Editor – The study from Gherardi and colleagues is both welcomed and timely (Clin Med Decmber 2009 pp 519–24). The physical appearance of doctors in hospitals has changed substantially over the past five years – the loss of the white coat, banning of neckties, widespread introduction of surgical scrubs (also for non-medical staff) and the ‘bare below the elbow policy’. These changes have all been made to reduce the incidence of hospital-acquired infections (HAIs), though no trial has shown these measures to have had this effect.
It is of interest that the authors used pictures of male doctors wearing neckties. One wonders if their results would have been any different had they not included a necktie? In 2006, the board of science of the British Medical Association (BMA) published a guide for healthcare professionals in which neckties were described as of ‘no beneficial function’.1 This same description was used in the Department of Health's (DH) guidance document published the following year.2
Actually, neckties do give a more professional appearance to a male doctor and thus stating they have no beneficial function seems wholly inaccurate. Neckties have previously been shown to carry microbes, but again no evidence exists that ties can actually transmit infections between patients.3 Similarly, there are no trials proving that removing neckties in a hospital leads to a reduced rate of HAIs.
The findings from this study echo the results of previous surveys which have found that patients do draw confidence from a professional appearance of their doctor. The healthcare profession understands that serious measures are necessary to reduce the rate of HAIs and to that end the widespread drive for improved hand hygiene has been highly successful. However, this study adds further weight to the argument that the doctor–patient relationship is affected by our physical appearance at work, and thus a balance needs to be struck between maintaining the confidence of our patients while striving to minimise the risk of HAIs.
References
- 1.British Medical Association. Healthcare associated infections – a guide for healthcare professionals. London: BMA; 2006. [Google Scholar]
- 2.Department of Health. Uniforms and workwear – an evidence base for developing local policy. London: DH; 2007. [Google Scholar]
- 3.Steinlechner C, Wilding G, Cumberland N. Microbes on ties: do they correlate with wound infection? Ann R Coll Surg Eng. 2002. pp. 307–9. [Suppl 84] [DOI]