Why doctors should stop wearing ties

I stopped wearing a tie to work at the start of 2004. It was summer and I was hot.

Its much more comfortable working without a tie, particularly in my job. Its easier to examine patients, its easier when I need to perform a medical procedure. I’m sure you can see how a dangling tie would get in the way.

I’ve also lost quite a few ties, sadly enough, to spillage, followed by dry cleaning. Dry cleaning and silk ties don’t mix well. The tie comes out worse for wear and never again, does it look quite right.

I wonder then how people clean their ties? I guess that the answer is that they don’t.

A tie could possibly be a source of infection. Imagine your doctor seeing patient after patient, either in the hospital or in their rooms, with that dangling tie. Later that week or the next week, he may wear the same tie, probably after the tie has been sitting in a drawer somewhere at home, and almost certainly, without any attempt at cleaning. I am sure there are proper scientific studies on these but I must admit I’ve not bothered to hunt for them. It seems common sense and provides me enough extra vindication for what I do.

Many of my friends are tie-wearing doctors. They’re probably not so keen on this blog. Most would not like to give up this very traditional symbol of male authority. Some would even say that the tie (and a suit or the Doctor’s white coat) enhances patients’ satisfaction and confidence. To look like the wise and experienced consultant, some will argue that you need this part of the uniform.

I hope not. I’ll wear a nice shirt and pants because I like to and being less dressed would seem quite inappropriate. I hope that I make a good enough first impression with my practice settings, our clinic’s attention to detail, and my manner that my patients don’t mind my lack of a tie.

Irwin Lim is a rheumatologist in Australia who blogs at BJC Health Connected Care.

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  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    I always wear scrubs now. In residency, we were at times “forced” to wear ties, but I recall especially avoiding ties during urodynamics clinic.

    • http://twitter.com/_connectedcare BJC Health

      Scrubs make sense! No ironing, easy to wash, no thinking what to wear. Unfortunately, I’m in private practice & scrubs just won’t complement the look! Cheers, Irwin

  • http://www.facebook.com/saoakman Scott Oakman

    Agree with all of the above–but add for my discipline, psychiatry, the hazard of giving an agitated, psychotic patient an easy handhold designed to strangle the physician! 

    • http://twitter.com/_connectedcare BJC Health

      I never thought of that! Has it happened to you? Irwin

      • Kent Willyard

        No, but it’s just one more reason not to shun the bow tie.  :-)

    • Kent Willyard

      Not if you’re wearing a bow tie.  ;-)

  • http://twitter.com/otiskerr David Kerr

    In UK hospitals traditional neckties are banned in clinical areas – the occasional surgeon resorts to a bow tie (no surprises!) but in general it is accepted by patients. 

    Any one interested in making me an offer for 10 Jerry Garcia ties???

    • Kent Willyard

      Importantly, there has been no decrease in the nosocomial infection rate since ties were banned in the UK. It’s not the ties. It’s the HANDS.

  • Yeşim Yılmaz Demirdağ

    This is true for ID badges too. Kids love to lick them :)

    • http://twitter.com/DoctorPullen Edward Pullen

      Maybe nudist physicians will become the rule.  It seems like everything possible to wear is just a germ laden fomite.  

  • Kent Willyard

    Everybody always talks about “dangling ties.” I wear my lab coat buttoned up. Voila – no dangling tie. It’s also worth mentioning that all of the “tie studies” involved cultures only. No studies have ever implicated ties in disease TRANSMISSION, which is the important part. You could do the same culture studies on pens, stethoscopes, or computer keyboards. How often do you wash your pen…? The important message as far as nosocomial infections are concerned is WASH YOUR HANDS.

  • Kent Willyard

    Scrubs will be as colonized as a necktie within minutes of putting them on.

  • http://www.facebook.com/people/Philip-Owen/100000779388523 Philip Owen

    It used to be that Doctors (at least GP’s and Surgeons) and Engineers traaditionally wore bow ties.  In the Doctors’ case it avoided blood.  In the Engineers’s case it avoided machinery.  This passed away in the earl 1960′s.  Professor Ian Fellows, a mechanical engineer and TV presenter at Newcastle still occassionally shows up on TV in a bow tie but his fellow professionals have forgotten why.

    • http://www.facebook.com/profile.php?id=100001480124278 Hideo Matsui

      Now I understand why my boss (he is a Harvard) wore bow tie during his work. Not because it’s Ivy.
      TNX for your comment.

  • http://www.facebook.com/dr.benabio Jeffrey Benabio

    I wear scrubs and white coat most days. When I do get dressed, always a tie — my coat is always buttoned and tie has never touched a patient. I don’t think it’s a risk in that case unless someone knows otherwise. 

  • James deMaine

    Hey, Dr. Oz wears scrubs!  Maybe it’s the clean sexy surgical look.  It would be interesting for someone to survey patients to see if they really care about ties and white coats!  I know it’s the hand washing but we put our hands on our stethoscopes and in the pockets of our white coats.  We generally put on new scrubs at least daily, but how about laundered white coats, is it daily?  In a study of central line infections it was found that having the whole patient draped, plus the doctor in full mask, cap, and gown – all of this was necessary to bring the infection rate down to zero.  So particularly in the hospitals where C Diff, VRE, and MRSA are significant problems, we need to do wash hands +++ as we roam the wards.
    See:  http://www.endoflifeblog.com/2011/04/ce-nest-pas-si-difficle.html

  • http://profiles.google.com/petermbenglish Peter English

    The more interesting question is “why is it de rigeur for anybody to wear a tie?”

    You might choose to wear a tie because it’s an acceptable way, in a boring culture where you’re expected to wear dull-coloured clothes, to wear something bright. But whey should it be inappropriate for a professional or person in a “smart” job to work without a tie? 

    Why should we so fetishise a piece of coloured cloth around the neck? 

    Does it really make the collar look scruffy if you don’t? (only if you’ve been socialised to think so IMO – and do you demand this of women?)?

    Is it a phallic symbol of power?

    Is it a hangover when only wealthy people could afford a tie? And thus a sign that you’re well off, and therefore (Ha!) decent?

    So, if you can’t explain why anybody should have to wear a tie, the idea that somebody in an occupation where tie-wearing is inconvenient at least, and potentially an infection risk or other hazard should be expected to do so is obviously ludicrous.

    (COI – when I was in clinical practice I wore a bow-tie, so that I could conform to the requirement that I wear a tie, and not having it dangling in the way when doing e.g. gynae examinations or procedures.)

  • http://www.facebook.com/profile.php?id=594852106 Hamish Cole

    Working in psychiatry I stopped wearing ties after getting fed up with them being grabbed by patients intent on throttling me, perhaps this was their way of expressing their displeasure in my treatment of them.

  • http://twitter.com/Doctor4Quality Pär Höglund

    ” I am sure there are proper scientific studies on these but I must admit I’ve not bothered to hunt for them”  Evidence for/or against ties would have strengthened the argument. It would interesting to take part of the evidence.

  • http://twitter.com/DoctorPullen Edward Pullen

    I doubt many infections are caused by neckties, but it’s a good enough excuse for me.  I stopped a few years ago because I just hate having the constriction around my neck.  Why be uncomfortable.  Whoever invented neckties put a curse on men. 

    • http://twitter.com/_connectedcare BJC Health

      Ed, I agree with you. It’s so much more comfortable without one. Haven’t looked back after 7 years. The only times I wear ties now seem to be formal dinners or weddings. Cheers, Irwin

    • Anonymous

      I recall reading a recent study (I think it was reported in Prevention magazine, so it probably doesn’t stand up as scientific proof) that neckties do indeed spread a lot of germs from room to =room. Idiscussed it at the time with my PCP, and he informed me that he’d seen the original study, and he had his ties cleaned every time he wore thm. 

  • http://pulse.yahoo.com/_MQOK6UL2J6CZOFIU27AGST4DZM Kilgore

    Maybe we need to go back to those Ben Casey shirts that buttoned up the side, like you see in the old movies.

  • http://twitter.com/Sukuhuke 西村有史

    I love ties and I wear it whenever I think it appropriate. But I don’t think my ties will endanger my patients. I wash my hands over fifity times a day, before and after seeing a patient, after moving fron a room to another, and so on. I understand my hands that touch my patients are main carrier of bags and health care provider’s hands are the blame for in-hospital infection. A recent study shows that wearing long-sleeve coat does not increse the risk of infection rate in hospital. Don’t bother thinking what to wear, watch your hands.

  • Narong Budhraja

    Infection or no infection, a neck tie is a useless piece of apparel. It doesn’t serve any purpose at all – doesn’t cover up any part of your body. Using it you waste time, money and energy. I think it should be a world agenda to do away the the tie. A white coat is good enough to identify your status as a doctor. 

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