse relationship. Research studies have
found that a negative or positive outward appearance changes the anxiety and comfort levels of
patients (Rizk, 2008) . The healthcare industry has specific judgments and biases related to tattoos, body
piercings, extreme hairstyles, and overweight employees. These four distinguishing characteristics have
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become more prevalent and accepted in modern society, but still produce strong negative stereotyped
images.
Hairstyles
Hairstyles play an important part in stereotyping because they are one of the most obvious
images when looking at a person's outward appearance. Hair is one of the first things noticed and used
in impression formation (Mesko, 2004). The hairstyle may seem like it is an irrelevant piece in the
overall assessment of a person, when actually it is all that a person needs to trigger impressionformation and a stereotyping, however inaccurate it may be (Brebner, 2009). Basic stereotyping
behavior indicates that men should have short hair, and women long hair (Brebner, 2009). However,
research also shows that women with large hairstyles are perceived as being powerful and authoritative
(Wilson, 2010) . Blonde-haired women are often stereotyped as being incompetent (Takeda, 2006),
feminine, emotional, and pleasure-seeking, while brunettes are considered to be more intelligent than
other hair colors women wear (Mesko, 2004). Redheaded women are stigmatized as having a hot
temper, being clownish or wild, but also intellectually superior (Takeda, 2006; Heckert, 1997).
Redheaded males are perceived as being wimpy (Heckert, 1997). Balding men are stereotyped
as having greater intelligence although they are also considered less attractive, while men with short
hair are viewed as strong and physically active (Mesko, 2004) . Stereotyping behaviors concerning hair
correlate with race as well. African American women who wear their hair in an afro style, braids,
dreadlocks, and knots are often perceived as being bold, rebellious, self-confident, and spiritually
conscious (Patton, 2006). Straight hair worn on white women indicates a bias towards increased sex
appeal (Patton, 2006). Beards, a hairstyle not altogether uncomplimentary in healthcare, elicit a
particular impression, which develops into a stereotype . Some people consider beards to be Ita sign of
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masculinity, strength, intelligence, and desirability," while others believe a beard represents
"recklessness, dirtiness, lower mental competence, and inferior intellectual ability, as well as a reduced
social maturity," (Stein, 2007) . Evidence confirms that people associate certain beliefs about others
based on individual hairstyle.
Healthcare employees are expected to conform to a standard of acceptable hairstyles in an
attempt to avoid offending the patient. An important objective for healthcare workers is to develop an
appearance that demonstrates professionalism . Professionalism can be equated with a neat, clean
conservative appearance. When the conservative appearance is missing, the person is in jeopardy of
being judged or stereotyped. Rizk, (2008) warned nursing students to be aware that appearance outside
the normally accepted for the profession will increase the risk of clinical competence being judged solely
based on the outward appearance.
Tattoos and body piercings
The healthcare profession perceives tattoos and body piercings as health risks and a threat to
patient safety, but overtly the outward appearance gives a negative image of the caregiver. There is a
growing concern that people with body modifications (tattoos and body piercings) are likely to have
Hepatitis B, Cor HIV, extracted from a dirty needle (Halliday, 2005; Rizk, 2008). It is possible to develop
these diseases during body piercing or the tattooing procedure, but studies indicate that self-reporting
of Hepatitis B, C or HIV disease transmission is lacking (Halliday, 2005; Rizk, 2008). The concern for
infection posing a health risk to the safety of patients is legitimate, although not well-grounded or
pervasive in occurrence. Well-maintained body modifications should not be a threat to the safety of
patients (Rizk, 2008) .
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In a recent study of the perception others have on tattooed individuals, participants indicated a
negative opinion in regards to attractiveness and caring personality traits. Those without tattoos were
considered more athletic, physically attractive, motivated, honest, more generous, and intelligent
(Resenhoeft,2008). Tattoos clearly heighten interpersonal opinions. Tattooed women reported
negative responses from physicians, nurses and the general public (Rizk, 2008). Fellows, (2006) found
that greater than half of the 100 healthcare employer participants interviewed believed that visible
tattoos and body piercings should prevent potential employees from being hired because the
appearance would greatly impact patients' perception of care.
Why do people perceive tattoos and body piercing negatively? Many individuals opposed to
body modifications place stereotypes on those individuals as being rough, gruff, and un-educated. A
participant comment from the Fellows, (2006) study indicated how strong the feelings were: liThe desire
for a good personal appearance has gone by the wayside. We are selling a product, healthcare, and
people expect to see professionalism as well as receive it. I grew up in an era where tattoos were only
worn by bikers, servicemen, or trashy people, and body piercing was only for ladies to wear their
earrings in" (p.4). The assumptions made regarding body modifications correlating with people
engaging in more risky behavior and fewer health promoting behaviors may not be factual. Research
has found that in an Emergency Department tattooed patients were no more likely than non-tattooed
patients to have an injury, illness, or psychiatric/chemical dependency issue (Rizk, 2008).
Tattooing is another image that is perceived negatively. A study of 1,010 participants concluded
that one in seven people have at least one tattoo and 20 million Americans with tattoos considered
themselves to have a 'soccer Mom image' or were 'average' (Fellows, 2006; Rizk, 2008). The majority of
people with tattoos and body piercings consider themselves adventurous and the tattooing art as a form
of self-expression and outward display of personal identity (Halliday, 200S). In an article titled, Are
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Tattoos and Body Piercings Acceptable in the Workplace?, a radiology technologist of 10 years stated, "A
tattoo on someone's arm does not brand him or her as unfit for imaging or treating patients. There is a
stereotype that tattoos and piercings are the special domain of miscreants and criminals. In reality
individuals have many reasons for inking themselves," (Greer, 2009, p.56). For this woman, having a
tattoo actually meant a sense oft rust was given to her by patients because the patients believed they
could be honest about themselves and their personal histories with her.
However, not everyone thinks the same way. Elizabeth Greer, a director of radiology at
University of New Mexico believes that working in healthcare means being part of a unified team with
matching goals and standards (Greer, 2009). The individuality demonstrated through tattoos and body
piercings sets healthcare providers apart from colleagues. Body art can be distracting to patients and
coworkers, and when it is excessive, it raises concerns about hygiene and patient safety. Greer says, lilt
should not be necessary to follow up on comments such as, 'The technician with all those piercings
scared me,III(Greer, 2009, p. 57}. Patients also questioned the cleanliness of a tattooed nurse. While
these examples are distressing, they indicate the reason healthcare management has implemented
strict policies regarding body modifications.
Body weight
Body weight does not evoke quite the same stereotypes as hairstyles, body piercings, and
tattoos mainly because people rarely make a conscious decision to become obese. Nevertheless, just as
people with body art and extreme hairstyles are stereotyped negatively in the healthcare industry, so
are overweight employees and patients. Obese employees may possibly be judged more harshly
because of the association between weight and good health. Although the healthcare industry should
be aware that many factors may contribute to obesity, evidence suggests that the individuals who
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stereotype against obese people fail to recognize this truth. Addressing Negative Attitudes to Weight
found that overweight individuals are not only subjected to discrimination in employment situations,
but also were stereotyped as being emotionally impaired, socially handicapped and possessing negative
personality traits (Williams, 2009).
Study findings by Williams, (2009) indicated body weight reflects many aspects of an
individual's character, such as motivation, willingness to work, ambition, personal control, and
discipline. The situation is even more heinous from the results of 81 employers' attitudes toward
employing obese people. The results indicated that 15.9% of employers believed that obese applicants
should be barred from employment and 43.9% believed that obesity was a valid medical reason for not
employing people (Williams, 2009). In another study concerning physicians' opinions of obese patients,
67% surveyed stated obese people lacked self-control, 39% thought obese people were lazy, and 34%
believed they were unhappy (Williams, 2009). Other physicians have perceived obese patients as weakwilled, ugly, and awkward, and many nurses indicated a preference to not care for obese patients (Stein,
2007).
Patients' perceptions of obese healthcare workers mirror a similar mindset towards other
biases. One researcher wrote, "Any health professional, especially one who is recommending healthy
eating and regular exercise, needs to be aware of the impression physical appearance makes, although it
does not always accurately portray how hard or how little he or she works to maintain a healthy
weight," (Stein, 2007, p. 30). Unfortunately, studies have indicated patients perceive an obese provider
negatively. Patients place emphasis on the appearance of hairstyle, bodyweight, and body
modifications. The critical message is that biases and stereotypes towards outward appearance should
never dictate patient care .
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In 2005, the Employment Law Alliance (ELA) found that 39% of Americans believed employers
should have the right to deny employment to potential employees based on appearance (Le., clothing,
body weight, body art, and hairstyle (Fellows, 2006). Judgmental ideas form a barrier in creating a
caring and trusting relationship between healthcare provider and patient. The appropriate professional
appearance in healthcare will look different to everyone. Healthcare professionals are powerless to
justify outward appearance to patients. However, patients should not need to justify their appearance
to healthcare providers. A therapeutic relationship is holistic and culturally sensitive, bypassing personal
preference and seeing the true character of a person. One author stated, "Most healthcare
professionals have significant deficits in the area of cultural competence and holistic care," (Halliday,
2005).
Personal story
I experienced this stereotyping behavior for two years as a nursing student wearing dreadlocks
as a hairstyle. I first put my hair in dreadlocks because I liked the way they looked on other people; the
hairstyle was different and intriguing. My life up to that point was rather conventional: I was not a rebel,
I did not do many things out of the ordinary, and I played by the rules of society. For me, putting
dreadlocks in my hair was saying, "This is what I want to do, so I am going to do it, regardless of what
other people think." I knew the decision would be a commitment, but I did not realize the effect it
would have on my life. Many of my close friends were very accepting; they did not perceive me as
different or unusual because of my dreadlocks. My parents were rather shocked when I came home for
the first time with my new hairstyle; they did not expect their daughter to look so unconventional.
Several customers at the hardware store where I worked stopped having such friendly conversations
with me when I showed up to work with dreadlocks. Shortly after I put dreadlocks in my hair, a fellow
student exclaimed, " Gross! Why would you do that to you hair? You are so dirty!" Most people did not
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express such overt opinions openly. More often people would state, "You put strange things like
peanut butter in your hair don't you?" Many of my friend's parents were particularly concerned about
my hair, informing me of their opinion, "You know you won't ever get a job with hair like that!" It was
not easy to be criticized and not respond negatively.
I perceived a societal bias forming against me and believed I had to justify myself to others
because of my hairstyle, especially when I was around healthcare professionals. Simply entering a
hospital created extreme augmentation of being judged. I was judged on my appearance when in fact I
was an Honors student, who often led Bible study groups, preferred classical music, and enjoyed
knitting. However, no one knew this about me from the image the dreadlocks created. People formed
conclusions that I was dirty, lazy, strange, and more than likely involved in illicit drug use. My character
was the same before, during and after I cut off the dreadlocks. Yet I was subjected to uncomfortable
stares by other nurses, inappropriate comments by physicians, and received questions from patients
concerned about the dreadlock hairstyle. I finally realized the decision to wear dreadlocks was
negatively impacting the ability to assume the role of a professional care provider. I was confronted
with conflicting decisions to maintain the dreadlocks or remove them, conforming to the pressure of
being stereotyped as a person I was not.
Eliminating stereotyping behaviors
Negative stereotyping will never become obsolete in healthcare, however preventing the effects
from damaging the relationship between professional and patient is essential to providing quality care.
Currently, minimal steps have been taken to reduce the effects of negative stereotyping in healthcare.
Three things are crucial to changing the culture; (a) becoming aware of personal judgments and biases;
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(b) participating in continuing education concerning negative stereotypes; and (c) appreciating unique
and positive differences in others.
Personal attentiveness to thoughts, feelings, judgments, and biases can reveal reasons why
people develop stereotyping. It is often easier to continue making negative judgments and stereotyping
without discovering the underlying reasons. Realizing how judgments are formed creates a greater
likelihood of generating new, realistic strategies for interacting and forming impressions. Asking
personal questions such as, "Why do I think an overweight physician is not reliable?" "What makes me
perceive dreadlocks so negatively?" and "What in my past has taught me to think particular thoughts
and feelings about tattoos?" This personal inquiry can help uncover personal biases. Adm itting the
truth about feelings and judgments concerning the outward appearances of others is necessary to
creating change, but realizing it is not sufficient, action must follow.
Increasing education and participation in learning strategies is a beginning to change and opens
the mind to truth in regards to forming impressions about others. Becoming aware of common negative
stereotypes that are unfairly placed or wrongfully conceptualized can relieve the false validity people
easily give to these ideas. Research articles, books, pamphlets, and seminars are superfluous to help
people change negative attitudes. Interacting with those who are different and unique allows reality
based impressions to be formed and wrongly placed negative stereotypes to be reduced and prevented.
Asking respectful questions related to a tattoo or hairstyle is an easy way to begin . Instead of
responding negatively or avoiding a person who outwardly looks different, allowing the relationship to
continue through positive communication devalues biases. Exchanging derogatory comments and
demeaning jokes for creative thought, questions, and conversation is definitely a move in the right
direction. It is easy to forget that all people have differences, making them distinctive individuals.
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Final thoughts
Since I have been the victim of prejudice and judgments I have had to re-evaluate how I want to
be perceived by others. I cut my dreadlocks off after two years because I was ready to try something
different and because I had learned a lesson about humanity. I knew that although I did not want to
become a conformist to society and its stereotypes, my future success as a nurse would be
compromised if I kept my hair in dreadlocks. As much as I hoped I could prove to other healthcare
providers that I was just as good of a nursing student as any of my fellow classmates, I discovered the
harsh reality about first impressions and negative stereotyping in regards to outward appearance,
specifically my hairstyle. I was fighting a battle I knew I was going to lose. It was an easy temptation for
me to look at the many doctors and nurses who reacted disapprovingly towards my hairstyle and
negatively judge them, thinking they are closed-minded and cold-hearted. I would have been falling
prey to the same issue of stereotyping if I reacted in that way. Rather, the lesson I have learned and
want to pass on is that first impressions can easily be wrong. Forming stereotypes on the basis of
outward appearance is a simple way to misconstrue a person's character. My experience as a victim of
negative stereotyping has changed the future of my professional nursing practice. I cannot look at a
patient anymore without wanting to know more about the true character on the inside instead of being
satisfied with only knowing what I see on the outside. Each patient is unique and deserves respect,
which I can show by not forming stereotypes against them based on outward appearance.
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