Doctors should abandon ties and avoid nose rings

BMJ 2003; 326 doi: (Published 05 June 2003) Cite this as: BMJ 2003;326:1231
  1. Roger Dobson
  1. Abergavenny

    The necktie, that traditional symbol of male medical authority, is under threat. Pressure is mounting for doctors to either pin their ties back to stop the spread of infection from flapping tie ends or get rid of them altogether.

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    Model of a modern doctor: no dangling tie and no nose ring


    Junior doctors are this week being asked to back a resolution saying that there is no longer a reason for doctors to wear ties while at work and while seeing patients.

    Wearing a tie may enhance patients' satisfaction and confidence, say critics, but a dangling tie also substantially increases the risk of passing infection from one patient to another.

    “There is no point being very careful about gelling your hands between patients if your tie has just landed in something nasty and then landed on the next patient,” said specialist registrar Jim McCaul, who was to propose the motion at the junior doctors' conference on Friday, after the BMJ went to press.

    Delegates will be told that female doctors and male nurses are excused ties and that US doctors are not required to wear them.

    “On a weekday basis it's still a shirt and tie for men. It's worn to look professional, especially in clinics and outpatients… It's a tricky one, because there is a need to appear formal. If I was going to see a lawyer about something important I would expect them to dress appropriately,” said Dr McCaul.

    He suggests that doctors should either not wear a tie at all or, if they do, should have it firmly clipped to the shirt to prevent it from coming into contact with patients. On wards, he says, scrub tops are best.

    Recognising the risks of ties, some doctors prefer a bow tie in the belief that the lack of a flapping tail reduced the risk of infection. But one multicentre, randomised controlled trial showed that there was no difference in contamination rates between conventional ties and bow ties (BMJ 1993;307: 1582-4).

    The authors of that study concluded, “Because of its negative image and difficulty to tie, the bow tie will probably remain a minority fashion.”

    A study in Australia that looked at the effect of doctors' dress on their patients' trust and confidence in them found that more than just the tie was involved (Medical Journal of Australia 2002:177: 681-2).

    The study involved 12 doctors in a teaching hospital who over a seven month period removed, changed, or added, at one month intervals, one piece of clothing. In sequence they shed the white coat, lost the tie, changed from dress pants to flared jeans, changed from dress shirt to Hawaiian shirt, moussed and highlighted their hair, and finally started wearing a nose ring.

    The results indicate that, when it comes to patients' confidence, not wearing a tie does not have the biggest negative effect. While two items—formal trousers and shirt—accounted for most of the patients' confidence, the one item that triggered the most dramatic loss of confidence was the nose ring.

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