Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Doctors are told to ditch “disease spreading” neckties

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:442

Should medical doctors abandon the neck tie?

BMA’s Board of Science guidance on healthcare associated infections
in February 2006 was that doctors ‘refrain from wearing functionless
pieces of clothing such as ties’1. Small studies have shown that doctors’
ties harbour bacteria 2,3. Neckties have therefore been implicated in the
spread infection like MRSA and clostridium difficile as it may carry
infection from one patient to another as doctors move from patient to
patient. It is these concerns that have caused some to call for doctors to
desist from wearing neckties 1. Others argue that there is no evidence
linking bacteria on neckties to the spread of infection 4. Seeing there
might be a theoretical risk of neckties transmitting infection why then
not just abandon the necktie. But can we simply abandon the necktie or is
it that patients expect to see a doctor in a tie and view it as a sign of
respect and a marker of professionalism. Do doctors, seniors and juniors
hold the same views?

To see if we can simply do away with the necktie as suggested by the
BMA we conducted a survey to see if it matters to patients or doctors
whether or not doctors wear a tie. We surveyed patients, consultants and
junior doctors in a district general hospital to observe attitudes to
doctors wearing a necktie. Questionnaires were issued to 100 consecutive
patients attending a cardiology outpatients clinic and to all consultants
(80) and junior doctors (110) in a medium sized district hospital. The
question asked of patients and junior and senior doctors was whether or
not they preferred to see a male doctor wearing a necktie.

Of one hundred patients attending the cardiology outpatients clinic
86 returned their questionnaires (mean age: 67.7yrs, (SD: 11.3), 71%
>60 yrs age, M 56 (65%)). Fifty three (66.5%) consultants (median age:
47 yrs( age range 33-60 ) ; males:35 (73%) ) and 41 (37.3%) junior
doctors (median age: 30 yrs ( age range 24-43 ), males: 25 (64%)
responded to whether or not doctors should wear a tie. Some consultants
(12/53, 22.6 %) did not like revealing their ages making it difficult to
determine the influence of the age of consultants on their preferences.

Half of the patients and consultants either did not want doctors to
wear neckties or did not mind. Three quarters of junior doctors either did
not want to wear a tie or did not mind (Table 1).

Group surveyed	Tie 	No Tie	Don’t Mind
Patient n = 86	44 (51.2%)	3 (3.5%)	39 (45.3%)
Consultant n = 53	26(49%)	10(19%)	17(32%)
Junior Doctors n = 41	10(25%)	12(30%)	18(45%)

This short survey shows that half of all patients either do not want
or do not mind if doctors do not wear neckties. It does indicate that if
we change or practice we do need to advise patients why we are changing
dress codes as half would prefer neckties to be worn. Equally this survey
shows to those consultants that wear ties that half of their patients are
happy to consult them with or without a necktie. So if the clinical need
in a hospital area is such that a necktie should be removed, then this
should be possible with simple explanations to patients attending that
hospital service. The next generation of male doctors appear happy to drop
neckties as part of the doctors ‘uniform’.

This survey shows that patients and consultant doctors are equally
split on their preference for neckties. Junior doctors prefer not to wear
neckties. If neckties are to be removed in hospital clinics patients
probably should be given an explanation.


1.BMA Board of Science. Healthcare associated infections – a guide
for healthcare professionals 2006:p13.

2. Nurkin S, Urban C, Mangini E, Mariano N, et. al. Is the
Clinicians' Necktie a Potential Fomite for Hospital Acquired Infections?
In Abstractsof the 104th General Meeting of the American Society for
Microbiology 2004, New Orleans, Louisiana, 2004:p204

3. Dixon M. Neckties as Vectors for Nosocomial Infection. Intensive
Care Medicine 2000, 26:250-260.

4. Steinlechner C, Wilding G, Cumberland N. Microbes on ties: do they
correlate with wound infection? Ann R Coll Surg Eng 2002, (Suppl) 84:307-

Competing interests:
None declared

Competing interests: Group surveyed Tie No Tie Don’t MindPatient n = 86 44 (51.2%) 3 (3.5%) 39 (45.3%)Consultant n = 53 26(49%) 10(19%) 17(32%)Junior Doctors n = 41 10(25%) 12(30%) 18(45%)

09 February 2007
Christopher R Hayes
Cardiology Registrar
Christine Lim, James Glancy, Nerraj Prasad
Russells Hall Hospital, Pensett Road, Dudley. DY1 2HQ